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Med surge 2 Final > Biliary/Pancreatic > Flashcards

Biliary/Pancreatic Flashcards

(89 cards)

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1
Q

Where is the gallbladder located?

A

Behind the liver in the right upper quadrant (RUQ)

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2
Q

What is the function of the gallbladder?

A

To store and release bile through the common bile duct into the small intestine to help break down fat.

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3
Q

What is bile and where is it made

A

A digestive fluid made by the liver and stored in the gallbladder to help break down fat.

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4
Q

What does bile contain?

A

Bile salts

Bilirubin (RBC waste)

Cholesterol

Water

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5
Q

What happens if the gallbladder isn’t working properly

A

Fat digestion is impaired due to reduced bile flow.

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6
Q

What is cholecystitis

A

Inflammation of the gallbladder, often caused by gallstones (cholelithiasis) blocking the common bile duct

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7
Q

What is cholelithiasis

A

The formation of gallstones, which are hard deposits made from bile

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8
Q

What is calculous cholecystitis

A

Cholecystitis with gallstones

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9
Q

What is acalculous cholecystitis

A

Cholecystitis without gallstones

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10
Q

When is gallbladder removal considered

A

If a patient has repeated gallstone flare-ups, the gallbladder may need to be surgically removed

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11
Q

What are cholesterol stones caused by?

A

High-fat diets leading to cholesterol buildup in bile

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12
Q

What are pigmented stones caused by

A

Bilirubin buildup, often from bile duct obstruction

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13
Q

What are mixed stones?

A

Gallstones formed from both cholesterol and bilirubin buildup.

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14
Q

What are the risk factors for Cholecystitis (5 F’s)

A

Female
Fat
Fare
Over Forty
Fertile

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15
Q

What are the signs and symptoms of cholecystitis?

A

Positive Murphy’s sign

Jaundice/ Dark-colored urine

Tachycardia/Fever/Chills

RUQ pain (may radiate to right shoulder/back)

Rebound tenderness/ Abdominal guarding

Steatorrhea/Clay-colored stools

Pain after eating fatty meals or at night

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16
Q

What is a positive Murphy’s sign?

A

Pain in the right upper quadrant (RUQ) during deep inspiration while the examiner palpates — indicates gallbladder inflammation.

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17
Q

What causes jaundice and dark-colored urine in cholecystitis?

A

Buildup of bilirubin due to bile duct blockage.

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18
Q

Why do tachycardia, fever, and chills occur in cholecystitis?

A

From the inflammation

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19
Q

Why must an MI (heart attack) be ruled out in cholecystitis?

A

Because symptoms can mimic an MI, especially chest and upper abdominal and epigastric pain.

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20
Q

Where is the pain located in cholecystitis?

A

RUQ pain that may radiate to the right shoulder or back.

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21
Q

What causes steatorrhea or clay-colored stools in cholecystitis?

A

Blocked bile flow leads to poor fat digestion and lack of bile pigment in stool.

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22
Q

Why does pain occur after a fatty meal or at night?

A

Because the body can’t break down fat

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23
Q

What imaging tests are used to diagnose cholecystitis?

A

Abdominal X-ray/Ultrasound

CT scan

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24
Q

What is the purpose of ERCP in cholecystitis?

A

To visualize and access the gallbladder, bile ducts, and pancreas; can be used to remove or break up gallstones.

