 Hi! Welcome to Nursing School Explained and today's video on pancreatitis. Let's just review briefly on the functions of the pancreas. The pancreas itself has exocrine as well as endocrine functions. Endocrine meaning that it helps in regulation of blood sugar by secreting insulin as well as glucagon and then exocrine functions help in the digestion of proteins, fats and carbohydrates and it secretes pancreatic enzymes, amylase for the digestion of carbohydrates, lipase for the digestion of fats and chymotrypsin for the digestion of proteins. So when we have pancreatitis, it means that the pancreas is acutely inflamed and pathophysiologically this acute inflammation can range anywhere from mild to severe where severe pancreatitis can lead to necrosis as well as hemorrhage so these patients can get very very ill and then because of this acute inflammation these these pancreatic enzymes are just discussed they get spilled inside the pancreas rather than in the small intestine to aid in digestion and then this leads to auto digestion and severe pains. The pancreas is basically trying to eat itself in pancreatitis and there's severe pain associated with that. Now causes or risk factors for acute pancreatitis number one is gallbladder disease because the gallbladder also has digestive functions and when there is a blockage in the common bile duct and the pancreatic enzymes are unable to be released into the small intestine for digestion that makes the enzymes and all the digestive juices or fluids back up into the pancreas causing acute pancreatitis and then two of the causes are chronic alcohol intake so unfortunately that's a pretty common cause as well of acute pancreatitis and we'll certainly have to consult patients to decrease their alcohol intake or completely lay off of alcohol and then hyper triglycerideemia so elevated triglycerides are also really bad for the patient and can cause acute pancreatitis. Signs and symptoms associated with pancreatitis are acute left upper quadrant pain so right with the pancreas lies and it can radiate to the back or the flank in that left upper quadrant as with most abdominal inflammation or inflammatory disorders there's nausea and vomiting associated and then if it's due to gallbladder disease and there is a backup of the digestive fluids and the liver and the gallbladder are not functioning correctly it can lead to jaundice as well as hypoactive bowel sounds and abdominal distention as the inflammation gets worse there might even be crackles in the left lower lobe as the inflammation from that pancreas in the left upper quadrant spread into the thoracic cavity and because of the inflammation and fluid accumulation it can lead to crackles in the lungs and then there are two things called the great turner and colon sign and I've drawn a little man out here so both of these leads is basically hemorrhage underneath the skin that then will be evidenced by these two signs and this will be a hematoma or purplish discoloration that you can see in the colon sign is this purplish discoloration around the belly button as the fluids and that hemorrhage basically settles down and a great turner sign would be at the patient's flank so anywhere from the left upper quadrant around the flank mostly it's going to be in the back because the blood will settle with gravity and most likely the patient is going to spend a lot of time on their backs if they're ill and all these so this hemorrhage now that this patriotic autodigestion is causing can lead to low blood pressure and an elevated heart rate and actually can lead to hyperbolemic shock and we'll talk more about the treatment options and why fluid resuscitation is so important in patients with acute pancreatitis now pancreatitis in itself is already painful and can be really severe but there are two specific complications that we need to keep an eye out for and those are number one pancreatic pseudo cysts so now these the cyst forms right next to the pancreas or outside of the pancreas where this these pancreatic enzymes the spillage just kind of gets encapsulated and that's usually evident by a palpable mass in that left upper quadrant and the patient has maybe even more nausea and vomiting and pain than they previously had with already the acute pancreatitis or maybe they just come in and the pseudo cyst has already formed now it might resolve spontaneously but we have to be very careful because the spontaneous resolving of the pseudo cyst might mean that it burst that it opened up and now all these digestive enzymes all these inflammatory cells spill into the peritoneum causing acute peritonitis which can lead to sepsis and septic shock and then the complication number two is a pancreatic abscess which is an extension of this pancreatic pseudo cyst so now it becomes infected and after the infection forms the abscess can become necrotic and in addition to the palpable mass nausea vomiting and pain the patient is also going to spider fever because now we have this severe infection and necrosis on top of the inflammation of the pancreas and the patient will usually need surgical drainage to prevent sepsis and septic shock just like in the pseudo cyst so as you can see patients with pancreatitis can be very very ill and these complications are not unusual so we need to be hyper vigilant in monitoring these patients and keep these complications from happening or detect them early so that then we can intervene in terms of diagnostic tests because it has these exocrine functions the two enzymes that we usually measure are amylase and lipase and they will be skyrocketing elevated in a patient with acute pancreatitis because they're just spilling all over and we can now