ACUTE PANCREATITIS

ZENA SANTOS
Mind Map by ZENA SANTOS, updated more than 1 year ago
ZENA SANTOS
Created by ZENA SANTOS about 3 years ago
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Mind Map on ACUTE PANCREATITIS, created by ZENA SANTOS on 11/02/2018.

Resource summary

ACUTE PANCREATITIS
  1. PATHOPHYSIOLOGY
    1. PRECIPITATING FACTORS: ALCOHOL CONSUMPTION, BILIARY TRACT OBSTRUCTION, TUMOR, MUMPS VIRUS
      1. ACTIVATION OF PANCREATIC ENZYMES INSIDE THE PANCREATIC DUCTS
        1. AUTODIGESTION OF PANCREATIC TISSUE
          1. TISSUE NECROSIS AND SEVERE INFLAMMATION OF PANCREAS
            1. Enzymes and cell contents leak into general circulation and may cause:
              1. SHOCK
                1. DISSEMINATED INTRAVASCULAR COAGULATION
                  1. ADULT RESPIRATORY DISTRESS SYNDROME
                  2. Active enzymes leak into peritoneal cavity and continue to destroy tissue with massive inflammation
                    1. SEVERE PAIN
                      1. HEMORRHAGE AND SHOCK
                        1. PERITONITIS AND HYPOVOLEMIC SHOCK
                2. Van Meter & Hubert, 2014
                3. ASSESSMENT
                  1. CLINICAL MANIFESTATIONS
                    1. Abrupt onset of Severe Epigastric and Left Upper Quadrant Pain that may radiate to back
                      1. Nausea, vomiting, and fever
                        1. Decreased bowel sounds, abdominal distention, and rigidity
                          1. Tachycardia, hypotension, cold clammy skin
                            1. Possible Jaundice
                              1. Retroperitoneal bleeding
                                1. Turner’s sign (Flank ecchymosis)
                                  1. Cullen’s sign (periumbilical ecchymosis)
                                2. LeMone et. al, 2015
                                3. DIAGNOSIS
                                  1. SERUM LIPASE TEST
                                    1. 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
                                    2. ULTRASONOGRAPHY
                                      1. 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)
                                      2. Magnetic resonance cholangiopancreatography (MRCP)
                                        1. 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
                                        2. COMPUTED TOMOGRAPHY (CT)
                                          1. 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
                                          2. Greenberg, J. A., et al, 2015
                                          3. MANAGEMENT AND TREATMENT
                                            1. FLUID THERAPY
                                              1. Initial management
                                                1. Fluid replacement, optimization of electrolytes and provide caloric intake
                                                  1. Crystalloid, colloid fluids or combination
                                                    1. RINGER'S LACTATE (Prefered)
                                              2. ANTIBIOTIC THERAPY
                                                1. Active against Gram negative bacteria
                                                  1. IMIPINEM
                                                    1. CLINDAMYCIN
                                                      1. PIPERACILLIN
                                                        1. FLUOROQUINOLONES
                                                          1. METRONIDAZOLE
                                                        2. NUTRITION
                                                          1. Oral food and fluids are withheld during acute episodes
                                                            1. Reduce pancreatic secretions and promote rest of the organs
                                                            2. Enteral Nutrition (severe)
                                                              1. Maintains intestinal motility, which preserves the gut barrier function and subsequently reduces the risk of secondary infections
                                                                1. Nasogastric
                                                                  1. Nasojejunal
                                                                2. Oral food or fluids are begun once serum amylase levels have return to normal, bowel sounds are present and pain disappears
                                                                  1. SOFT DIET
                                                                    1. LOW FAT SOLID DIET
                                                                      1. FULL SOLID DIET
                                                                3. SURGICAL INTERVENTION
                                                                  1. Endoscopic trans duodenal sphincterectomy
                                                                    1. Cholecystectomy
                                                                    2. Shah, A.P., Mourad, M.M., & Bramhall, S.R., 2018
                                                                    3. NURSING CARE
                                                                      1. Perform health history and Physical assessment
                                                                        1. Determine presence of clinical manifestations
                                                                          1. Monitor for severity and for any further complications
                                                                        2. Health Promotion
                                                                          1. Educate patient on the risks/factors in developing pancreatitis
                                                                          2. Focus on managing pain, promoting nutrition and maintaining fluid balance
                                                                            1. Develop activity goals
                                                                              1. Discuss dietary restrictions
                                                                                1. LeMone et. al, 2015
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