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MS > BILIARY DISORDERS > Flashcards

BILIARY DISORDERS Flashcards

1
Q
  • inflammation of the gallbladder which can be __ or __
A

Cholecystitis
acute or chronic.

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2
Q

___ is the cause of more than 90% of cases of ____

A

Calculous cholecystitis (gall stones)
acute cholecystitis.

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3
Q

___ describes acute gallbladder inflammation in the absence of obstruction by _____.

A
  • Acalculous cholecystitis
    gallstones
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4
Q
  • _____ of the gallbladder develops if the gallbladder becomes filled with purulent fluid.
A

empyema

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5
Q

CALCULOUS CHOLECYSTITIS

  • a gallbladder stone ___ bile outflow.
  • ___ of bile occurs in approximately 50% of cases.
  • The organisms involved are generally enteric and include ,,_
A

obstructs

Secondary infection

Escherichia coli, Klebsiella species, and
Streptococcus.

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6
Q
  • acute gallbladder inflammation in the absence of obstruction by gallstones.
A

ACALCULOUS CHOLECYSTITIS

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7
Q
  • hard deposits (gallstones, calculi) that may form in the gallbladder.
  • gallstones usually form from the solid constituents of bile.
A

CHOLELITHIASIS

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8
Q

(____ in color)
- Caused by conditions that produces __
- The risk is increased in patients with cirrhosis, hemolysis, and infections of the biliary tract.
- cannot be dissolved and must be removed ___.

A
  1. Pigment stones

dark brown or black
too much bilirubin
surgically

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9
Q

(_____ in color)
– caused by ___. (decreased bile acid synthesis and increased cholesterol synthesis in the liver
- resulting in bile supersaturated with cholesterol, which precipitates out of the bile to form stones.

A
  1. Cholesterol stones

yellow-green
imbalances bile composition

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10
Q

RISK FACTORS OF CHOLELITHIASIS:

  • ____ (leads to rapid development of gallstones and high risk of symptomatic disease)
  • Treatment with high-dose estrogen (eg, in prostate cancer)
  • ___ – a small increase in the risk of gallstones
  • Ileal resection or disease
  • Cystic fibrosis
  • Diabetes mellitus
A

Rapid weight loss

Low-dose estrogen therapy

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11
Q

Clinical Manifestations

  1. Pain and Biliary Colic
    - excruciating ___ pain that radiates to the ___ or ___
    - usually associated with nausea and vomiting.
    - noticeable several hours after a heavy meal.
    - In some patients, the pain is ___ rather than colicky
  2. ____
    - frequently accompanied by marked pruritus of the skin.
  3. Changes in Urine and Stool Color
    – ______ urine (bile excretion by the kidney) and
    - _____ feces (absence of bile)
  4. Vitamin Deficiency
    - vitamins _____ deficiency. No absorption.
A

RUQ
back or right shoulder.

constant

Jaundice

dark-colored urine

grayish or clay-colored feces

A, D, E, and K

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12
Q
  • the diagnostic procedure of choice because it is rapid and accurate with 90% accuracy.
  • most accurate if the patient fasts overnight so that the gallbladder is distended
A

Ultrasonography

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13
Q

____

  • used successfully in the diagnosis of acute cholecystitis or blockage of a bile duct.

a radioactive agent is administered IV which is taken up by the ___ and excreted rapidly through the biliary tract.

  • The biliary tract is then scanned, and images of the gallbladder and biliary tract are obtained.
  • often used when ultrasonography is not conclusive, such as in ____.
A

Radionuclide Imaging or Cholescintigraphy

hepatocytes

acalculous cholecystitis

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14
Q
  • used if ultrasound equipment is not available or if the ultrasound results are inconclusive.
  • an iodine-containing contrast agent that is excreted by the liver and concentrated in the gallbladder is given 10 to 12 hours before the x-ray study.
  • If gallstones are present, they appear as ___ on the x-ray image.
A

Oral Cholecystography

shadows

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15
Q

– permits direct visualization of structures.

  • examines the hepatobiliary system via a side-viewing flexible fiberoptic endoscope inserted through the esophagus to the descending duodenum.
  • __ & ___ are used during ERCP to evaluate the presence and location of ductal stones.
  • The patient is ___ for several hours before the procedure.
  • Moderate is used.
  • During ERCP, the nurse monitors ___, administers medications, and positions the patient.
  • After the procedure, the nurse monitors the patient’s condition, observing vital signs and assessing for signs of ____
A

Endoscopic Retrograde Cholangiopancreatography

Fluoroscopy and multiple x-rays

NPO

Sedation

IV fluids

perforation or infection.

