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But, before we do, let’s review the basic functions of the pancreas. Like we always say, once we understand how something works, we can better understand what happens when it isn’t working. So the pancreas is both an endocrine and exocrine gland. Endocrine means it secretes hormones directly into the bloodstream - those are insulin, which decreases blood glucose, and glucagon which increases blood glucose. Exocrine means it secretes these chemicals out into the GI tract. The pancreas secretes these digestive enzymes amylase, lipase, trypsin, and nuclease. Amylase helps break down carbs, lipase helps break down fats, trypsin breaks down proteins, and nuclease helps to break down nucleic acid. So the pancreas plays a huge role in the digestion and absorption of our food and nutrients.
So Pancreatitis is inflammation (that’s the -itis) of the pancreas. The unique thing here is that when this happens, the pancreas will actually start to eat itself. It’s called autodigestion. Remember it has all these digestive enzymes in it, so if they can’t get where they need to be they begin the digestion process from inside the pancreas. Ultimately this can lead to loss of function of the pancreas. The two most common causes are chronic alcoholism and gallbladder disease, especially if the ducts get obstructed. You can see here that the exocrine duct of the pancreas joins with the common bile duct just before it enters the duodenum. So if there are gallstones or if there’s inflammation here in the bile ducts, it can obstruct the pancreatic duct as well. Then also hyperlipidemia, peptic ulcer disease, and of course pancreatic cancer can all cause pancreatitis.
The #1 symptom of pancreatitis is severe, severe abdominal pain. This is extremely painful. It’s usually midepigastric or Left Upper Quadrant pain. They’ll also have nausea/vomiting and weight loss - think about how they aren’t digesting and absorbing the nutrients like they should. They’ll have an elevated white blood cell count, bilirubin, and ALP, as well as elevated levels of Amylase and Lipase because they aren’t being used. We’ll also see Cullen’s sign which is this bruising around the umbilicus like you see here, and Grey Turner’s Sign which is bruising on the flank. And finally they will have steatorrhea, which is fatty, foul-smelling stools.
So our #1 goal with medical management is to suppress or decrease the amount of enzymes that the pancreas secretes to try to limit that autodigestion. We’ll make them NPO and sometimes place an NG tube to decompress the stomach - less gastric acid secretion means less pancreatic secretions. So when they are NPO, it’s important that we make sure they are getting hydration and we’ll do TPN which is nutrition through the IV as well. As far as medications, we’ll give analgesics for the pain and acid reducers like H2 blockers and PPI’s. The one thing that is different about Pancreatitis is the we WILL actually give them Anticholinergics. That’s because these meds will actually decrease gastric secretions and gastric motility. The less gastric activity, the less pancreatic stimulation. That’s actually what we want. And then of course keep in mind that the pancreas controls insulin and glucagon, so we need to monitor their blood sugars closely and give those meds to them as needed.
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