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N324 > Ch. 54 Patients w/ Problems in Biliary System and Pancreas > Flashcards

Ch. 54 Patients w/ Problems in Biliary System and Pancreas Flashcards

1
Q

Biliary System Functions

A

Promotes food digestion in stomach and small intestine

Impairment in biliary system impairs digestion leading to inadequate nutrition

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2
Q

Biliary System Causes of Inflammation & Obstruction

A

Gall stones

Edema (vessel, organ, vascular)

Strictures

Tumors

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3
Q

Acute Cholecystitis

A

Chemical irritation and inflammation from gallstones and calculi that obstructs the cystic duct, gallbladder neck, or common bile duct

Edema in the gallbladder and pericholecystic fluid

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4
Q

Cholelithiasis

A

Gall stones/calculi

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5
Q

Choledocolithiasis

A

Common bile duct problem or stone

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6
Q

Cholecystitis

A

Gallbladder infection or inflammation

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7
Q

Acute Cholecystitis Rick Factors or Co-Morbidities

A

Female, Obesity, Estrogen, Age

Crohn’s, Gastric bypass, SCD, DM, pregnancy

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8
Q

Gall Stones

A

Cholesterol calculi/cholesterol stones (bile salts, cholesterol metabolism, calcium, protein)

Mixed w/ mucous and viscous bile builds gall stones

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9
Q

Gall Stones Causes

A

Obesity
Genetics
High Cholesterol
60-70% American Indians
Pregnancy & HRT decreasing bile emptying

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10
Q

The 4 F’s in Gall Stone Causes

A

Female
Fat
Forty
Fertile

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11
Q

Cholecystitis Physical Assessment

A

Abdominal pain (RUQ)
Atypical s/s w/ diabetics and age-related
Rebound tenderness
Jaundice, dark urine, icterus, steatorrhea (late)
Inflammation: fever, tachycardia, dehydration (late)

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12
Q

Cholecystitis Clinical Manifestations

A

Episodic or vague upper abd pain or discomfort that can radiate to right shoulder (RUQ)

Pain triggered by high-fat or high-volume meal

Dyspepsia, Eructation
Flactulence, Steatorrhea, N/V

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13
Q

Acute Cholecystitis Lab

A

WBC > 10K
Elevated AST/LDH
Elevated bilirubin
Elevated amylase/lipase

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14
Q

Acute Cholecystitis Diagnostic

A

Abdominal XR
US (most reliable)
HIDA scan
ERCP, MRI

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15
Q

Acute Cholecystitis Interventions

A

Managing acute pain (opioids, NSAIDs)

Hydration or IV fluids, pain meds, NSAIDs, antiemetics, ABX, lithotripsy (ultrasonic waves to break stones)

Monitor for infection or peritonitis

Lap Chloe - removal of GB

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16
Q

Gallbladder (GB) Motility Issues

A

Lead to stone formation by delaying bile emptying and causes biliary stasis

Twist or kinking of gallbladder neck or cystic duct

17
Q

Inflamed Gallbladder Complications

A

Sepsis
Severe trauma or burns
Long-term total parenteral nutrition (TPN)
MODS
Major abdominal surgery
Hypovolemia

18
Q

Acute Cholecystitis Pt Education

A

Promoting nutrition - high fiber, low fat diet

Prevention

Diet controlled w/ GB attacks

19
Q

Chronic Cholecystitis

A

Recurrent episodes of cystic duct obstruction caused by chronic inflammation

Calculi present

GB becomes weak, fibrotic atrophy, decreased motility, deficient absorption

20
Q

Chronic Cholecystitis Causes

A

Diet low in fat, vegetarian diet

Pancreatitis or Cholangitis

Back up bile = obstruction & jaundice

21
Q

Acute Pancreatitis

A

An inflammatory process due to activated pancreatic enzymes auto digesting the pancreas

22
Q

Acute Pancreatitis Risk Factors/Causes

A

Alcohol abuse/smoking
Gall stones
Obstructive pancreatitis
Kidney failure
Trauma
Cholecystitis

23
Q

Acute Pancreatitis Physical Assessment

A

Sudden onset of severe abdomen pain

Epigastric pain

Abdominal assessment - jaundice, decreased BT, palpation/rigid abdomen, N/V, wt loss

Respiratory and cardiac assessment - shock, sepsis, fever, VS trends (late)

24
Q

Acute Pancreatitis Labs

A

Increased amylase, lipase, trypsin, elastase

Increased glucose, bilirubin, ALT, AST

Increased WBC, CRP

Increased BUN, triglycerides

Decreased Ca, Mg

Decreased platelets

Decreased albumin

25
Q

Complications of Acute Pancreatitis

A

Type 1 DM
Pancreatic infection
Hypovolemic shock
Multi-organ system failure
DIC
Atelectasis
Pneumonia

26
Q

Acute Pancreatitis Interventions

A

Pain management

Decrease inflammation

Nutrition therapy

NPO, no food until pain free; then bland, high protein, low fat

Position of comfort

NG tube - enteral or TPN

IV fluids, electrolyte replacement therapy

27
Q

Acute Pancreatitis Drug Therapy

A

Opioid medication - Morphine or Hydromorphone

Ketorolac (Toreador) - NSAID

PPI, H2 receptors

Pancreatic enzymes - Pancrelipase

ABX

Calcium or Magnesium Replacement

28
Q

Chronic Pancreatitis

A

Progressive, destructive disease of the pancreas that has remissions and exacerbations “flare-ups”

Inflammation w/ tissue fibrosis

Pancreatic insufficiency

29
Q

Chronic Pancreatitis Clinical Manifestations

A

Intense abd pain - continuous and burning or gnawing

Ascites

Abdominal tenderness

Possible LUQ mass

Steatorrhea

Jaundice

30
Q

Chronic Pancreatitis Interventions

A

Drug therapy - same as acute

Long-term dietary management

Calories up to 4000/day to maintain wt.

Foods high in carbs/protein

Avoid high fat foods

No alcohol

31
Q

Chronic Pancreatitis Pt Education

A

Discharge and follow up planning

No cure, prevention/symptom focused

Avoid: caffeine, alcohol, nicotine

Eat bland, small meals

32
Q

Pancreatic Cancer

A

Vague manifestations and diagnosed in late stages after liver or gallbladder involvement - 5 yr survival rate

Palliative Interventions - pain management and decreasing symptoms

Rapid growing tumor w/ rapid metastasis to lymph and vascular systems

Spreads to lung, breast, thyroid, kidney, and skin

33
Q

Pancreatic Cancer Risk Factors

A

Age, smoking, genetic, family hx, processed red meat diet

High risk - DM, cirrhosis, chronic pancreatitis

34
Q

Pancreatic Cancer Clinical Manifestations

A

Asymptomatic (early)
Abdominal pain (late)
Clay stools, GI bleed
Jaundice
Weakness and wt loss (late)

35
Q

Pancreatic Cancer Labs

A

No direct labs
Increase LFT, amylase, lipase, Alk phos, bilirubin

N324 (18 decks)

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