Hey guys, Woodruff here. Now let's talk about chronic pancreatitis. So this is different, you know, with an acute pancreatitis in that acute pancreatitis, there's this inflammation of the pancreas that leads to a ton of enzymes getting spelled out.
And they're like little Pac-Man going and chomping on everything. Chronic pancreatitis is kind of think of it like a chronic assault on the pancreas, chronic inflammation on the pancreas leads it to get really stiff and fibrotic. And so then it loses its...
function. So acute pancreatitis, it's working a little too well. It's an overdrive. It's spilling all those enzymes where chronic pancreatitis, it actually starts to lose the ability to one, secrete the digestive enzymes we need and to secrete the insulin that we need.
So the causes are going to be very similar. Chronic alcohol use and gallstones is most common. Oh, this is a good practice.
So anytime you have two things, there's like an acute and a chronic or two things that are very similar. it's good to kind of go through and say like, okay, which things like you can even do like a Venn diagram where you can compare and contrast what's different about them and then what's the same about them. So let's look at each of these statements and see whether it applies to acute pancreatitis or chronic pancreatitis or both. So the first one says we'll need lifelong pancreatic enzyme replacement. So acute pancreatitis is an acute process.
Um, and it's too many pancreatic enzymes. So I don't think it's going to apply to acute. So if it can't apply to acute, it has to be chronic.
So, um, we'll talk about this more, but pink, uh, chronic pancreatitis, they need replacement because remember that pancreas is getting hardened, fibrotic, it's not working. And I need something to act as those enzymes. Like I need a replacement of those because I'm missing them because my pancreas isn't working anymore.
Um, B need to monitor closely for development of diabetes. So I know we talked a little bit that you can have hyperglycemia in acute, but acute is a passing process where, um, you know, I think if we're worried about development of diabetes, it would be more chronic issues, um, uh, versus like an acute process, like in the acute process, I'm really in like survival mode, just trying to make sure that I can get them by, get them stable. So I'm going to say that's also chronic need to be NPO and have an NG tube in place. Um, So, I mean, I guess it's possible that both of them, if they're under an acute attack, but I would really say that, you know, with chronic pancreatitis, they're usually on a diet.
So I would think that it applies more to acute versus chronic. And just know if we had a question like this on the exam, it would be something very clear cut. It's not like, well, they could, but I know you guys feel like all of our questions are that way. And I get it. We write them.
They have to like literally in our testing guidelines, it says has to be like feasible. And so it's really hard to figure out things that are feasible, but also, you know, not too far close to feasible that it's like, well, if so, yes, come back and teach with us one day and you'll understand. Deep.
So, so far, by the way, we have chronic, chronic, acute benefit from daily proton pump inhibitor administration. Hmm. Well, both of them could have gastric acid issues. Both of them, I do not want more irritation or agitation in the GI tract.
So I think this is going to be one where both, it applies to both, is more likely to develop or experience shock. Well, since chronic is more of a slower long-term process, I would think I would be more worried during acute because we talk about those fluid shifts, the inflammation. We talked about how we could possibly give albumin for acute for if they were hypotensive or in shock. So I'm going to say acute for this one.
Need to monitor closely for respiratory infections and failure. So while of course, you know, it's always possible on either side of things, I think that when I'm thinking respiratory infections and failure, I'm thinking more of an acute process because we worry about, again, that ARDS or that acute respiratory failure that can happen with that. So I'm going to say acute for this.
We'll need to receive alternative nutrition like TPN, PPN. So like I mentioned, chronic, they're actually on a diet, like not a regular diet, but a specialized diet. And I don't think they normally need alternative nutrition.
Normally their diet can be enough. So I think during acute, it's going to be more indicated because of the acute process and then being on bowel rest. So I'm going to say acute for that one too. Nest disorder, they will find the client has elevated AST and ALT. Well, we're thinking.
both of them, it could be elevated. I definitely think it's more elevated in acute versus chronic, but I think both of them, they can't be elevated. So we have chronic, chronic, acute, both acute, acute, acute, both. So let's learn more about kind of what chronic pancreatitis looks like. Chronic pancreatitis, they have abdominal pain as well.
Pain is a big thing here and a big part of treatment. They usually describe their pain as a gnawing or heavy pain. And it's a pain that doesn't get better with food or antacids. A lot of times they can have weight loss due to that they're not, it's not that they're not eating. It's that they're not breaking stuff down in a way that it can be absorbed because they don't have those digestive enzymes they need because their pancreas isn't working.