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16
Q
  • involves the injection of dye directly into the biliary tract.
  • reserved for patients whom an _____ due to previous surgery.
  • The fluoroscopy table is tilted and the patient is repositioned to allow x-rays to be taken in multiple projections.
  • It is useful for:
    1. distinguishing jaundice caused by liver disease (____) from that caused by
    biliary obstruction,
    2. investigating the GI symptoms of a patient whose gallbladder has been removed,
    3. locating stones within the bile ducts, and
    4. diagnosing cancer involving the biliary system.
A

Percutaneous Transhepatic Cholangiography (PTC)

ERCP may be unsafe

hepatocellular jaundice

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17
Q

Pharmacologic Therapy

  • acts by inhibiting the synthesis and secretion of cholesterol.
  • can reduce the size of existing stones, dissolve small stones, and prevent new stones from forming.
  • ____ of therapy is required in many patients to dissolve stones.
A
  • Ursodeoxycholic acid (ursodiol) and chenodeoxycholic acid (chenodiol)

Six to 12 months

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18
Q

Nonsurgical Removal of Gallstones

  • infusion of a __ into the gallbladder.
  • used for patients who may not be candidates for __
A

Dissolving Gallstones

solvent (mono-octanoin or methyl tertiary butyl ether [MTBE])

laparoscopic cholecystectomy.

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19
Q

____

  • a catheter and instrument with a basket attached are threaded through the T-tube tract or fistula formed at the time of T-tube insertion.
  • the __ is used to retrieve and remove the stones lodged in the common bile duct.
A

Stone Removal by Instrumentation

basket

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20
Q

___

  • Stones are fragmented by means of laser pulse technology.
  • A ___ is directed under fluoroscopic guidance with the use of devices that can distinguish between stones and tissue.
  • The laser pulse produces rapid expansion and disintegration of plasma on the stone surface, resulting in a __
  • used percutaneously with a basket or balloon catheter system or by direct visualization through an ___.
A

Intracorporeal Lithotripsy

laser pulse

mechanical shock wave.

endoscope

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21
Q

Surgical Management

a. Preoperative Measures

  • __ may be given if the prothrombin level is low.
  • Provide IV glucose with protein supplements to __
A

Vitamin K

aid wound healing.

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22
Q
  • __ nonsurgical fragmentation of gallstones.
  • uses repeated shock waves directed at the gallstones in the gallbladder or common bile duct to fragment the stones.
  • The waves are transmitted to the body through a fluid-filled bag or by immersing the patient in a water bath.
A

Extracorporeal Shock Wave Lithotripsy (lithotripsy or ESWL)

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23
Q
  • __ is the standard of therapy for symptomatic gallstones.
A

Laparoscopic Cholecystectomy

24
Q

-___ the gallbladder is removed through an abdominal incision.

  • performed for __ & __ .
  • In some patients, a drain is placed close to the gallbladder bed and brought out through a puncture wound if there is a bile leak.
  • only a small amount of __ drains in the initial 24 hours after surgery; afterward, the drain is removed.
  • The drain is maintained if there is excess oozing or bile leakage.
A

Cholecystectomy

acute and chronic cholecystitis

serosanguinous fluid

25
Q
  • a surgical procedure in which the gallbladder is removed through a small abdominal incision.
  • Drains may or may not be used.
A

Small-Incision Cholecystectomy

26
Q

-__ reserved for the patient with acute cholecystitis who may be too ill to undergo a surgical procedure.

  • Involves making an incision in the __
  • a tube is usually inserted into the duct for drainage of bile until edema subsides.
  • A __ is planned for a future date after acute inflammation has resolved.
A

Choledochostomy

common duct.

laparoscopic cholecystectomy

27
Q
  • performed when the patient’s condition precludes more extensive surgery or when an acute inflammatory reaction is severe.
A

Cholecystostomy

28
Q

-__ The gallbladder is surgically opened, stones and the bile or the purulent drainage are removed, and a drainage tube is secured with a purse-string suture.

  • __ Under local anesthesia, a fine needle is inserted through the abdominal wall and liver edge into the gallbladder under the guidance of ultrasound or computed tomography (CT).
A

Surgical

Percutaneous

29
Q

Acute pain and discomfort related to surgical incision - NI

A

Relieving Pain

30
Q
  • sudden inflammation of the pancreas.
  • There are two main types:

(1)mild ()
(2)severe ()

A

ACUTE PANCREATITIS

interstitial edematous pancreatitis
acute hemorrhagic pancreatitis

31
Q
  • affects the majority of patients.
  • Characterized by a lack of pancreatic or peripancreatic parenchymal necrosis with diffuse enlargement of the gland due to inflammatory edema.
  • The edema and inflammation is confined to the pancreas itself.
  • return to normal function usually occurs within __.
A

Interstitial pancreatitis

6 months

32
Q
  • presence of tissue necrosis in either the pancreatic parenchyma or in the tissue surrounding the gland.
  • Enzymes damage the local blood vessels, and bleeding and thrombosis can occur.
  • Local complications include __ or __ and acute fluid collections in or near the pancreas.
  • Also, patients who develop systemic complications with organ failure, such as pulmonary insufficiency with hypoxia, shock, kidney disease, and GI bleeding are categorized as ___.
A

acute hemorrhagic pancreatitis

pancreatic cysts or abscesses

severe

33
Q
  • by its own proteolytic enzymes, principally trypsin, causes acute pancreatitis.
A

Self-digestion of the pancreas

34
Q

Pain is frequently acute in onset, occurring ____ (unrelieved by __)

A

24 to 48 hours after a very heavy meal or alcohol ingestion

antacids

35
Q

ASSESSMENT AND DIAGNOSTIC FINDINGS
* __‘& __ (elevated within 24 hours of the onset of the symptoms).

