What is pancreatitis?
Auto-digestion of the pancreas. Obstruction in the pancreatic ducts (scar tissue, stones) leads to occlusion. Digestive enzymes become trapped and activate, digesting the pancreas itself. Very painful!
What is the #1 cause of pancreatitis?
Gallbladder disease. Second cause is alcoholism.
S/S of pancreatitis?
- pain that increases with eating
- ascites
- abdominal mass (swollen pancreas)
- rigid, board-like abdomen with guarding (indicates bleeding that could lead to peritonitis)
- Cullen’s sign (bruising around umbilicus)
- Grey-Turner’s sign (bruising in the flank area)
- fever
- nausea/vomiting
- jaundice (liver is involved)
- hypotension from bleeding or ascites
What procedure is used to determine causes of abdominal bleeding?
DPL “Diagnostic Peritoneal Lavage”
Are digestive enzymes normally in the blood?
No. Elevated serum lipase and amylase indicate pancreatic problems.
What is diagnostic for pancreatitis?
- elevated serum lipase and amylase
- elevated WBCs
- elevated blood sugar
- elevated liver enzymes (ALT, AST)
- prolonged PT, aPTT
- increased bilirubin
- increased hemoglobin and hematocrit with dehydration
- decreased hemoglobin and hematocrit with bleeding
What is treatment for pancreatitis?
- fluid resuscitation for acute pancreatitis is first intervention
- NGT to suction to decrease gastric secretions
- PCA narcotics for pain
- anticholinergics to dry them up
- GI protectants
- insulin as needed
- TPN as needed
- daily weights and I/Os
- eliminate alcohol
What organ synthesizes albumin?
The liver
What is portal hypertension?
Elevated blood pressure in the liver. Occurs as a result scar tissue that alters liver circulation.
What is the antidote for acetaminophen overdose?
acetylcysteine (Mucomyst)
What builds up in the blood with liver problems?
Ammonia
What is a major cause of ascites?
Decreased albumin. Fluid cannot remain in the vascular space without albumin, so it shifts into the tissues.
Ammonia acts like a ___?
Sedative. Hepatic coma can result from ammonia buildup.
How is cirrhosis of the liver diagnosed?
- Ultrasound
- CT, MRI
- labs (increased AST/ALT, decreased albumin)
- liver biopsy CONFIRMS diagnosis
How is a patient positioned during and after a liver biopsy?
During: supine with right arm behind head
After: lateral on right side to hold pressure
What medication decreases serum ammonia?
Lactulose
What causes esophageal varices?
Portal hypertension.
What are esophageal varices?
Basically internal hemorrhoids.
What is a Sengstaken-Blakemore tube?
A type of balloon tamponade use infrequently as an emergency procedure to stabilize clients with hemorrhage from esophageal varices.
How often is TPN adjusted?
Daily, according to electrolytes.
What is the most common complication of TPN?
Infection due to high glucose levels.
Is a filter needed with TPN?
Yes
What is the FIRST intervention if a patient is suspected of having an air embolism caused by a displaced central line?
Clamp off the tube! Encourage valsava.
What position do you place a patient suspected of air embolism?
Left side trendelenburg.
