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Pancreatitis - Inflammation of pancreas (Managements (Aggressive IV…
Pancreatitis - Inflammation of pancreas
Functions
Endocrine
Alpha cells
Glucagon
Beta cells
Insulin
Exocrine
Amylase
enzymes to digest lipids, carbs, proteins
Lipase
Acute
SIRS (systemic inflammatory response syndrome)
can lead to sepsis
lungs first organ to respond to inflammation
Chronic
Can develop diabetes mellitus
Etiology
Alchohol
Dull pain
Biliary obstruction
amylase and lipase back flow and causes autodigestion in pancreas
Inflammation
tripsin
Leads to
necrosis and ischemia
retroperitonal bleeding
cullens bruising on belly button
grey turner
on flack
increase capillary permeability
blood supply around abdomen get congested (secuestration of fluid)
bloating
pain
hypotensive bc loss of blod volume
tachycardia
fever bc inflammation
Shallow breathing + fast
Vasodialation
Sharp pain (sometimes radiated into back
smoking
nicotine irritates pancreatic tissue
Dx
Labs
amylase
lipase
3 times the upper limit is a marker for pancreatitis
low calcium
trussous and chkvostics signs (hypocalcemia)
dysrhymias
seizures
bronchospams
low magnesium
normal up to 1.2 -1.8
H + H
hemoglin <7 we give transfusion
CBC
high WBC
glucose elevated
becase pancreas is not releasing insulin
Managements
NPO to rest GI and prevent more enzyme release
Aggressive IV replacement (resucitation
NS
250 or 500 ml/hr (2 to 3 L)
LR
Check BP is going up systolic at least 90
Pain management
morphine
ketorolac
hydromorphone (dilaud)
Blood transfusion after h/h check
lungs
*
especially left
get inflammed + pleural effusion
intubaation
collapse
give calcium
clacium gluconate
1 - 2 grams
lifestyle
alchool cessation
smoking cessaition
low fat food
IV antibiotic for perinotitis
flagyl
antiemetic
suction at bedside
oral care
NG tube
measure nose to ear to xyphoid process
NPO
to rest GI tract
antipyretic
procedure
P tube drain (at bile duct)
oxygen if hypoxia
insulin drip
cholelithiasis - stone in gallbladder
cholescystitis - gallbladder is inflammed
mild - interstitial edematous pancreatitis
severe - necrotizing pancreatitis
Assessment
s/s
Pain
alhoholic
dull
biliary
sharp
radiates to back
nausea and vomiting
bile stained if billiary natrue
abdominal guarding
peirtonitis symptoms
rigid boardlike abdomen
bc of secuestration of fluid
hypotensive
tachycardic
low urine output
cullens sign
turners
fever
because of prostaglandins
acetaminophen
ibuprofen
altered mental status
bc low perfusion (bp)
hypoxia (lungs affected)
low calcium