They also can have issues as a result of that as well. They're not absorbing fat, so they can end up having really fatty stools. So in other words, the stuff that normally breaks down the fat is not there. The enzymes aren't there. They end up with these really fatty stools.
So this is something else that's different about chronic pancreatitis. They also, and it could happen in acute too, but you know, there's more issues maybe with bilirubin buildup with a chronic inflammation can cause inflammation in that tube that connects the gallbladder, the pancreas, and then going into the intestines. And so this can lead to backup of bile and they can turn jaundice or have dark urine.
And then there also is a lack of insulin secretion usually with chronic pancreatitis. In acute pancreatitis, their glucose is elevated because of the inflammatory process, the infectious process. process or, you know, just the general effects of being in that state. Whereas chronically, this is more because, hey, the pancreas isn't working.
It's not doing the jobs that normally does. I'm going to assess their GI system and their symptoms, like what makes it better or worse, their pain, what's their nutritional status. Are they getting adequate nutrition? And then of course, assessing their skin, urine and stool for changes, because there could be a lot of changes there and then looking for diabetes. I wonder why.
Oh, you know what probably happened? I left this picture of ARDS up because I copied and pasted. Copy and paste gets me all the time. And so I know that I need to be a little bit more careful.
So I do apologize. This is just a picture of lungs for fun because lungs are beautiful. But look at this little tiny heart. Isn't it cute? So yes, let's just look at this beautiful heart for a second and admire.
It'd be beautiful if it was a little bit bigger, like a little heart failure-esque, but we'll appreciate it while it's there. I'll change out this picture for my actual lecture. Sincere apologies for getting a little come fuzzled. So just ignore the picture and just act like it's not there.
So, you know, I wish I could cover it up right now, but just keep moving forward. So no ARDS or no whited out lungs worried about here. We're more worried about their pain and symptoms improving.
We want good adequate nutrition, no signs of acute inflammation or acute pancreatitis and no complications. The big complications we would look out for with chronic pancreatitis are going to be fluid and electrolyte imbalances. So we look for ascites or that third spacing into the abdomen or a pleural effusion.
So they can't have a lung issue. It just doesn't look like this. Maybe I'll just change this out for a picture of a pleural effusion. And then again, looking for that diabetes.
So lab wise, like again, I said, their amylase and lipase might be slightly elevated or it could be normal. Check their liver function out. I'm going to look biliary obstruction.
So remember with bilirubin, the normal is going to be less than 0.1. Now there's different levels with the bili. There's the direct indirect.
This is just the total that's normal. We don't get too, too deep into it. So don't drive yourself nuts, but you can always put that on your note card.
If you need help remembering that we'll need to get stool samples to see if there's that extra fat content, check a hemoglobin A1C to look for signs of the complications. And then we might get like an ultrasound or CT to visualize what's going on. Overall, I want to prevent and manage complications like reducing acid productions. Again, you know, the PPI or antacids. We're going to monitor for diabetes and manage blood glucose.
And again, this patient's not like, it's not necessarily that they have diabetes or not everyone with chronic pancreatitis gets diabetes, but we'll just regularly kind of keep an eye and see where their trends are. This is not necessarily a patient that has to. have a glucometer at home and checking their glucose every single day, multiple times a day or anything, but just regular checks, managing their pain and keeping up with their symptoms.
This person might have chronic pain issues and need pain support. Their diet is going to be a low fat diet. We like small, bland, frequent meals.
And then the other big difference, like I mentioned, they're not able to make pancreatic enzymes. So we actually have to replace them. So there's a medication that can take called pancreal lipase, and this is actually pancreatic enzymes. So if the point of pancreatic enzymes is to digest food, when do you need to take it? You need to take it when you're eating, because otherwise it's just going to be chomping at nothing.
So we want to always take it with meals. Um, and the effectiveness of this or how I know this is working. is if there is decreased or no steatorrhea, and that's remember that fatty stools.
So effectively, I just want to signs that there are able to digest the food that they're eating. So like not having those fatty stools would be a very positive sign. I think that Oh, no, almost done.
Overall, I want to focus as the nurse on their lifestyle changes, preventing further attacks, kind of letting them know what an acute attack would look like when they need to come seek help. Because keep in mind, if they have chronic You know, sometimes there are some similarities and they may not realize, hey, I'm having an acute flare. So just kind of letting them know, you know, when they need to seek help and then staying away from all the irritants, smoking, drinking and avoiding caffeine.
All right. That's it for pancreatitis. We're going to finish up biliary disorders with gallbladder problems next.
See you there.