The diagnosis of pancreatic adenocarcinoma and to monitor the response to treatment of cancer *CA 19-9 is elevated in pancreatic cancer and is most commonly used tumor marker

Once considered relatively rare, now is the fourth leading cause of cancer death in US and Canada

Pancreatic cancer

According to American Cancer Society, it is estimated that more than 54,000 Americans will be diagnosed with pancreatic cancer during 2017 and that more than

43,000 Americans will die of the disease

What is a major factor in the high death rate from Pancreatic Cancer?

Difficulty in diagnosing it at an early curable stage

When does the risk for Pancreatic Cancer increase?

With age, with peak incidence occurring between 65 and 80 yrs of age

What is the most common ENVIRONMENTAL risk factor for Pancreatic Cancer?

Cigarette Smoking

Smoking is seen in

30% of pts diagnosed with Pancreatic Cancer disease

What are other risk factors in developing Pancreatic Cancer?

Exposure to chemical Carcinogens Diabetes Mellitus Cirrhosis Diets high in red meat pork fat and coffee *Obesity genetics and being of African American male increase risk of developing disease

Pancreatic cancer may originate in the Pancreas or be the result of

Metastasis from cancer of the lung, stomach, duodenum or common bile duct

Most often the head of the pancreas is involved and causes jaundice by compressing and

Obstructing the common bile duct

When Pancreatic Cancer spreads, where may it invade in the body?

Posterior wall of the stomach Duodenal wall Colon Common bile duct

What is the treatment for Pancreatitis?

Medical unless the precipitating cause is biliary tract disease; then surgery may be indicated

What are withheld to avoid stimulating pancreatic activity?

Food and fluids while IV fluids are administered *Pt is on NPO status and an NG tube is inserted to decrease pancreatic stimulation to treat or prevent nausea and vomiting and to decrease abdominal distention

Analgesics are usually prescribed for pain with pancreatitis by health provider and may be combined with an

Antispasmodic to achieve optimum pain control

What helps decrease Pancreatic activity?

Parenteral Anticholinergic meds such as Atropine or Propantheline

What may be given to prevent stress ulcers caused by decreased gastric pH?

Antacids or Antihistamine H2 receptor Antagonists such as Cimetidine

When does Enteral feeding begin?

24-48 hrs after the onset of Acute Pancreatitis and is administered via the jejunum to prevent the release of Pancreatic enzymes

Why is Enteral feeding preferred?

It is more nutritionally sound, less costly, and has fewer complications *However, if enteral feeding is not tolerated in 5-7 days, the patient may need to be switched to total parenteral nutrition TPN, intravenous feeding

Once pain is under control for at least 24 hrs a clear

Liquid diet with gradual progression may be started *Diet should also be free of caffeinated beverages because acts as a gastric stimulant

Oral Hypoglycemic agents or insulin may be needed if there is destruction of the

Islets of Langerhans in Pancreas

The patient is usually on bed rest with bathroom privileges to decrease the

Flow of Pancreatic Enzymes *Determine location of pain and what aggravates or relives pain in pt, keeping them comfortable as possible through proper administration of Analgesics and Antispasmodic meds

An inflammatory condition of the Pancreas that may be Acute or Chronic

Pancreatitis *Degree of inflammation varies from mild Edema to severe Hemorrhagic Necrosis

The exact cause of Pancreatitis remains

Unknown, many predisposing factors have been identified *Acute or Chronic Pancreatitis generally is the result of damage to the Biliary tract [ most common in women ], alcohol consumption [ most common in men ], trauma infectious disease, or certain drugs

What are the two factors most commonly associated with Pancreatitis?

Alcoholism and Biliary Tract disease

What can Pancreatitis develop as in patients who have had surgery of the Pancreas, stomach, Duodenum, or Biliary tract?

Postoperative complication

Pancreatitis can also occur after undergoing what?

ERCP [ Endoscopic retrograde cholangiopancreatography ] *A procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope—a long, flexible, lighted tube

What happens in the pathophysiologic process of Pancreatitis?

