TP

Abbreviation for:
tea polyphenols
teenage pregnancy
telepathology
temperature and pressure
temporal peak
temporal pole
temporoparietal
tender point
tension pneumothorax
tensor palati
term pregnancy
terminal phalanx
terminal phase
testosterone propionate
theta pattern
ThinPrep
thiopental
thrombocytopaenia
thrombocytopaenic purpura
thromboplastin
thymic peptide
thymidine phosphorylase
tibialis posterior
tinea pedis
tissue pressure
tongue protrusion
topotecan
torsades de pointes
torus palatinus
total pancreatectomy
total protein
transient paralysis
transpeptidase
transplantation
transverse process
treatment plan
treatment protocol
Treponema pallidum
trigger point
trimethoprim
tripolar
true-positive
tryptophan
tubal pregnancy
tuberculous pleuritis
tyrosine phosphorylation

pancreatitis

(pang?kre-a-tit'is, pan?) [ pancreat- + -itis] Inflammation of the pancreas, sometimes accompanied by damage to neighboring organs (e.g., the bowel, lungs, spleen, or stomach) or by a systemic inflammatory response. acute pancreatitis; chronic pancreatitis;

acute pancreatitis

Pancreatitis of sudden onset, marked clinically by epigastric pain, nausea, vomiting, and elevated serum pancreatic enzymes. Varying degrees of pancreatic inflammation, autodigestion, necrosis, hemorrhage, gangrene, or pseudocyst formation may develop. The disease may be relatively mild, resolving in 3 or 4 days, or severe enough to cause multiple organ system failure, shock, and death (in about 5% of patients). The patient may assume a sitting or fetal position in attempting to ease the pain because lying supine or walking tends to increase discomfort.

Etiology

Alcohol abuse and obstruction of the pancreatic duct by gallstones are the most common causes of the disease; less often, pancreatitis results from exposure to drugs (e.g., thiazide diuretics or pentamidine), hypertriglyceridemia, hypercalcemia, abdominal trauma, or viral infections (e.g., mumps or coxsackievirus).

Treatment

The patient receives nothing by mouth until pain, nausea, and vomiting have resolved and diagnostic markers (e.g., serum lipase level) show evidence of normalizing. Standard supportive measures include the administration of fluids and electrolytes, sometimes in massive quantities if dehydration or third-spacing of fluids in the abdomen occurs.

CAUTION!

Refeeding patients before pancreatic inflammation has resolved may cause a relapse.

Prognosis

Several techniques are used to determine how well (or how poorly) patients with pancreatitis will progress during their illness and whether they may benefit from intensive care. The best of these is the Acute Physiology and Chronic Health Evaluation (APACHE II) system; it grades patients with pancreatitis on the basis of 14 measurable physiological parameters, including the patient's body temperature, heart rate, mean arterial pressure, respiratory rate, serum creatinine and sodium levels, arterial pH, white blood cell count, Glasgow coma scale, and age.

Other methods for determining the severity of illness in pancreatitis rely on abnormalities seen on computed tomography (CT) imaging or the measurement of other physiological criteria, including the serum calcium and glucose levels, fluid deficit, and liver function.

Patient care

Intravenous fluids, antiemetics, and pain relievers are administered parenterally. A nasogastric tube may be inserted and placed on low, intermittent suctioning for patients with intractable nausea and vomiting or to reduce hydrochloric acid levels or relieve distention. Required nutritional support is best provided by jejunal enteral feedings that maintain gut integrity. These are as effective as parenteral feeding is and have the benefit of reducing the potential for infection and hypoglycemia. Total parenteral nutrition may be needed for patients with evidence of severe pancreatitis. Such patients may be critically ill and will require close monitoring of vital signs, oxygenation and ventilation, body temperature, cardiac and hemodynamic status, fluid and electrolytes, balance, body weight, serum calcium levels, renal function, level of consciousness, peripheral circulation, possible delirium, and possible multiorgan system failure. Severe pancreatitis often results in a prolonged and complicated hospitalization. Throughout the illness, range-of-motion exercises, correct positioning, prophylaxis against deep venous thrombosis, oral hygiene, and other physical support measures prevent debilitation and complications of prolonged illness. Both patient and family may need support, esp. in the presence of complications (pulmonary, cardiovascular, renal, immune, and coagulation abnormalities). After pancreatitis has resolved, alcoholic patients should be encouraged to seek help from Alcoholics Anonymous or other supportive programs. Follow-up with a gastroenterologist, primary care provider, or nutritionist may be helpful during convalescence and recovery. Patients should return for prompt reevaluation if they have nausea, vomiting, epigastric pain, fevers, or jaundice after discharge.

alcoholic pancreatitis

Pancreatitis due to excessive (typically chronic) alcohol consumption. It is the second most common cause of pancreatitis, after ductal obstruction by gallstones.