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25
How does the ERCP scope travel through the body?
Mouth → Esophagus → Stomach → Duodenum → Bile ducts
26
Why might a patient with cholecystitis be hypokalemic?
Due to vomiting or NGT suction.
27
What causes elevated BUN/Creatinine in cholecystitis?
Dehydration and poor intake (not eating)
28
What lab change can dehydration cause besides BUN/Cr?
Hemoconcentration → elevated hematocrit.
29
What liver function tests (LFTs) are elevated in cholecystitis?
Bilirubin ALT AST
30
Why is WBC elevated in cholecystitis?
Due to inflammation.
31
What type of suction should the patient be on?
Low intermittent suction
32
What supportive care is given early on?
IV fluids and NPO status.
33
Why are bile acid reducers given
To help break up gallstones
34
What position should the patient be in? The chronic pancreatitis.
Semi-Fowler’s — never lay flat (prevents abdominal pressure)
35
What medication is used to dissolve cholesterol stones?
Ursodiol (Actigall) — reduces number and size of
36
What type of stones does Ursodiol (Actigall) work best on?
cholesterol stones.
37
What other medications are used in cholecystitis treatment
NSAIDs or narcotics for pain Antibiotics for infection
38
What is lithotripsy used for
To break up small gallstones
39
What is a laparoscopic cholecystectomy
Minimally invasive gallbladder removal using small (½ inch) abdominal incisions.
40
When might a laparoscopic procedure become open surgery?
If there’s a perforation or complication
41
What is the purpose of a T-tube or biliary drain post-op?
To monitor bile drainage and prevent buildup of ALT, AST, and bilirubin.
42
How much bile drainage is normal in the first 24 hours?
Less than 500 mL
43
How long is the T-tube or drain typically in place?
About 2 weeks.
44
When should a biliary drain be emptied or changed?
When it is 2/3 full.
45
What diet changes should the patient make post-op?
Avoid high saturated fat and alcohol Eat small, frequent meals
46
When can the patient return to regular activity after laparoscopic cholecystectomy?
In about 1 week
47
What are the two main functions of the pancreas?
Endocrine: Secretes insulin and glucagon (blood sugar regulation) Exocrine: Releases enzymes (lipase, amylase, protease) to digest food
48
Why do people with acute pancreatitis become hyperglycemic?
Inflammation prevents the pancreas from delivering insulin to cells → glucose stays in blood.
49
What enzymes does the pancreas produce and what do they do?
Lipase: Digests fat Protease: Digests protein Amylase: Digests carbohydrates
50
Define acute pancreatitis.
Reversible inflammation of the pancreas caused by early activation of digestive enzymes that autodigest the pancreas.
51
What causes the enzymes to attack the pancreas in pancreatitis?
Enzymes are activated early and become trapped (often by duct obstruction), so they start digesting pancreatic tissue.
52
What is the most common cause of acute pancreatitis?
Alcohol abuse (responsible for about 1/3 of cases)
53
Why do symptoms of alcohol-related pancreatitis take time to appear?
Alcohol slowly inflames the pancreas and makes pancreatic juices thicker, leading to duct obstruction over hours to days.
54
Where is the pain located in acute pancreatitis and what worsens it?
LUQ or epigastric pain Radiates to the back Worse after eating fatty meals or lying down
55
What GI symptoms are common in acute pancreatitis?
Abdominal fullness Bloating Hiccups Indigestion
56
Why does hypotension occur in acute pancreatitis?
Leaking enzymes cause third spacing (ascites), pulling fluid out of blood vessels → dehydration and low BP.
57
Why does hypocalcemia occur and what are the signs?
Fatty acids bind calcium → calcium trapped in fat → ↓ calcium in blood Signs: Chvostek, Trousseau, numbness/tingling, muscle cramps/spasms
58
Why does pancreatitis cause hyperglycemia?
A: Pancreas is damaged → can’t release enough insulin → glucose builds up in blood
59
What changes in vitals may be seen in acute pancreatitis?
Tachycardia Tachypnea Fever
60
What causes steatorrhea and clay-colored stool in acute pancreatitis?
Steatorrhea = undigested fat in stool Clay-colored stool = blocked bile flow
61
What indicates a retroperitoneal bleed in pancreatitis?
Cullen sign: Bruising around umbilicus Turner sign: Bruising around flanks
62
What lab values are elevated in acute pancreatitis?
