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what 2 items from pmh were of relavence for pancreatitis
- prior cholecystectomy
- hepatitis C positive (5yrs)
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family and social history risk
heavy alcohol use (10-12 cans of beer/day for 15 yrs)
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in pancreatitis what 4 vital signs were abnormal and which way
- BP - low 85/60
- HR - high 120
- RR - high 35
- Temp - high 101.4
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4 points of significance on physical examination
- slightly diminished pulses in all extremities
- diaphoretic
- guarding
- rebound tenderness
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2 major functions of the pancreas
- produce digestive enzymes and juices (trypsin, chymotrypsin, lipase and amylase) produced in exocrine cells
- secretes insulin, glucagon, and somatostatin into the bloodstream, produced in the endocrine cells
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which ethnic group is at risk of developing AP
african americans 10X
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approximately how many cases of pancreatitiis occur nationally every year
80000
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most common cause of AP in the U.S.
long term alcohol abuse
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significant point of examination for the heart
sinus tachycardia
-
significant point of examination for th skin
- dry with poor skin tugor
- some tenting
- above 2 indicate elevated specific gravity
- (-) grey turner sign
- (-) cullen sign
- above 2 suggest no retroperitoneal hemorrhaging
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2 points in the patient that were significant for having pancreatitis
- acute renal failure
- hypotensive shock
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5 risk factors the patient had for AP
- long term alcohol use
- gallstones
- serum triglycerides > 1000mg/dl
- surgery, especially abdomen(cholecystectomy)
- hepatitis C
-
generalized S&S of AP
- sweating
- anxiety
- patient looks and feels sick
- hypotension
- pallor
- cool, clammy skin
- upper abdominal pain radiating into the back
- N/V
- Fever
- elevated HR
-
7 abnormal lab tests
- elevated serum amylase and lipase
- elevated BUN and serum creatinine
- elevated serum alkaline phosphatase
- hyperglycemia
- leukocytosis
- glycosuria
- abnormal coagulation tests
- low serum calcium
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2 causative factors for pancreatic damage
-
three mechanisms by which alcohol causes damage
- causes premature activation and relaease of the digestive enzymes
- increases the permeability of the pancreatic duct
- increases the protein in the pancreatic juices and then decreases bicarbonate and trypsin inhibitors
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6 significant high lab levels
- BUN - 34
- glucose - 415
- Cr - 1.5
- WBC - 16,400/mm3
- all liver stuff except T bilirubin(normal) & albumin (low)
- triglycerides - 971
-
significant low lab value
lymphocyte
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2 significan normals for the abdominal ultrasound
- non specific gas pattern
- no regions of dilated bowel
-
5 tx goals
- relieve abdominal pain and nausea
- fluid and electrolyte replacement
- control glucose and lipid levels
- minimize systemic complications
- prevent pancreatic necrosis and infection
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how many ranson criteria were present
6 with a 40% mortality
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