Late clinical manifestations= non specific= weight loss, anorexia, fatigue, n/v/ and hoarseness. Persistent pneumonitis. Hoarseness. Hemoptysis. Unilateral paralysis of the diaphragm. Dysphagia. Palpable lymph nodes in the neck. Medistinal involment will show cardiac signs and symptoms. Clinically silent, and the symptoms appear late. Persistent productive cough. Chest pain, dyspnea, wheezing. Unexplained fever.
CT scan is the single most effective non invasive technique for diagnosis.
Large cell undifferentiated.
2 functions of the pancreas= endocrine--insulin and glucagon production and exocrine--digestive. Secretes 500-1000cc digestive juices/day.
Pancreatic Enzymes= Amylase breaks down starches. Chymotripinsinogent, elastase, trypsinogen break down proteins. Lipase, phospolipase A & B break down fats.
Pancreatitis is acute or chronic inflammation of the pancreas. Auto digestion (it is eating itself). The enzymes are activated BEFORE being secreted into the pancreatic duct. The cause may be----
Gall bladder disease 80%
Cysts, tumors, viral infection, trauma, surgery, mumps, steroids, thiazide, diuretics, oral contraceptives.
Pain--extreme abdominal pain umbilical pain that radiates to the back. Abd distention and decreased bowel sounds. N/v. chronic steatorrhea. Low grade fever. Tachycardia. Dyspnea. Hypotension, restless confused.
Sign of hemorrhage
Cullen’s sign= bluish color around the umbilicus.
Turners sign= bluish color on the flank.
Just remember that everything is going to be up EXCEPT the serum calcium.
What is up
***Amylase is going to be up
WBC--tissue damage inflamation
SGOT, SGPT, LDH--tissue destruction
Down is the Ca+….hypocalcemia leads to Tetany so watch for signs.
Reduce the anxiety. Anxiety stimulates the vagus nerve which will increase the secretions.
NPO--NO ICE CHIPS
IV therapy w/ I&O and daily weights.
Anticholinergics--reduction of enzymes. Decrease spasms of Oddi.
Calcium gluconate IV
Diet is progressed from NPO to low fat bland diet high in CHO after inflammation is over.
NO Coffee. NO ETOH
Avoid heavy spicy meals.
Give pancreatic enzymes with meals.