Lecture on Acute Pancreatitis

Overview

• Acute pancreatitis is an acute inflammation of the pancreas.
• It's common in hospitals and frequently appears in NCLEX questions.
• Can occur alongside other GI issues but is categorized separately.

Functions of the Pancreas

• Secretes insulin.
• Deposits enzymes into the digestive tract to break down food.

Pathophysiology

• Pancreas releases digestive enzymes that start to auto-digest the pancreas itself.
• Can spread to nearby tissues, affecting organs like lungs.

Causes

• Men: Chronic alcohol use.
• Women: Gallbladder disease.
• Other causes: drug reactions, high triglycerides, pancreatic cancer.

Symptoms

• Severe pain in left upper quadrant or mid-epigastric area, worsened by eating.
• Pain can radiate to the back, described as deep or piercing.
• Nausea, vomiting, decreased or absent bowel sounds, low-grade fever.
• Possible respiratory symptoms like shortness of breath and abnormal lung sounds.
• Priority assessments include heart rate, blood pressure, GI symptoms, pain, and respiratory status.

Key Signs

• Gray Turner's sign: Flank discoloration.
• Cullen's sign: Blue or bruising around the umbilicus.

Complications

• Systemic inflammation and infection.
• Acute respiratory distress syndrome (ARDS).
• Electrolyte imbalances, notably low calcium levels.
• Sepsis and other systemic infections.

Diagnostic Measures

• Elevated pancreatic enzymes (amylase and lipase).
• Liver function tests.
• Checking calcium levels and glucose levels.
• ABG for respiratory status, especially for ARDS.

Treatment

• IV fluids: To prevent dehydration.
• Calcium and electrolyte replacement if needed.
• Nutritional support: NPO initially, possibly TPN or postpyloric feeding.
• Pain management: Typically IV opioids.
• Antiemetics for nausea and vomiting.
• Possible surgery for complications.
• Respiratory support if needed.

Nursing Care

• Monitor vital signs, pain levels, and respiratory status.
• Oral care, flexion of trunk, and side-lying position for comfort.
• Education on lifestyle changes like reducing alcohol and smoking.

Practice Question Evaluation

• NPO: Indicated.
• Daily chest x-ray: Unnecessary.
• IV fluids: Indicated.
• Ibuprofen PO: Contraindicated.
• TPN: Indicated.
• Ondansetron for nausea: Indicated.
• Daily CBC and BMP: Indicated.
• Oxygen therapy: Indicated.
• Insulin drip: Unnecessary.

Key Takeaways

• Acute pancreatitis requires a multifaceted approach, focusing on preventing complications, managing symptoms, and supporting recovery through dietary adjustments and lifestyle changes.