NCLEX Review: Pancreatitis

Overview

• Pancreatitis: Inflammation of the pancreas, leading to malfunctioning of hormone and enzyme secretion.
• Types: Acute and Chronic pancreatitis.

Function of the Pancreas

• Location: Upper abdomen, next to the duodenum.
• Structure:
  • Pancreatic duct: Joins with the common bile duct at the ampulla of Vater to secrete enzymes into the duodenum.
  • Sphincter of Oddi: Controls flow of bile and enzymes; prevents reflux into the pancreas.

Functions

• Exocrine Function:
  • Performed by acinar cells.
  • Secretes inactive digestive enzymes: Amylase, Protease, Lipase.
  • Enzymes activate in the duodenum.
• Endocrine Function:
  • Performed by islets of Langerhans.
  • Secretes hormones like insulin, glucagon into the bloodstream.

Pathophysiology

• Activation of Enzymes in Pancreas: Leads to self-digestion and inflammation.
• Chronic Pancreatitis: Causes irreversible changes, fibrosis, cyst formation.

Acute vs Chronic Pancreatitis

Acute Pancreatitis

• Causes: Gallstones, alcohol abuse.
• Characteristics:
  • Sudden onset.
  • High amylase and lipase levels.
  • Reversible if treated promptly.
  • Can lead to chronic pancreatitis if not managed.

Chronic Pancreatitis

• Causes: Long-term alcohol abuse, cystic fibrosis.
• Characteristics:
  • Ongoing inflammation leading to structural damage.
  • Normal or slightly elevated enzyme levels.
  • Irreversible damage.
  • Can lead to cysts, necrosis, diabetes mellitus.

Causes

Acute Pancreatitis

• Gallstones: Block pancreatic duct, causing enzyme buildup.
• Alcohol abuse: Damages pancreatic cells, leads to duct occlusion.

Chronic Pancreatitis

• Alcohol: Prolonged abuse leads to recurrent inflammation.
• Cystic Fibrosis: Lack of CFTR protein, thickens mucus, blocks ducts.
• Other Causes: High calcium, high cholesterol.

Diagnosis

• Blood Tests: Elevated amylase, lipase.
• Imaging: CT scan, ultrasound.
• ERCP: Diagnoses and treats blockages or cysts.

Signs and Symptoms

Acute Pancreatitis

• Severe epigastric pain, nausea, vomiting.
• Fever, increased heart rate, decreased blood pressure.
• Cullen's Sign: Bluish discoloration around the umbilicus.
• Grey Turner's Sign: Bluish discoloration on the flanks.

Chronic Pancreatitis

• Chronic mid-epigastric pain, weight loss.
• Steatorrhea: Oily, greasy stools.
• Potential jaundice, diabetes mellitus.

Nursing Interventions

• Goals: Rest pancreas, control pain, monitor complications.
• Medications: Pancreatic enzymes, insulin, antibiotics, acid blockers.
• Diet: NPO initially, then low-fat, small meals.
• Monitoring: Blood sugars, urine color, stool consistency.

Specific Interventions

• IV Hydration: Maintain fluid balance.
• NG Tube: Decompress stomach, prevent pancreatic stimulation.
• Pain Management: Avoid morphine, use alternative positions.
• Dietary Education: Avoid alcohol, fatty foods; consume complex carbs.

Conclusion

• Importance: Understanding of pancreas function and related diseases critical for effective nursing care.
• Further Study: Take quizzes and explore related videos for comprehensive learning.