autoimmune pancreatitis

Chronic pancreatitis, usually found in association with other autoimmune disorders (e.g., inflammatory bowel disease, rheumatoid arthritis, or Sjogren's syndrome). It is a relatively rare disease, suggested by the finding of antibodies against lactoferrin and carbonic anhydrase in the blood of affected patients. Biopsy specimens reveal infiltration of the organ by lymphocytes. It is treated with corticosteroids. Synonym: autoimmune-related pancreatitis

autoimmune-related pancreatitis

Autoimmune pancreatitis.

centrilobar pancreatitis

Pancreatitis located around divisions of the pancreatic duct.

chronic pancreatitis

Pancreatitis due to repeated or massive pancreatic injury, marked by the formation of scar tissue, which leads to malfunction of the pancreas. The disease may be diagnosed with endoscopic procedures, with radiographic studies (e.g., x-rays of the abdomen showing pancreatic calcification), or with so-called tubeless tests that assess malabsorption caused by failure of the pancreas to release digestive enzymes into the gastrointestinal tract.

Symptoms

The pain may be mild or severe, tending to radiate to the back. Jaundice, weakness, emaciation, malabsorption of proteins and fats, and diarrhea are present.

drug-induced pancreatitis

Pancreatitis due to medications, such as antiretroviral agents used to treat HIV/AIDS.

gallstone pancreatitis

Pancreatitis caused by the obstruction of the ampulla of Vater by a biliary stone.

interstitial pancreatitis

Pancreatitis with overgrowth of interacinar and intra-acinar connective tissue.

perilobar pancreatitis

Fibrosis of the pancreas between acinous groups.

purulent pancreatitis

Pancreatitis with abscess formation. Synonym: suppurative pancreatitis

suppurative pancreatitis

Purulent pancreatitis.

tropical pancreatitis

Abbreviation: TP
Pancreatitis of unclear cause, found primarily in children in Northern Africa and Southeast Asia.

tropical pancreatitis

Abbreviation: TP
Pancreatitis of unclear cause, found primarily in children in Northern Africa and Southeast Asia.See also: pancreatitis

Triple-P positive parenting program

TP

A parental education program, devised in Australia and adopted in many other countries, to help parents intervene nonviolently when their child displays disruptive or hyperactive behavior.

Protein, Blood, Total and Fractions

Synonym/acronym: TP, SPEP (fractions include albumin, α₁-globulin, α₂-globulin, β-globulin, and γ-globulin).

Common use

To assess nutritional status related to various disease and conditions such as dehydration, burns, and malabsorption.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube.

Normal findings

(Method: Spectrophotometry for total protein, electrophoresis for protein fractions) Total Protein

Age	Conventional Units	SI Units (Conventional Units × 10)
Newborn–5 days	3.8–6.2 g/dL	38–62 g/L
1–3 yr	5.9–7 g/dL	59–70 g/L
4–6 yr	5.9–7.8 g/dL	59–78 g/L
7–9 yr	6.2–8.1 g/dL	62–81 g/L
10–19 yr	6.3–8.6 g/dL	63–86 g/L
Adult	6–8 g/dL	60–80 g/L

Values may be slightly decreased in older adults due to insufficient intake or the effects of medications and the presence of multiple chronic or acute diseases with or without muted symptoms. Protein Fractions

	Conventional Units	SI Units (Conventional Units × 10)
Albumin	3.4–4.8 g/dL	34–48 g/L
α₁-Globulin	0.2–0.4 g/dL	2–4 g/L
α₂-Globulin	0.4–0.8 g/dL	4–8 g/L
β-Globulin	0.5–1 g/dL	5–10 g/L
γ-Globulin	0.6–1.2 g/dL	6–12 g/L

Values may be slightly decreased in older adults due to insufficient intake or the effects of medications and the presence of multiple chronic or acute diseases with or without muted symptoms.

Description

Protein is essential to all physiological functions. Proteins consist of amino acids, the building blocks of blood and body tissues. Protein is also required for the regulation of metabolic processes, immunity, and proper water balance. Total protein includes albumin and globulins. Albumin, the protein present in the highest concentrations, is the main transport protein in the body. Albumin also significantly affects plasma oncotic pressure, which regulates the distribution of body fluid between blood vessels, tissues, and cells. α₁-Globulin includes α₁-antitrypsin, α₁-fetoprotein, α₁-acidglycoprotein, α₁-antichymotrypsin, inter-α₁-trypsin inhibitor, high-density lipoproteins, and group-specific component (vitamin D–binding protein). α₂-Globulin includes haptoglobin, ceruloplasmin, and α₂-macroglobulin. β-Globulin includes transferrin, hemopexin, very-low-density lipoproteins, low-density lipoproteins, β₂-microglobulin, fibrinogen, complement, and C-reactive protein. γ-Globulin includes immunoglobulin (Ig) G, IgA, IgM, IgD, and IgE. After an acute infection or trauma, levels of many of the liver-derived proteins increase, whereas albumin level decreases; these conditions may not reflect an abnormal total protein determination.

