Exemplar 4.4: Pancreatitis

Question 1 of 13

14

There are 2 types of pancreatitis: Acute and chronic (what a shocker). Below are descriptions of the 2 types. Drag and drop the correct answer.

Acute pancreatitis is an inflammatory disorder that involves self-destruction of the pancreas by its own enzymes through ❌. The milder form is called ❌; it leads to inflammation and edema of the pancreatic tissue, and it is often self limiting. The more severe form is called ❌; it is characterized by inflammation, hemorrhage, and ultimately death of pancreatic tissue.
Although the exact cause of acute pancreatitis is unknown, the following factors may lead to activation of the pancreatic enzymes and cause the symptoms of acute pancreatitis:

-❌ may obstruct the pancreatic duct or cause bile reflux, activating pancreatic enzymes in the duct system.
-❌ causes duodenal edema, and may increase pressure and spasm in the sphincter of Oddi, causing pancreatic outflow.

Regardless of what caused it, the process begins with the release of activated pancreatic enzymes into pancreatic tissue. ❌ in particular will digest pancreatic tissue and activate other enzymes, such as ❌ (responsible for digesting cell membrane phospholipids) and ❌ (responsible for digesting elastic tissue of blood vessel walls). All of this will lead to proteolysis, edema, vascular damage and hemorrhage, and necrosis of parenchymal cells.

Chronic pancreatitis, on the other hand, is characterized by chronic inflammation, fibrosis, and gradual destruction of functional pancreatitis tissue. ❌ is the primary risk factor, but about 10-20% of cases are idiopathic. A genetic mutation associated with ❌ may play a role in the idiopathic cases.
In chronic cases related to alcoholism, pancreatic secretions have an increased concentration of ❌. These proteins calcify and block the ❌ and flow of pancreatic juices. In other cases, a stricture or stone may block the outflow, causing ❌.
Recurrent episodes of inflammation eventually lead to ❌ changes in the perenchyma, with loss of exocrine function. This leads to malabsorption from pancreatic insufficiency. It can also cause a loss of endocrine function.

Drag and drop to complete the text.

autodigesion

autolysis

interstitial edematous pancreatitis

necrotizing pancreatitis

Gallstones

Kidney stones

Alcohol

Tobacco

Trypsin

phospholipase A

elastase

Alcoholism

Drug addiction

Tobacco use

cystic fibrosis

tay-sachs disease

insoluble proteins

proteins

soluble proteins

chronic obstructive pancreatitis

fibrotic

elastic

pancreatic ducts

biliary ducts

Explanation

Question 2 of 13

1

Alcoholism is a risk factor in both acute and chronic pancreatitis.

Select one of the following:

True
False

Explanation

Question 3 of 13

1

Destruction from chronic pancreatitis is reversible. Destruction from acute pancreatitis, on the other hand, is not.

Select one of the following:

True
False

Explanation

Question 4 of 13

1

Which of the following is NOT a factor associated with acute pancreatitis?

Select one of the following:

Gallstones
Alcoholism
Tissue ischemia or anoxia
Trauma or surgery
Pancreatic tumors
Infectious agents
Third trimester pregnancy
Elevated calcium levels
Hyperlipidemia
Genetic mutation

Explanation

Question 5 of 13

1

Select the individuals that display a risk factor for developing chronic pancreatitis.

Select one or more of the following:

A 50 year old female with rheumatoid arthritis.
A 10 year old male with cystic fibrosis.
A 60 year old male with elevated LDL that's taking a thiazide diuretic for hypertension.
A 40 year old female with hyperparathyroidism.
A 16 year old female on sertaline for major depressive disorder.
A 50 year female with osteoporosis

Explanation

Question 6 of 13

1

You have a male patient come after passing out at home. His wife reports that he's been nauseated and hasn't been able to keep anything down for the past 24 hours. She also reports that he's been complaining of pain right above his belly button.

Upon physical assessment, you find that his abdomen is distended and rigid. His heart rate is at 110 bpm, his BP is at 90/60, his respirations are at 25 per minute, and his temperature is at 102.5 degrees Fahrenheit. When you were taking his pulse, his hands were cold and clammy.

Which type of pancreatitis do you think this patient has, based off his symptoms?

Select one of the following:

Acute pancreatitis
Chronic pancreatitis.
Neither.

Explanation

Question 7 of 13

1

Select the options that are NOT a complication of untreated acute pancreatitis.

