ACUTE PANCREATITIS - created from Mind Map

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PATHOPHYSIOLOGY

ASSESSMENT

DIAGNOSIS

MANAGEMENT AND TREATMENT

NURSING CARE

PRECIPITATING FACTORS: ALCOHOL CONSUMPTION, BILIARY TRACT OBSTRUCTION, TUMOR, MUMPS VIRUS

ACTIVATION OF PANCREATIC ENZYMES INSIDE THE PANCREATIC DUCTS

AUTODIGESTION OF PANCREATIC TISSUE

TISSUE NECROSIS AND SEVERE INFLAMMATION OF PANCREAS

Enzymes and cell contents leak into general circulation and may cause:

Active enzymes leak into peritoneal cavity and continue to destroy tissue with massive inflammation

SHOCK

DISSEMINATED INTRAVASCULAR COAGULATION

ADULT RESPIRATORY DISTRESS SYNDROME

SEVERE PAIN

HEMORRHAGE AND SHOCK

PERITONITIS AND HYPOVOLEMIC SHOCK

CLINICAL MANIFESTATIONS

Abrupt onset of Severe Epigastric and Left Upper Quadrant Pain that may radiate to back

Nausea, vomiting, and fever

Decreased bowel sounds, abdominal distention, and rigidity

Tachycardia, hypotension, cold clammy skin

Possible Jaundice

Retroperitoneal bleeding

Turner’s sign (Flank ecchymosis)

Cullen’s sign (periumbilical ecchymosis)

SERUM LIPASE TEST

ULTRASONOGRAPHY

Magnetic resonance cholangiopancreatography (MRCP)

COMPUTED TOMOGRAPHY (CT)

3-fold elevation of serum lipase from the upper limit of normal (NORMAL VALUE: 14-280 units/L)is required to make the diagnosis of acute pancreatitis

Performed in all patients at baseline to evaluate the biliary tract and in particular to determine if the patient has gallstones and/or a stone in the common bile duct (CBD)

Recommended only in patients in whom there is elevation of liver enzymes and in whom the CBD is either not visualized adequately or is found to be normal on ultrasound

Performed selectively when patient presents with substantial abdominal pain and a broad differential diagnosis that includes acute pancreatitis, or in patients with suspected local complications of acute pancreatitis

FLUID THERAPY

ANTIBIOTIC THERAPY

NUTRITION

SURGICAL INTERVENTION

Initial management

Fluid replacement, optimization of electrolytes and provide caloric intake

Crystalloid, colloid fluids or combination

RINGER'S LACTATE (Prefered)

Active against Gram negative bacteria

IMIPINEM

CLINDAMYCIN

PIPERACILLIN

FLUOROQUINOLONES

METRONIDAZOLE

Oral food and fluids are withheld during acute episodes

Enteral Nutrition (severe)

Oral food or fluids are begun once serum amylase levels have return to normal, bowel sounds are present and pain disappears

Reduce pancreatic secretions and promote rest of the organs

Maintains intestinal motility, which preserves the gut barrier function and subsequently reduces the risk of secondary infections

Nasogastric

Nasojejunal

SOFT DIET

LOW FAT SOLID DIET

FULL SOLID DIET

Endoscopic trans duodenal sphincterectomy

Cholecystectomy

Perform health history and Physical assessment

Health Promotion

Focus on managing pain, promoting nutrition and maintaining fluid balance

Develop activity goals

Discuss dietary restrictions

Determine presence of clinical manifestations

Monitor for severity and for any further complications

Educate patient on the risks/factors in developing pancreatitis