Med-Surg - Gastrointestinal System, part 10: Pancreatitis
by Cathy Parkes November 28, 2021 Updated: January 17, 2022 4 min read
Hi. I am Cathy with Level Up RN. In this video, I am going to talk about pancreatitis. If you have our Level Up RN medical-surgical nursing flashcards, definitely pull those out. And make sure you review the bold red text on these cards because there are several very important points you need to know about pancreatitis. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video, so definitely stay tuned for that.
Pancreatitis is inflammation of the pancreas. So any time you see -itis, that means inflammation, so inflammation of the pancreas. So normally, the pancreas sends inactivated enzymes to the small intestine, where they become activated and they help to digest fat, protein, and carbs. With pancreatitis, those enzymes become prematurely activated, such that they end up auto-digesting the pancreas, and that results in fibrosis of the pancreas. So risk factors associated with pancreatitis include alcohol abuse, which is a really important key factor. Other risk factors can include bile tract disease, GI surgery, gallstones, trauma, as well as medication toxicity. Signs and symptoms can include severe, left upper quadrant, or epigastric pain, and there will be possible radiation of this pain to the left shoulder or back.
In addition, the patient will have nausea and vomiting, and they'll have something called Cullen's sign, which is where we have blue-grey discoloration around the umbilicus or the belly button. So I was trying to think of a good way to help you guys remember Cullen's sign. One of my viewers said, "Hey, Edward Cullen from Twilight has kind of a blue-grey discoloration to his complexion." And so I have to admit I've not seen Twilight, but I did Google Edward Cullen, and he does kind of have a pale complexion, might be a little blue or grey in discoloration. If that helps you to remember Cullen's sign, then I am all for that. The other sign that may be present is Turner's sign, so we do have a cool chicken hint here for Turner Sign. So if you turn your patient over on their side, you will see Turner's sign, which is ecchymosis that will show up on the patient's flank. Other signs and symptoms include jaundice as well as tetani, which is associated with hypocalcemia that we often see with pancreatitis.
Abnormal labs that are associated with pancreatitis are very important to know. Labs that may be elevated include amylase, lipase, white blood cells, bilirubin, as well as glucose. So why is glucose elevated? Well, the pancreas normally makes insulin. So if the pancreas is messed up and not making enough insulin, then that glucose is not getting from the bloodstream into the body's cells, and it's accumulating in the bloodstream. Lab values that may be decreased include calcium, magnesium, and platelets. So in terms of diagnosis, we can use an ultrasound, CT scan, or MRI to help diagnose pancreatitis. For patient with pancreatitis, we're going to place them on NPO and then gradually have them consume a bland and low-fat diet over time. In addition, we're going to provide IV fluids and electrolytes. We're going to provide opioid analgesics because pancreatitis is associated with severe pain.
In addition, we need to provide antibiotics, antiemetics for nausea and vomiting, insulin so that we can get that glucose into the body's cells, and then pancreatic enzymes with all meals and snacks. Because again, the pancreas is messed up, so it's not doing its normal job, which includes bringing those digestive enzymes over to the small intestine to help with digestion. In terms of nursing care, we're going to want to monitor for complications, which can include chronic pancreatitis, which is something we see often with alcohol abuse. Other complications include a pancreatic pseudocyst. So this is where we have these fluid-filled sacs that form kind of in or around the pancreas. And then type 1 diabetes is also a complication of chronic pancreatitis. In terms of patient teaching, we want to definitely emphasize that the patient should not consume alcohol. And if appropriate, we should refer the patient to an alcohol recovery program. And then we should encourage the patient to consume a low-fat diet, ongoing, and no smoking.
All right. Are you guys ready for your quiz? I have three questions for you. First question, what do you call the ecchymosis on the flanks of a patient with pancreatitis? The answer is Turner's sign. Question number two, what do you call the blue-grey discoloration around the umbilicus with pancreatitis? The answer is, Cullen's Sign. All right. For this third question, I want you to tell me whether the lab value will be increased or decreased with pancreatitis. You ready? Glucose? It will be increased. Amylase, increased. Calcium, decreased. Lipase, increased. Magnesium, decreased. Okay. That's it for pancreatitis. I hope you learned a lot. Take care and good luck with studying.
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