Select one or more of the following:

Manifestations of ARDS
Pancreatic necrosis
Shock and multiple organ failure
Pancreatic pseudocysts
Generalized peritonitis
Pancreatic ascites
Malabsorption and malnutrition
Peptic ulcer disease
Pancreatic abscesses.

Explanation

Question 8 of 13

1

You have a patient in your office complaining about recurrent episodes of pain in her left upper abdomen. She hasn't been able to eat, and whenever the pain comes back she feels nauseated. She said that she's dropped about 10 pounds from being unable to eat. She also notes that she's been taking laxatives a lot more often because she's having a hard time defecating. When she does defecate, she notes that her fecal matter is frothy and smells absolutely horrible. Which kind of pancreatitis does this individual have?

Select one of the following:

Acute pancreatitis
Chronic pancreatitis
Neither

Explanation

Question 9 of 13

1

Select all of the potential complications of chronic pancreatitis.

Select one or more of the following:

Malabsorption
Malnutrition
Peptic ulcer disease
Pancreatic pseudocyst or abscess
Stricture of the common duct
Diabetes mellitus
Generalized peritonitis
Chronic kidney failure

Explanation

Question 10 of 13

1

Which of the following is NOT an appropriate intervention for treating acute pancreatitis?

Select one of the following:

Giving an opioid analgesic, such as morphine sulfate or hydromorphone (Dilaudid).
Prophylactic antibiotics.
Pancreatic enzyme supplements
Withholding oral food and fluids.

Explanation

Question 11 of 13

1

Which of the following is NOT a medication given for chronic pancreatitis?

Select one of the following:

Cimetidine (Tagamet)
Ranitidine (Zantac)
Omeprazole (Prilosec).
Pancreatic enzyme supplements.
Metoclopramide (Reglan)

Explanation

Question 12 of 13

1

You are assessing a patient that you believe has pancreatitis. Select everything that would be in your assessment.

Select one or more of the following:

Bowel sounds
Abdominal distension
Jaundice
Nausea/vomiting.
Presence of flatus
Last bowel movement.
Last time bladder was voided.
Presence of fever

Explanation

Question 13 of 13

1

You are implementing care for a patient with pancreatitis. He will need an endoscopic transduodenal sphincterotomy. He is NPO, both in preparation for his surgery and to promote rest of his pancreas. You believe him to be at risk of electrolyte imbalances. due to presence of abdominal distension. Select the appropriate interventions

Select one or more of the following:

Offer frequent oral hygiene.
Administer oral opioid analgesics.
Closely monitor intake and output.
Maintain a stool chart that notes the frequency, color, odor, and consistency of stools.
Assess cardiovascular status once a day.
Assess urine output once every 4 hours,

	Created by Olivia McRitchie about 6 years ago

NCLEX Nursing (Medical-Surgical) Quiz on Exemplar 4.4: Pancreatitis, created by Olivia McRitchie on 16/04/2018.

Exemplar 4.4: Pancreatitis

Question 1 of 13

Drag and drop to complete the text.

Explanation

Question 2 of 13

Alcoholism is a risk factor in both acute and chronic pancreatitis.

Select one of the following:

Explanation

Question 3 of 13

Destruction from chronic pancreatitis is reversible. Destruction from acute pancreatitis, on the other hand, is not.

Select one of the following:

Explanation

Question 4 of 13

Which of the following is NOT a factor associated with acute pancreatitis?

Select one of the following:

Explanation

Question 5 of 13

Select the individuals that display a risk factor for developing chronic pancreatitis.

Select one or more of the following:

Explanation

Question 6 of 13

Select one of the following:

Explanation

Question 7 of 13

Select the options that are NOT a complication of untreated acute pancreatitis.

Select one or more of the following:

Explanation

Question 8 of 13

Select one of the following:

Explanation

Question 9 of 13

Select all of the potential complications of chronic pancreatitis.

Select one or more of the following:

Explanation

Question 10 of 13

Which of the following is NOT an appropriate intervention for treating acute pancreatitis?

Select one of the following:

Explanation

Question 11 of 13

Which of the following is NOT a medication given for chronic pancreatitis?

Select one of the following:

Explanation

Question 12 of 13

You are assessing a patient that you believe has pancreatitis. Select everything that would be in your assessment.

Select one or more of the following:

Explanation

Question 13 of 13

Select one or more of the following:

Explanation