PANCREATITIS,

Ca PANCREAS,
CHOLELITHIASIS,
CHOLESISTITIS

calvin damanik
Pancreatitis
Definition and Etiology

• An acute inflammation process of the

pancreas with associated escape of the
pancreatic enzyme into surrounding
tissue.
• The primary etiologic factors are
alcoholism & biliary tract disease.
• May be a complication of viral or
bacterial disease, peptic ulcer, trauma.
Pancreatitis
Dincidence & Risk Factor

• Major- Biliary stones, Alcohol use/abuse

• Minor- Age: 55 to 65 yrs. for biliary
pancreatitis 45- 55 yrs. For alcohol-
related
• Female for biliary tract pancreatitis;
Male-for alcohol-related pancreatitis.
• Trauma, Infectious disease, drug
toxicities, chronic diseases
( inflammatory diseases).
 Treatment
• Alleviate pain & anxiety. Anxiety increases pancreatic
secretions. Demerol-then morphine.
• Reduce pancreatic stimulus- NPO, NGT to remove
gastric secretions. Drugs to reduce pancreatic secretions-
anticholinergics-suppress vagal stimulation, NaHco-reverse
metabolic acidosis.Regular insulin to treat hyperglycemia.
• Prevent or treat infection with abx.
• Aggressive respiratory care- monitor ABC.
• Reduce body metabolism bedrest, cool quiet
environment.
• Provide client and family instruction -avoid
alcohol, coffee,heavy meals and spicy food.
PancreatitisAssessment
Pain: Steady & severe
in nature; located in the epigastric or umbilical
region; may radiate to the back. Worsened by
lying supine; may be lessened by flexed knee,
curved-back position.

Vomiting Varies in
severity, but is usually protracted, worsened
by ingestion of food or fluid. Does not relieve
the pain. Usually accompanied by nausea.
Fever: Rarely exceeds 39
C.

Abdominal Finding: Rigidity,

tenderness, guarding, distended, decreased or
absent peristalsis and paralytic ileus.Fatty
stools-(steatorrhea)

Laboratory Finding: Elevation

of white count- 20,000-50,000. Elevated serum
lipase and amylase(5 to 40 times); glucose,
bilirubin, alkaline phosphatase. Urine amylase
elevated.Abnormal low serum CA, Na & Mg.-due
to dehydration. Binding of Ca in areas of fat
necrosis.
PancreatitisRanson's criteria
Admission criteria Criteria during initial 48 hours

Age: 55 yrs. Or older Hct: decrease or more than

10%

WBC: 16,000/mm3 or higher BUN:increase greater than 5

mg/dl.

LDH: 350 IU/L or higher CA: falls to less than 8 mg/dl.

Glucose > 200 mg/dl. PaO2 < 60 mm Hg

AST: 250 U/L or higher Fluid sequestration; greater

than 6 liter.
 Pancreatitis
Major complications

Cardiovascular- hypotension/shock from

hypovolemia.
Hematologic-Anemia from blood loss, DIC,
leukocytosis from gen.inflammation or secondary
infections.
Respiratory-atelectasis, pneumonia, pleural
effusion, ARDS
GI- bleeding
Renal- oliguria, acute tubular necrosis
Metabolic-hyperglycemia, hypocalcemia.
 CA of the Pancreas
Etiology
Etiology-unknown. Malignant disease of the
exocrine pancreas & more than 85% of the cases
are ductal adenocarcinomas. 2/3 develop in the
head; remainder occur in the body or tail of the
gland. It occurs more commonly in male.
The tumor is usually deeply encased in normal
tissue & poorly demarcated. The common duct is
often obstructed and distended by the presence of
the tumor. Metastasis has almost always occurred
before the tumor produces the first symptoms.
 CA of the Pancreas
Signs and Symptoms
Jaundice (lesions of pancreatic head only)
Clay-colored stool
Dark urine
Abdominal pain: usually vague, dull, non-
specific
Weight loss
Anorexia
Nausea and vomiting
Glucose intolerance
GI bleeding
Spleenomegaly
Ascites
 CA of the Pancreas
Treatment

Non-surgical- High doses of opioid analgesics.

Chemotherapy, radiation therapy-intensive
external beam radiation therapy by shrinking
the tumor cells.
Surgical management: Whipple procedures: the
procedure entails the removal of the head of the
pancreas, duodenum, a portion of the jejunum,
the stomach and the gallbladder, with the
anastomosis of the pancreatic duct, the common
bile duct, and the stomach to the jejunum.
CA of the Pancreas
Postoperative Care
 Cholelithiasis
Definition, Incidence, Predisposing Factors

Also known as stones in the gallbladder

It is the most common disorder of the biliary
system and it has been estimated that 8-10% of
all adults in the U.S. have this condition.
Predisposing factors includes: gender, age, estrogen
RX or BCP's, sedentary lifestyle, family history
and obesity.
Cholecystitis- inflammation of the gallbladder.
 Cholelithiasis
Clinical Manifestations
• Sudden-onset pain in the right upper quadrant
(RUQ) of the abdomen. Severe and steady in
quality. Frequently radiates to the right scapula
or shoulder. Persists for abt. 1 to 3 hours. May
awaken the patient at night. May be associated
with consumption of a large fatty meals.
• Anorexia, nausea and vomiting.
• Mild to moderate fever
• Decreased or absent bowel sounds
• Acute abdominal tenderness
• Elevated WBC, slightly elevated bilirubin, and
alkaline phosphatase.
 Cholelithiasis
Diagnostic Test

• Ultrasound-best way to dx; 90-

95% effective.
• Serum studies- liver function test
and serum amylase
• Cholangiogram
• Gallbladder x-ray test.
 Cholelithiasis
Interventions
• Provide relief from vomiting. NGT-reduces
distention & eliminates gastric juices that
stimulate cholecystokinin.
• Maintain fluid and electrolyte balance.
• Monitor drug therapy. Administer broad
spectrum Abx. Chenodeoxycholic acid- bile acid
dissolves cholesterol calculi (60% of the stone).
• NTG & papaverine to reduce spasms of duct.
• Synthetic narcotics (Demerol, methadone)
MSO4 may cause spasms of Oddi and increase
spasms.
 Cholelithiasis
Interventions
• Provide low-fat diet to decrease gallbladder
stimulation; avoid alcohol and gas forming
foods.
• Maintain bedrest
• Extracorporeal shock wave lithotripsy- shock
wave that disintegrates stones in the biliary
system. Ultrasound is used for stone
localization before the lithotriptor send waves
through a water bag upon which the patient
is lying. Analgesics and sedatives to reduce
pain during procedures.
 Cholecystitis
Assessment
• Epigastric pain- after eating
• Pain- localized in RUQ because of somatic
sensory nerves. Murphy's sign- can't take a
deep inspiration when assessor's fingers are
pressed below hepatic margin. Pain begins 2 to
4 hours after eating fried or fatty foods and
persist more than 4 to 6 hours.
• Nausea, vomiting, anorexia
• Low-grade fever
• Jaundice
• Weight loss
 Cholecystitis
Surgical Management

• Cholecystectomy- removal of gallbladder after

ligation of the cystic duct and vessels.
• Choledochostomy-opening into the common
bile duct for removal of stones. T-tube inserted
into duct and connected to drainage bottle.
Purpose- to decompress biliary tree and allow
for postoperative cholangiogram.
• Endoscopic cholecystectomy-removal of
gallbladder through small puncture hole in the
abdomen. Laser dissects gallbladder.