The Enzymes cannot flow out of the Pancreas because of occlusion by edema, stones or scar tissue *Occlusion - obstruction or closing off of the Pancreatic duct [ duct of Wirsung ]

When the duct ruptures releasing enzymes, begiuns digesting the

Pancreas [ autodigestion ]

What happens in Chronic Pancreatitis?

Enzyme producing acinar tissue atrophies and is replaced with fibrotic tissue, resulting in the Pancreas becoming necrotic

What is a serious complication that develops in the Pancreatic tissue?

Pseudocysts or Abscesses

What forms and happens after autodigestion in the Pancreas?

The surrounding organs occasionally form walls around cystic fluid, including Pancreatic enzymes, and necrotic debris. *These Pseudocysts [ pseudo means "false" ] can develop into an abscess [ pus, sign of infection ]

Where is the pain usually located with Pancreatitis?

Abdominal pain radiating to the back in the left upper quadrant. *JAundice may be noted if common bile duct is obstructed

How are Acute and Chronic Pancreatitis diagnosed?

Radiologic studies - Abdominal CT scan/ultrasound of Pancreas - Endoscopy.Laboratory analysis of pancreas enzymes in serum/urine

Amylast and lipase levels that are three times above normal are considered

Most definitive for Pancreatitis

What is a better indicator of Pancreatitis?

Elevation of the Pancreatic amylase level *A protein made by your pancreas and by glands in and around your mouth and throat. It helps you break down carbohydrates and starches into sugar. It's normal to have some amylase in your blood. But too much of it could mean one of the ducts (tubes) in your pancreas is blocked or injured.

The level of lipase is more specific for diagnosing what?

Acute Pancreatitis *Acute - are severe and sudden in onset. *Lipase - a type of protein made by your pancreas, an organ located near your stomach. Lipase helps your body digest fats. ... But, a high level of lipase can mean you have pancreatitis, an inflammation of the pancreas, or another type of pancreas disease.

How long does lipase level typically remain elevated with Pancreatitis?

12 days

In Chronic Pancreatitis both lipase and amylase levels

Remain normal

What may be present in Chronic Pancreatitis?

Leukocytosis Elevated Hematocrit level Hypocalcemia Hypoalbuminemia Hyperglycemia

Pancreatic insulin production may be diminished if

The Islets of Langerhans become infected, and some pts develop Diabetes Mellitus

The Amylase level is not a specific indicator for

Pancreatitis *Abnormal levels also can be seen in cases of perforated peptic ulcer, perforated bowel, and diabetic ketoacidosis

What are nursing interventions for Pancreatitis?

Monitor all replacement fluids and meds for proper administration Be prepared to protect pt from injury and provide supportive care Restrict diet as necessary prevent aggravation eliminate fats, alcohol, caffeine Record I & O including NG tube suctioning output Instruct low fat high protein and carbs when tolerated Administer meds as prescribed

How is Pancreatitis pain decreased sometimes?

Flexing the trunk, leaning forward from a sitting position or by assuming the fetal position

When can Pancreatitis pain increase?

By eating or lying down *Other complaints; nausea, anorexia, malaise, restlessness

Pain is the most common subjective data associated with Pancreatitis; pain is caused by the

Enlargement of the Pancreatic capsule, an obstruction, or chemical irritation from enzymes

Collection of objective data of Pancreatitis includes noting the presence of

Low grade fever Leukocytosis Hypotension Vomiting

If Jaundice is seen the abdomen usually appears

Swollen, bowel sounds may be decreased or absent, leading to an Ileus [ a temporary arrest of intestinal peristalsis, paralysis of the bowel ]

Prognosis of Pancreatitis [ The likely outcome or course of a disease; the chance of recovery or recurrence ]

Depends on the course of disease and complications including Pseudocysts and Abcesses; Most pt's acute pancreatitis is mild requiring less than 1 week of hospitalization *However, 5%-25% of patients have a more complicated course

Some pts recover from Pancreatitis, others have recurring attacks; overall mortality rate for acute is 10% to 15%. The mortality rate for pts with severe disease result in

Organ failure, is approx 30% Complications may occur with mild, acute necrotizing Pancreatitis are 20% and higher, depending on other organs that become involved