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Disorders of the Pancreas

Terminal Learning Objective


At the completion of this lesson you (the
student) will relate planning and
provision of safe and effective nursing
care of a client with a disorder of the
pancreas
ENABLING LEARNING
OBJECTIVES
 A: Describe the structure and function of the
pancreas
 B: Explain the etiology/pathophysiology, clinical
manifestations assessment, diagnosis, and medical
management of a patient with acute pancretitis.
 C: Describe the etiology/pathophysiology, clinical
manifestations, diagnoses, medical and nursing
management of chronic pancreatitis.
ENABLING LEARNING
OBJECTIVES
 D: Identify nursing diagnosis and interventions for
the client with pancreatitis
 E: Identify the etiology/pathophysiology,
assessment and medical management of pancreatic
cancer.
Structure and Function of the Pancreas
The pancreas lies behind the stomach in
the concavity produced by the C-shape
of the duodenum
It is both an exocrine and endocrine
gland
pancreatitis
Structure and Function of the Pancreas

 Exocrine function
 Pancreatic juice

 Endocrine function
 Hormones
Etiology/Pathophysiology of
Pancreatitis
 Inflammation of the pancreas
 Reflux of bile and duodenal contents leads to
autodigestion
 Swelling results in impaired release of pancreatic
contents
 Obstruction leads to further autodigestion
Etiology/Pathophysiology of
Pancreatitis
 Structural/vascular abnormalities
 Trauma or disruption of the pancreatic fluids
 Infectious disease
 Metabolic disorders Inflammatory bowel disease
 Heredity
 Excessive alcohol intake and certain drugs
 Refeeding after prolonged fasting or anorexia
Clinical Manifestations
 Necrosis, caused by autodigestion
hyperglycemia, hypocalcemia
 Hemorrhage of the gland with hypovolemic
shock
 Peritonitis, pancreatic abscess, pseudocyst
Clinical Manifestations
 Severe fluid and electrolyte imbalance, acute
renal failure
 Sepsis
 Pleural effusion, ARDS
 Blood coagulopathies
Assessment
 The most common- Severe mid upper
abdominal pain, which may radiate to both
sides and straight up the back
 Nausea, vomiting and flatulence
 Stools may be frothy and foul smelling
 Jaundice may be noted if common bile duct is
obstructed
Assessment
 Bowel sounds may be diminished, with
abdominal distention and tenderness
 Hypotension and hypovolemia
 May also have Cullen’s and Turner’s signs
 Fever, tachycardia
 Chvostek’s sign
 Trousseau’s sign
Cullen’s Sign
Chvostek’s Sign
Trousseau’s Sign
Diagnosis
 Elevated serum and urine amylase, lipase and
AST/ALT levels
 Billirubin level may be elevated with obstructed
common bile duct
 Elevated WBC level indicated by CBC
 Hyperglycemia, hypocalcemia, hypokalemia,
hypomagnesemia
 CT scan (pancreatic edama and necrosis)
Diagnosis
 Endoscopic and Ultrasound exams to
determine pancreatic cysts, abscesses and
pseudocysts (fibrous capsules filled with fluid,
blood, enzymes, pus and tissue debris)
Medical Management
 Measures to relieve pain and spasms
 Restore fluid and electrolyte loss
 Prevent or treat systemic complications
 Clear liquid diet with progression to low fat diet
 Avoid digestive stimulants
Etiology/Pathopysiology of Chronic
Pancreatitis
 Chronic pancreatitis is defined as
prolonged,progressive inflammation of the
pancreas
 The gland undergoes fibrotic scarring
recurrent inflammation
 The pancreas hardens and exocrine and
endocrine functions are partly or completely
lost as pancreatic tissue is destroyed
Etiology/Pathopysiology of Chronic
Pancreatitis
 The most common cause is chronic alcoholism
 Hyperparathyroidism
 Trauma to the pancreas
 Heredity pancreatitis
 Hypertriglyceridemia
Etiology/Pathopysiology of Chronic
Pancreatitis
 Autoimmune pancreatitis
 Repeatedly formed gallstones
 Most causes are similar to acute pancreatitis
