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- NURS 6501 Week 5 Assignment Gastrointestinal Disorders
Student name
Walden University
NURS 6501
Professor Name
Submission Date
Gastrointestinal Disorders – Concept Map
Primary Diagnosis: Pancreatitis
- What are the patient’s risk factors for this diagnosis?
| Pathophysiology of Primary Diagnosis | |
| The pancreas is the organ that regulates blood glucose and digestion, and pancreatitis is inflammation of the pancreas. The pancreas secretes digestive enzymes into the small intestine to digest food. It makes hormones that regulate blood glucose (sugar), such as insulin and glucagon. Acute and chronic pancreatitis. Acute pancreatitis is due to sudden inflammation and can be lethal (Heckler et al., 2020). It’s usually cured with treatment. Acute pancreatitis is characterized by the activation of the pancreas’s enzymes. Normally, enzymes are inactive until the small intestine. In acute pancreatitis, enzymes in the pancreas turn on, and digest, inflame, and destroy tissue. | |
| Causes | Risk Factors (genetic/ethnic/physical) |
| Early secretion of pancreatic enzymes may result from a number of factors. Most of these are brought about by gallstones, 40-70. In case of a gallstone that blocks the bile duct and occludes the pancreatic duct, the pancreas stores the digestive enzymes. This obstruction causes pressure, enzymatic damage, and inflammation to pancreatic tissue.Another reason that leads to acute pancreatitis is alcohol misuse (Enver Zerem, 2023). The alcohol may also form protein blockages and calcifications in the pancreatic ducts, blocking the digestive enzymes. Enzyme activation and inflammation are the result of this blockage and the toxicity of alcohol on the cells of the pancreas.The other causes of acute pancreatitis are hypertriglyceridemia, medications like diuretics, antibiotics, and chemotherapy, infections, and injuries to the pancreas. Etiology is unknown.Chronic pancreatitis permanently destroys and scars the pancreas. Pathophysiology of chronic pancreatitis consists of repeated events of acute inflammation leading to the destruction of pancreatic tissue. The pancreas becomes unable to produce digestive enzymes and hormones, which leads to nutritional malabsorption and diabetes.Hereditary pancreatitis may also be caused by mutations in PRSS1, SPINK1, or CFTR genes (Panchoo et al., 2022). Alterations in the pancreatic enzymes or pancreatic enzyme inhibitors enhance the risk of pancreatitis. Other causes include autoimmune pancreatitis, where the immune system of the body attacks the pancreas, and obstructive pancreatitis, whereby the pancreatic ducts are blocked by gallstones, tumors, or strictures over a long duration of time. | Risk factors of pancreatitis are different. Gallstones, excessive alcohol use, hypertriglyceridemia, and some medications are the primary risk factors in acute pancreatitis (Enver Zerem et al., 2023). Risk factors are smoking, pancreatitis in the family, and abdominal trauma. The most significant risk factor of chronic pancreatitis is chronic alcohol consumption, then genetics and autoimmune diseases. Chronic pancreatitis is also caused by smoking and a high-fat diet. |
| Signs and Symptoms – Common presentation | Complications? |
| Pancreatitis, irrespective of its acute or chronic nature, shares similar signs and symptoms. The most frequent symptom of acute pancreatitis is acute, severe abdominal pain in the upper abdomen with a possibility of extension to the back (Gliem et al., 2020). Diet, in particular, fatty foods may aggravate the chronic or acute pain. Adjustments in posture and vomiting rarely relieve the pain. Nausea and vomiting often accompany the pain and can be incapacitating and long-lasting.Symptoms of acute pancreatitis include fever, rapid pulse, and a bloated, painful belly. In severe cases, patients might also show the presence of systemic inflammation and organ dysfunction, including hypotension, tachycardia, and respiratory distress. ARDS, serious renal failure, and shock may be the outcomes of severe acute pancreatitis, requiring medical intervention. | As the disease progresses, there is a lack of digestive enzymes, leading to nutritional malabsorption. This may lead to steatorrhea, weight loss, and nutritional indicators like muscular atrophy and vitamin deficits. Symptoms of fat-soluble vitamin A, D, E, and K deficiency include bone pain and fractures, night blindness, and easy bruising.Another significant complication of chronic pancreatitis is diabetes (Kichler & Jang, 2020). When the pancreatic islets (insulin and glucagon producers) of the patients are destroyed, they may develop glucose intolerance and insulin-dependent diabetes. This type of diabetes is weak and is likely to experience hyperglycemia and hypoglycemia.Complications are also possible in the other physiological systems in pancreatitis. Acute pancreatitis may lead to damage of organs and inflammation due to systemic inflammatory response syndrome (SIRS) (Ge et al., 2020). ARDS results in severe hypoxia due to inflammation and accumulation of fluid in the alveoli. Acute renal failure can