measure them certainly we want to measure their liver function and their bilirubin because we know that it can be caused by gallbladder disease and then triglycerides because we want to rule out or or determine the underlying cause certainly we want to keep an eye on the patient's blood sugars because again the endocrine function of the pancreas is the release of insulin and glucagon on the balance of the blood sugar now with the pancreas being so inflamed there might be fluctuations there in either in either direction and then as for diagnostic tests for visualization the patient might need an ultrasound or a CT scan they might need an ERCP which is an endoscopic retrograde coli angiopancreatography so it's a visualization of the pancreas as well as the gallbladder and all the ducts that drain those these two organs to see what exactly is going on and see maybe there's a blockage because of a gallstone that's causing that and i described the procedure a little bit in more detail in my colisostitis gallbladder disease video and certainly we want to also check the chest x-ray because of the proximity of the pancreas to that left lower lobe that we said here can cause these crackles with the inflammation so we want to make sure that the lungs stay clear of this inflammation or again detect early if there are any changes such as infiltrates now on that left lower lobe as for treatment so severe pain we need to manage this patient they might need high doses of IV opioids to deal with this pain of course we want to be always cautious with administering those but these patients they will be in severe severe pain and we also need to have aggressive fluid resuscitation with fluids that are isotonic normal saline and lactated ringers to prevent this hyperbolic shock that can occur over here and we discussed and then of course you want to prevent these complications here that we just talked about and treat and remove the underlying cause so if it's a gallbladder they might a gallbladder or gall gallbladder disease or gallstone they might need that removed or maybe if it's because of acute alcohol intake certainly we can have the patient not do that while they're at the hospital and then because of this decrease we want to decrease the pancreatic enzyme secretion because the the pancreas is hyperactive and the the enzymes sustain the pancreas and they're unable to be released in the regular digestive tract so we want to keep the patient in PO and then we want to manage their fluids and electrolytes keep in the close eye on their electrolytes specifically sodium and potassium as always because of this aggressive fluid resuscitation so nursing care always goes along with the treatment so we want to manage their fluid and the electrolytes keep an eye on their labs as well as their I and O so that's going to be very important because the patient is going to get this aggressive fluid resuscitation and we want to make sure that we don't over hydrate them so keeping an eye on their eyes and also going to be very important the patient will be in PO now if this is a severely ill patient who might not be able to eat for quite a few days they might start the patient on TPN and this is very important because we want to make sure that the patient received the nutrients that they need for supporting their immune system during this acute bout of acute pancreatitis and an IV flu it's here with an exclamation mark I already talked about this and we want to be very diligent about assessing their abdomen and lungs very frequently because maybe they didn't have a palpable mass but now they have one so now we know that they probably are developing a pseudosystem maybe even an abscess and we need to intervene and then of course the lung sounds that we already discussed because of the inflammation and the crackles that can develop if that would extend the patient can go into septic shock again or they can even develop ARDS acute respiratory distress syndrome because of all these inflammatory cells that are being released so again these patients can be very very very very sick and we need to make sure that we assess them frequently and keep an eye on those important things and then certainly we want to monitor for signs and symptoms of infection to see if this abscess and necrosis are developing so keep an eye on their vital signs trending those very carefully and maybe even detecting early changes so that we can again intervene early the patient might be so severely ill that they need to go to the ICU and have a cdp central venous pressure monitoring to account for or to really monitor this aggressive fluid resuscitation where they might be needing vasoactive medications if maybe they came in late or now we're dealing with complications and they are turning hypovolemic or turning into hypovolemic shock and then there are three different surgical treatments so if it's because of a gallbladder issue then there can be a laparoscopic colisospectomy that's recommended or again the ERCP or they might need a percutaneous drainage of the psuedocyst or the abscess to remove all these things that are causing the symptoms as well as could possibly lead to these complications so thank you for watching this video on acute pancreatitis please also watch my video on acute colisostitis and colithiocis so gallstones and gallbladder inflammation where I go into a little bit more about explaining about the procedure and so that you understand how the digestive issues one can lead to the other and sometimes are related to one another please give me a thumbs up if you enjoyed the video it helps me keep this going and I'll see you soon right here on nursing school explain thanks for watching