 Some causes are unknown
Complications
 Simliar to those of acute pancreatitis
 Biliary tract obstruction
 Partial to complete loss of gland function
Assessment
 Persistent pain in epigastrium or LUQ
radiating to the back
 Weight loss
 Flatulence, vomiting, and diarrhea
 Firm mass may be felt in upper left quadrant
 Light colored and foul smelling stools,
steatorrhea
Assessment
 If pseudocysts are present, they contribute to
the severity of symptoms
 If secondary diabetes occurs, patient may have
increased appetite, thirst and urination
 Peripheral edema and ascites
Diagnostic procedures
 Abnormal labs, as with acute pancreatitis
 CT, MRI and Ultrasound
 ERCP (Endoscopic Retrograde
Cholangiopancretography)
 Glucose tolerance test
Medical Management
 Depends on the cause and weather pancreatic
duct is obstructed
 If no obstruction
 Abstinence from alcohol
 Clear liquid, advance to fat free diet
 Correction of biliary tract disease and/or
hyperparathyriodism may give good results
Medical Management
 Demerol is ordered cautiously
 Insulin and pancreatic enzyme replacement
 Pancreatin (Creon, Bioglan, Panazyme, Creon 10 and
Creon 20, Protilase, Ultrase, Viokase, Zymase,
Pancreacarb)
 Partcial or total pancreatectomy
 Reconstitution of the duct with scarring, stricture
and stenosis
 Pancreatic autotransplantation
Nursing Diagnoses Associated with
Pancreatitis
 Pain R/T stimulation of nerve endings caused
by enlargement of the pancreatic capsule,
obstruction, or chemical irritation from
enzymes
 Ineffective breathing R/T pain, ascites
 High risk for fluid volume deficit R/T
vomiting, diarrhea, gastric decompression, fluid
shifts, decrease oral intake, hemorrhage
Nursing Diagnoses Associated with
Pancreatitis
 High risk for altered nutrition R/T
malabsorption, N/V, pain
 High risk for ineffective management of
therapeutic regimen R/T to insufficient
knowledge or self care, diet therapy
Etiology/Pathophysiology of
Pancreatic Cancer
 Pancreatic cancer is the fourth leading cause of cancer
death in men and sixth in women
 High death rate attributed to the difficulty in
diagnosing the cancer at a curable stage
 Occurs after middle age with peak incidence around
age 60
 Found in cigarette smokers, those exposed to chemical
carcinogens and people with diabetes mellitus
Etiology/Pathophysiology of
Pancreatic Cancer
 Linked to diet high in meat, fat and coffee
consumption
 May be primary or metastasis from lung,
stomach, duodenum or common bile
 Tumor grows rapidly and quickly invades
surrounding organs and tissue
 Many patients only live 4 to 8 months after
diagnoses
Assessment of Pancreatic Cancer
 Vague symptoms, which accounts for the delay
in diagnosis
 Pain present in 85% of cases
 Anorexia, nausea, flatulence, change in stools
 Fatigue
Assessment of Pancreatic Cancer
 Steady, dull and aching pain in the epigastrium
or referred to the back; usually worse at night
 Weight loss
 Jaundice, pruritis
 Recent onset of diabetes mellitus
Medical Management
 Definitive diagnosis before surgery is difficult
 However, tumors are usually inoperable by the time
a diagnoses is made
 Whipple produce often performed
 Total pancreatectomy with resection of parts of the
GI tract
 Subtotal pancretectomy has complication of
postoperative pancreatic fistulas and is not
recommended
Medical Management
 Medical Management
 Adjuvant therapy (surgical resection, radiation
and chemotherapy) is believed by some to be the
most effective treatment of the almost always
fatal pancreatic cancer
 Immediate post-operative care is usually done in
the intensive care setting
Review of Main Points
 Structureand function of the pancreas
 Acute pancreatitis
 Chronic pancreatitis
 Pancreatic cancer
QUESTIONS??

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