A

Serum amylase and lipase levels

36
Q
  • to establish pancreatic drainage; or to resect or débride an infected, necrotic pancreas.
A

Diagnostic laparotomy

37
Q

Postacute Management
- oral feedings that are low in __ and ___
- __ and ___ are eliminated from the diet.
- Follow-up may include __, __, __ to determine whether the pancreatitis
is resolving

A

fat and protein

Caffeine and alcohol

ultrasound, x-ray studies, or ERCP

38
Q

6 MEDICAL MANAGEMENT OF PANCREATITIS

A
  1. Pain Management
  2. Intensive Care
  3. Respiratory Care
  4. Biliary Drainage
  5. Surgical Intervention
  6. Postacute Management
39
Q
  • an inflammatory disorder characterized by progressive destruction of the pancreas.
  • cells are replaced by fibrous tissue with repeated attacks of pancreatitis
  • Increased pressure within the pancreas causes obstruction of the pancreatic and common bile ducts and the duodenum.
  • Also, there is ___ of the epithelium of the ducts, inflammation, and destruction of the secreting cells of the pancreas.
A

Chronic Pancreatitis

atrophy

40
Q
  • __ and __ are the major causes of chronic pancreatitis.
  • Long-term alcohol consumption causes hypersecretion of ___ in pancreatic secretions,
    resulting in protein plugs and calculi within the pancreatic ducts.
A
  • Alcohol consumption and malnutrition

protein

41
Q

most useful study in the diagnosis of chronic pancreatitis

A

ERCP

42
Q
  • evaluates pancreatic islet cell function.
A

Glucose tolerance test

43
Q
  • ___collections of fluid walled off by fibrous tissue (___)
  • result of the local necrosis that occurs because of ___
A

PANCREATIC CYSTS
pancreatic pseudocysts

acute pancreatitis

44
Q
  • are amylase-rich fluid collections that occur within 4 to 6 weeks after an episode of acute pancreatitis.
  • ___ into the GI tract or through the skin and abdominal wall may be established.
A
  • Pseudocysts

Drainage

45
Q

CLINICAL MANIFESTATIONS of PANCREATIC CYSTS
* Same as _____

A

acute pancreatitis

46
Q
  • Diagnosis of pancreatic cysts and pseudocysts is made by
A

ultrasound, CT scan, and ERCP

47
Q

overproduction of insulin by the pancreatic islets.

The findings at the time of surgery or at autopsy may indicate ___

All of the symptoms that accompany spontaneous hypoglycemia are relieved by the __ or __

Surgical removal of the __ or __ from the pancreas is the only successful method
of treatment

A

HYPERINSULINISM

hyperplasia of the islets of Langerhans.

oral or parenteral administration of glucose.

hyperplastic or neoplastic tissue

48
Q
  • performed through a small incision or puncture made through the abdominal wall at the umbilicus
  • __ attached to the laparoscope permits the surgeon to view the intra abdominal field on a television monitor
  • The __ is dissected free and clipped.
  • The abdominal cavity is insufflated with carbon dioxide (___).
  • The __ is separated from the hepatic bed and removed from the abdominal cavity after bile and small stones are aspirated.
  • With the laparoscopic procedure, the patient does not experience __.
  • The patient is often discharged from the hospital on the same day of surgery or within 1 or 2 days.
A

Laparoscopic cholecystectomy

Camera

cystic artery

(pneumoperitoneum)

fiberoptic

paralytic ileus

49
Q
  • The most serious complication after laparoscopic cholecystectomy is a
A

bile duct injury

50
Q

Impaired gas exchange related to the high abdominal
surgical incision- ni

A

Improving Respiratory Status

51
Q

Impaired skin integrity related to altered biliary
drainage after surgical intervention -

A

Maintaining Skin Integrity And Promoting Biliary Drainage

52
Q

Imbalanced nutrition, less than body requirements,
related to inadequate bile secretion -

A

Improving Nutritional Status

53
Q

Monitoring And Managing Potential Complications

Ni

A

(Bleeding, Gi Symptoms, Infection)

54
Q
  • enter the common bile duct and lodge at the ampulla of Vater, obstructing the flow of pancreatic juice.
A

gallstones

55
Q
  • from the common bile duct into the pancreatic duct activates the powerful enzymes within the pancreas
A

Reflux of bile

56
Q

can lead to vasodilation, increased vascular permeability, necrosis, erosion, and hemorrhage.

A
  • Activation of the enzymes

MS (8 decks)

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