be caused by reduced supply of blood to the kidneys as well as by the toxicity of inflammatory mediators.Pancreatic necrosis is a severe acute pancreatitis complication that leads to the pancreatic tissue death and infection (Rashid et al., 2019). The mortality rate of infected pancreatic necrosis is high and normally requires surgery. Abdominal discomfort, blockage, or rupture can also be caused by pancreatic pseudocysts, which are fluid-filled sacs that develop after pancreatitis.The inflammation and fibrosis in chronic pancreatitis may obstruct the duodenum or bile duct, which causes jaundice and digestive problems. Chronic inflammation is also a risk factor for pancreatic cancer in patients with genetic pancreatitis or those who have a history of smoking and alcohol consumption. |
| The upper stomach can be painful, and nausea and vomiting can occur due to cholecystitis and biliary colic. The illness of the gallbladder results in pain in the right upper quadrant, which can extend to the back or shoulder. It can be brought about by fatty foods and can result in fever and jaundice in case of an infection or obstruction of the bile ducts. Abdominal pains can also be caused by peptic ulcer disease (PUD), which leads to the development of ulcers in the stomach or duodenum (Weledji, 2020). The pain of PUD is burning or gnawing, and it may be relieved by taking food or antacids. In difficult situations, perforation may result in severe, acute pain, mimicking acute pancreatitis.Acute appendicitis, inflammation of the appendix, is typically the cause of right lower quadrant pain, but can also be diffuse or peri-umbilical, such as pancreatitis. Right lower quadrant pain, fever, nausea, and vomiting are present as the inflammation intensifies. Moreover, mesenteric ischemia is a condition in which blood flow to the intestines is restricted, which can lead to sudden and acute discomfort in the stomach that is not anatomically related. This medical emergency has symptoms such as nausea, vomiting, and bloody stools, which are similar to pancreatitis.The bowel obstruction would lead to stomach pain, vomiting, and difficulty in passing gas and feces. The pain of colicky bowel obstruction is accompanied by abdominal distension and high-pitched bowel sounds. Gastritis may result in upper abdominal pain, nausea, and vomiting. Gastritis does not produce severe pain as compared to pancreatitis, and it could cause indigestion and burning. Right upper quadrant pain, nausea, vomiting, and jaundice may be due to hepatitis or liver inflammation. The dull ache may be accompanied by systemic symptoms such as weariness and fever. |
| Pancreatitis diagnosis is made on the basis of clinical and laboratory tests and imaging. The first assessment will consist of a full patient history and physical examination. A comprehensive history includes questions about the onset, duration, and character of the stomach pain and other symptoms associated with it, such as nausea, vomiting, and fever. Risk factors are also provided. The physical exam is characterized by upper abdominal discomfort, particularly in the epigastric area. Hypotension and tachycardia are two severe symptoms of systemic inflammation or shock.Laboratory tests are required to diagnose the severity of pancreatitis. AlEdreesi & AlAwamy 2021). High levels of pancreatic enzymes, amylase, and lipase are the primary lab results in acute pancreatitis. Lipase is more selective, lasts longer, and is a better pancreatitis marker than amylase. The enzymes demonstrate the presence of inflammation in the pancreas and the leakage of enzymes into the system.The severity of sickness is tested by other laboratory tests. An inflammation or infection may be indicated by a complete blood count (CBC), which reveals leukocytosis. Fluid shift-induced hemoconcentration or bleeding can increase or decrease the level of hematocrit. Renal activity and metabolic diseases are tested with serum electrolytes, BUN, creatinine, and glucose tests. Bilirubin and liver tests are signs that there is some blockage in the bile or liver disease.The importance of imaging studies is in diagnosis, cause, and effect. Abdominal ultrasound is the first imaging used to diagnose gallstones, biliary obstruction, and pancreatic diseases (Burrowes et al., 2019). This test identifies the presence of gallstones, which are among the major causes of severe pancreatitis. An imaging test used to evaluate acute pancreatitis is a contrast CT scan of the abdomen, which reveals pancreatic inflammation, necrosis, fluid collections, and abscesses.MRI and MRCP allow the imaging of the pancreas, bile, and pancreatic ducts in detail. MRCP is able to identify bile duct stones, strictures, and other anomalies causing pancreatitis. Also, another useful diagnostic method is the Endoscopic Ultrasound (EUS), which is a combination of endoscopy and ultrasound to scan the pancreas and the surrounding tissues. EUS can detect small gallstones, pancreatic cancers, or any other illness that cannot be detected by imaging studies. |
- What treatment options would you consider? Include possible referrals and medications.