Elevated LFTs: ALT, AST, bilirubin Elevated amylase, lipase, protease Increased aPTT/PT: liver can't make clotting factors Increased WBC: due to inflammation
63
What is necrotizing pancreatitis? Onset/Diagnostic Testing/Complications
A complication of acute pancreatitis where Pancreatic enzymes destroy tissue Leads to hemorrhage, inflammation, tissue damage Onset ~1 week after acute attack Diagnosed via CT scan (air/gas in pancreas) Can cause sepsis, shock, MODS
64
What are other complications of acute pancreatitis?
ARDS: fluid fills alveoli, impairs breathing Peritonitis: inflammation spreads to abdominal lining
65
What are key nursing interventions for acute pancreatitis?
NPO: prevent enzyme release IV fluids: for hydration NGT if needed Position: Fetal or semi-Fowler’s Monitor blood glucose Pain meds (avoid morphine – causes spasms)
66
What do antispasmodics do in pancreatitis?
Help reduce muscle spasms and support calcium balance (helpful in hypocalcemia).
67
What is the purpose of anticholinergics in acute pancreatitis?
Decrease pancreatic secretions, helping reduce enzyme activity and inflammation.
68
What do H2 blockers do, and how can you recognize them?
End in “-dine” (e.g., ranitidine, famotidine) Decrease gastric secretions Help prevent flare-ups by blocking histamine response
69
Why are antibiotics used in acute pancreatitis?
To treat or prevent infections, the #1 cause of death in acute pancreatitis.
70
What’s important to know about pancreatic enzymes like Creon?
More common in chronic pancreatitis Take before eating Do not chew (they’re enteric-coated) Aid in digestion and prevent enzyme overstimulation
71
What diet is recommended when NPO status is lifted?
Small, frequent meals Low in sugar, fat, and protein Helps reduce pain and inflammation
72
What is chronic pancreatitis?
Irreversible inflammation and damage to the pancreas from long-term autodigestion, causing scarring and enzyme imbalance.
73
What causes enzyme imbalance in chronic pancreatitis?
Scarring from prolonged auto digestion prevents the pancreas from making digestive enzymes.
74
Common risk factor for chronic pancreatitis?
Long-term alcohol use (especially in men ages 30–40).
75
Symptoms of chronic pancreatitis?
LUQ pain (radiating to the back), nausea, vomiting, steatorrhea, diarrhea, clay-colored stools, weight loss, and feeling worse after eating.
76
Why do patients with chronic pancreatitis have weight loss and malnutrition?
They can’t digest food properly due to lack of pancreatic enzymes.
77
Diagnostic tests for chronic pancreatitis?
CT, ultrasound, ERCP (to see structural or obstructive damage), and labs (glucose, amylase, lipase).
78
Are pancreatic enzymes elevated or decreased in chronic pancreatitis?
Elevated initially due to inflammation, but eventually decrease as pancreas loses function.
79
Why is blood sugar high in chronic pancreatitis?
The pancreas can't make insulin, so sugar stays in the blood. (Hyperglycemic)
80
Long-term medications for chronic pancreatitis?
Pancreatic enzymes (Creon), insulin, PPIs or H2 blockers, pain meds, electrolyte replacemen
81
How should pancreatic enzymes (Creon) be taken?
Take before eating, do not chew (they are enteric-coated).
82
What is the Puestow procedure?
A palliative surgery that opens the pancreatic duct and redirects enzymes to reduce pain—not a cure.
83
What type of surgery might be considered for severe cases?
Resection of the head of the pancreas (only in certain patients due to risks).
84
Patient education for chronic pancreatitis?
Avoid GI-irritating foods (fatty, spicy, caffeine, alcohol). Stick to a low-fat, small, frequent meal plan
85
What can long-standing diverticulitis lead to that resembles cancer?
Strictures may develop over time and can look like cancer, so a biopsy is needed to rule out malignancy.
86
What is often the first sign of diverticulitis-related infection in older adults?
Confusion, not fever, may be the first sign of infection in elderly patients.
87
What is the first-line broad-spectrum antibiotic used for diverticulitis?
Flagyl (metronidazole) – most commonly used.
88
What are other antibiotics used for diverticulitis besides Flagyl?
Sulfa drugs and Ciprofloxacin (Cipro).
89
Why are probiotics given during or after antibiotic treatment for diverticulitis?
To restore gut flora and prevent antibiotic-associated diarrhea or yeast overgrowth.

Med surge 2 Final (8 decks)

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