15849884
Descripción
Mapa Mental por ZENA SANTOS, actualizado hace más de 1 año
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Creado por ZENA SANTOS
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ACUTE
PANCREATITIS
- PATHOPHYSIOLOGY
- 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:
- SHOCK
- DISSEMINATED
INTRAVASCULAR
COAGULATION
- ADULT RESPIRATORY
DISTRESS SYNDROME
- SHOCK
- Active
enzymes leak
into peritoneal
cavity and
continue to
destroy tissue
with massive
inflammation
- SEVERE PAIN
- HEMORRHAGE AND SHOCK
- PERITONITIS AND
HYPOVOLEMIC
SHOCK
- SEVERE PAIN
- Enzymes and
cell contents
leak into
general
circulation and
may cause:
- TISSUE NECROSIS AND SEVERE
INFLAMMATION OF PANCREAS
- AUTODIGESTION OF
PANCREATIC TISSUE
- ACTIVATION OF PANCREATIC
ENZYMES INSIDE THE
PANCREATIC DUCTS
- Van Meter & Hubert, 2014
- PRECIPITATING FACTORS:
ALCOHOL CONSUMPTION,
BILIARY TRACT
OBSTRUCTION, TUMOR,
MUMPS VIRUS
- ASSESSMENT
- 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)
- Turner’s sign
(Flank
ecchymosis)
- Abrupt onset of Severe
Epigastric and Left Upper
Quadrant Pain that may
radiate to back
- LeMone et. al, 2015
- CLINICAL
MANIFESTATIONS
- DIAGNOSIS
- SERUM LIPASE TEST
- 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
- 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
- ULTRASONOGRAPHY
- 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)
- 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)
- Magnetic resonance
cholangiopancreatography
(MRCP)
- 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
- 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
- COMPUTED TOMOGRAPHY (CT)
- 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
- 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
- Greenberg, J. A., et al, 2015
- SERUM LIPASE TEST
- MANAGEMENT AND
TREATMENT
- FLUID THERAPY
- Initial management
- Fluid replacement, optimization of
electrolytes and provide caloric intake
- Crystalloid, colloid fluids or combination
- RINGER'S LACTATE (Prefered)
- RINGER'S LACTATE (Prefered)
- Crystalloid, colloid fluids or combination
- Fluid replacement, optimization of
electrolytes and provide caloric intake
- Initial management
- ANTIBIOTIC THERAPY
- Active against
Gram negative
bacteria
- IMIPINEM
- CLINDAMYCIN
- PIPERACILLIN
- FLUOROQUINOLONES
- METRONIDAZOLE
- IMIPINEM
- Active against
Gram negative
bacteria
- NUTRITION
- Oral food
and fluids
are withheld
during acute
episodes
- Reduce pancreatic secretions and promote
rest of the organs
- Reduce pancreatic secretions and promote
rest of the organs
- Enteral Nutrition (severe)
- Maintains intestinal
motility, which preserves
the gut barrier function and
subsequently reduces the
risk of secondary infections
- Nasogastric
- Nasojejunal
- Nasogastric
- Maintains intestinal
motility, which preserves
the gut barrier function and
subsequently reduces the
risk of secondary infections
- Oral food or fluids are
begun once serum
amylase levels have
return to normal, bowel
sounds are present and
pain disappears
- SOFT DIET
- LOW FAT SOLID DIET
- FULL SOLID DIET
- FULL SOLID DIET
- LOW FAT SOLID DIET
- SOFT DIET
- Oral food
and fluids
are withheld
during acute
episodes
- SURGICAL INTERVENTION
- Endoscopic trans duodenal
sphincterectomy
- Cholecystectomy
- Endoscopic trans duodenal
sphincterectomy
- Shah, A.P., Mourad, M.M., & Bramhall, S.R., 2018
- FLUID THERAPY
- NURSING CARE
- Perform health
history and Physical
assessment
- Determine presence
of clinical
manifestations
- Monitor for severity and for any
further complications
- Monitor for severity and for any
further complications
- Determine presence
of clinical
manifestations
- Health Promotion
- Educate
patient on the
risks/factors
in developing
pancreatitis
- Educate
patient on the
risks/factors
in developing
pancreatitis
- Focus on managing pain,
promoting nutrition and
maintaining fluid
balance
- Develop
activity goals
- Discuss dietary restrictions
- LeMone et. al, 2015
- Perform health
history and Physical
assessment
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