| The treatment of pancreatitis focuses on symptoms, complications, and the cause to prevent a recurrence. Pancreatitis (acute or chronic) needs different treatment. Acute pancreatitis needs to be hospitalized to be treated and monitored. Our goal is to alleviate the pain, to eliminate fluid and electrolyte imbalances, and to prevent complications.An essential component of the treatment is pain management. Mild to severe pain can be treated with such analgesics as acetaminophen or NSAIDs (Long et al., 2022). Opioids such as morphine or hydromorphone are given as painkillers in severe cases. Acute pancreatitis leads to hypovolemia and hemoconcentration, in which case fluid resuscitation is necessary. IV fluids hydrate, perfuse the pancreas, and enhance organ functions. IV supplementation helps to correct electrolyte imbalances, including hypocalcemia, hypokalemia, and hypomagnesemia.Nutritional assistance is another important aspect of the treatment. In uncomplicated acute pancreatitis, patients can be kept nil per os (NPO) to rest the pancreas, followed by a slow, gradual reintroduction of oral fluids and a low-fat diet (Sofia et al., 2023). Extensive fasting procedures can severely deplete the body, so nasojejunal feeding tubes are more preferable to parenteral nutrition to keep the gut intact and minimise the chance of infection.To prevent pancreatitis, its cause should be treated. In the case of gallstones, endoscopic retrograde cholangiopancreatography (ERCP) is able to clear the ducts of stones and relieve obstruction in the ducts. After the healing process, it is recommended to undergo a cholecystectomy to prevent subsequent attacks. To cure alcohol induced pancreatitis, quit drinking. Patients might require counseling and assistance to stop drinking, including referral to addiction specialists or support groups. Stop using drugs that trigger pancreatitis and explore other treatment options.The exocrine insufficiency is treated using enzyme replacement. Pancrelipase is used with food to help in the digestion and absorption of nutrients. A low-fat diet, fat-soluble vitamins, and medium-chain triglyceride supplements could benefit patients with malnutrition. Chronic pancreatitis diabetes is treated by the use of insulin or oral hypoglycemic agents, diet, and glucose monitoring. Surgery may be required in patients with chronic pancreatitis experiencing discomfort, complications, or cancer. Pseudocysts can be drained, damaged pancreatic tissue excised, and Puestow ductal decompression can be done. |
References
AlEdreesi, M., & AlAwamy, M. (2021). Serum pancreatic enzymes and imaging in paediatric acute pancreatitis: Does lipase diagnostic superiority justify eliminating amylase testing? Saudi Journal of Gastroenterology, 0(0), 0. https://doi.org/10.4103/sjg.sjg_204_21
Burrowes, D. P., Choi, H. H., Rodgers, S. K., Fetzer, D. T., & Kamaya, A. (2019). Utility of ultrasound in acute pancreatitis. Abdominal Radiology, 45(5), 1253–1264. https://doi.org/10.1007/s00261-019-02364-x
Enver Zerem, Admir Kurtcehajic, Suad Kunosić, Dina Zerem Malkočević, & Zerem, O. (2023). World Journal of Gastroenterology, 29(18), 2747–2763. https://doi.org/10.3748/wjg.v29.i18.2747
Ge, P., Luo, Y., Okoye, C. S., Chen, H., Liu, J., Zhang, G., Xu, C., & Chen, H. (2020). Biomedicine & Pharmacotherapy, 132, 110770. https://doi.org/10.1016/j.biopha.2020.110770
Gliem, N., Ammer-Herrmenau, C., Ellenrieder, V., & Neesse, A. (2020). Digestion, 102(4), 1–5. https://doi.org/10.1159/000506830
Long, Y., Jiang, Z., & Wu, G. (2022). Pain and its management in severe acute pancreatitis. Journal of Translational Critical Care Medicine, 4(1), 9. https://doi.org/10.4103/jtccm-d-21-00026
Panchoo, A. V., VanNess, G. H., Rivera-Rivera, E., & Laborda, T. J. (2022). Hereditary pancreatitis: An updated review in pediatrics. World Journal of Clinical Pediatrics, 11(1), 27–37. https://doi.org/10.5409/wjcp.v11.i1.27
Sofia, S., Marcello Candelli, Polito, G., Maresca, R., Mezza, T., Schepis, T., Pellegrino, A., Zileri, L., Nicoletti, A., Franceschi, F., Gasbarrini, A., & Enrico Celestino Nista. (2023). Nutrition in acute pancreatitis: from the old paradigm to the new evidence. Nutrients, 15(8), 1939–1939. https://doi.org/10.3390/nu15081939
Weledji, E. P. (2020). An overview of gastroduodenal perforation. Frontiers in Surgery, 7. https://doi.org/10.3389/fsurg.2020.573901
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