This procedure is contraindicated for

N/A

Indications

Evaluation of edema, as seen in patients with low total protein and low albumin levels
Evaluation of nutritional status

Potential diagnosis

Increased in

α₁-Globulin proteins in acute and chronic inflammatory diseases
α₂-Globulin proteins occasionally in diabetes, pancreatitis, and hemolysis
β-Globulin proteins in hyperlipoproteinemias and monoclonal gammopathies
γ-Globulin proteins in chronic liver diseases, chronic infections, autoimmune disorders, hepatitis, cirrhosis, and lymphoproliferative disorders
Total protein:
- Dehydration (related to hemoconcentration)
- Monoclonal and polyclonal gammopathies (related to excessive γ-globulin protein synthesis)
- Myeloma (related to excessive γ-globulin protein synthesis)
- Sarcoidosis (related to excessive γ-globulin protein synthesis)
- Some types of chronic liver disease
- Tropical diseases (e.g., leprosy) (related to inflammatory reaction)
- Waldenström’s macroglobulinemia (related to excessive γ-globulin protein synthesis)

Decreased in

₁

₂

Administration of IV fluids (related to hemodilution)
Burns (related to fluid retention, loss of albumin from chronic open burns)
Chronic alcoholism (related to insufficient dietary intake; diminished protein synthesis by damaged liver)
Chronic ulcerative colitis (related to poor intestinal absorption)
Cirrhosis (related to damaged liver, which cannot synthesize adequate amount of protein)
Crohn’s disease (related to poor intestinal absorption)
Glomerulonephritis (related to alteration in permeability that results in excessive loss by kidneys)
Heart failure (related to fluid retention)
Hyperthyroidism (possibly related to increased metabolism and corresponding protein synthesis)
Malabsorption (related to insufficient intestinal absorption)
Malnutrition (related to insufficient intake)
Neoplasms
Nephrotic syndrome (related to alteration in permeability that results in excessive loss by kidneys)
Pregnancy (related to fluid retention, dietary insufficiency, increased demands of growing fetus)
Prolonged immobilization (related to fluid retention)
Protein-losing enteropathies (related to excessive loss)
Severe skin disease
Starvation (related to insufficient intake)

Critical findings

N/A

Interfering factors

Drugs that may increase protein levels include amino acids (if given IV), anabolic steroids, angiotensin, anticonvulsants, corticosteroids, corticotropin, furosemide, insulin, isotretinoin, levonorgestrel, oral contraceptives, progesterone, radiographic agents, and thyroid agents.
Drugs and substances that may decrease protein levels include acetylsalicylic acid, arginine, benzene, carvedilol, citrates, floxuridine, laxatives, mercury compounds, oral contraceptives, pentastarch, phosgene, pyrazinamide, rifampin, trimethadione, and valproic acid.
Values are significantly lower (5% to 10%) in recumbent patients.
Hemolysis can falsely elevate results.
Venous stasis can falsely elevate results; the tourniquet should not be left on the arm for longer than 60 sec.

Nursing Implications and Procedure

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
Patient Teaching: Inform the patient this test can assist in assessing nutritional status related to disease process.
Obtain a history of the patient’s complaints, including a list of known allergens especially allergies or sensitivities to latex.
Obtain a history of the patient’s gastrointestinal, hepatobiliary, and immune systems; symptoms; and results of previously performed laboratory tests and diagnostic and surgical procedures.
Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

Potential complications: N/A
Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
Nutritional Considerations: Educate the patient, as appropriate, that good dietary sources of complete protein (containing all eight essential amino acids) include meat, fish, eggs, and dairy products and that good sources of incomplete protein (lacking one or more of the eight essential amino acids) include grains, nuts, legumes, vegetables, and seeds.
Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

Related tests include albumin, ALP, ACE, anion gap, AST, biopsy liver, biopsy lung, calcium, carbon dioxide, chloride, CBC WBC count and differential, cryoglobulin, fecal analysis, fecal fat, gallium scan, GGT, IgA, IgG, IgM, IFE, liver and spleen scan, magnesium, mediastinoscopy,β ₂-microglobulin, osmolality, protein urine total and fractions, PFT, radiography bone, RF, sodium, TSH, thyroxine, and UA.
Refer to the Gastrointestinal, Hepatobiliary, and Immune systems tables at the end of the book for related tests by body system.

tp

tp

TP

TP

pancreatitis

acute pancreatitis

Etiology

Treatment

CAUTION!

Prognosis

Patient care

alcoholic pancreatitis

autoimmune pancreatitis

autoimmune-related pancreatitis

centrilobar pancreatitis

chronic pancreatitis

Symptoms

drug-induced pancreatitis

gallstone pancreatitis

interstitial pancreatitis

perilobar pancreatitis

purulent pancreatitis

suppurative pancreatitis

tropical pancreatitis

tropical pancreatitis

Triple-P positive parenting program

TP

Protein, Blood, Total and Fractions

Common use

Specimen

Normal findings

Description

This procedure is contraindicated for

Indications

Potential diagnosis

Increased in

Decreased in

Critical findings

Interfering factors

Nursing Implications and Procedure

Pretest

Intratest

Post-Test

Related Monographs

TP

TP

TP

TP