Chapter 59 Flashcards
Risk for Cholecystitis
Fat fertile fourth female Familial or genetic tendency Obesity T2DM Dyslipidemia Insulin resistance Age Female Crohns Rapid wt loss American Indian Mexican American Increased cholesterol Hormone replacement therapy Cholesterol lowering drugs Prolonged TPN Gastric bypass Sickle cell Pregnant Diet- high fat, high calories, low fiber, high white carbs
Physical assessment Cholecystitis
Flatulence Dyspepsia Eructation Anorexia N/V Upper abd pain Feeling full Rebound tenderness (Blumbergs sign) Fever Jaundice Clay color stools Dark urine Steatorrhea Pruritis
Diagnostic Cholecystitis
Increased WBC Elevated alkaline phosphatase, AST, LDH Serum bilirubin elevated Increased glucose Xray to see gallstones US of RUQ is best initial diagnostic HIDA scan ERCP MRCP MRI with contrast
Nonsurgical management
Avoid fatty foods IV therapy for hydration Opioids- morphine or dilaudid Toradol for mild pain antiemetic IV ABT Oral bile acid dissolution- Actigall- dissolves stones- US for first 6 months- report D/V and sever abd pain- take with food or milk Lithotripsy or biliary cath
Surgical management Cholecystitis
Laparoscopic Cholecystectomy- “gold standard”, not common complications, low death rate, rare injuries, recovery is quicker, postop pain less severe- assess oxygen and educate on deep breathing exercises
NOTES- remove gallbladder through vagina
Risk acute pancreatitis
Biliary tract disease Trauma Pancreatic obstruction Metabolic disturbance Renal disturbance Hereditary Ulcers Viral infections Alcohol Drug toxicity Cigarette smoking Cystic fibrosis Gallstones Abd surgery
Physical assessment acute pancreatitis
Diagnosed with severe abdominal pain in mid epigastric or LUQ
Sudden onsets and radiates to back, left flank, left shoulder
Fetal position
Jaundice
Blue discoloration on abdomen and periumbilical area(Cullen’s sign)
Blue discoloration of flank(Turner Gray Syndrome)
Bowel sounds
Laboratory/ Imaging assessment
Increased amylase, lipase, trypsin, elastase, glucose, bilirubin, ALT, AST, leukocytes, BUN Decreased calcium and magnesium, albumin Amylase increases within 12-24 hours Calcium may be decreased for 7-10 days, poor prognosis < 8 US most sensitive CT with contrast Xray for gallstones ERCP for pancreatic stones
Interventions acute pancreatitis
Decrease inflammation Treat complications ABCs Pain management Hydration- isotonic Fasting and rest-NPO NG for more severe patients Morphine Histamine receptor antagonists- Zantac Proton pump inhibitor- Prilosec Side lying position
Chronic pancreatitis
Intense abd pain- burning Tenderness Ascites LUQ mass Respiratory compromise Steatorrhea Weight loss Jaundice Dark urine Polyuria, polydipsia, polyphagia
Interventions chronic pancreatitis
Manage pain- opioids
Nutrition- pancreatic enzyme replacement therapy to prevent malnutrition, pancrelipase take with meals, monitor stools to evaluate effectiveness- should become less frequent and fatty, drugs to decrease gastric acid to destroy lipase, 4-6000 calories, increase protein, avoid fat foods and alcohol
Prevent recurrence- avoid irritants such as caffeine, bland low fat meals, pancreatic enzyme replacement before meals, skin care, managing DM
Pancreatic CA assessment
Jaundice Clay color stool Dark urine Abd pain Weight loss Anorexia N/V Glucose intolerance Splenomegaly Flatulence GI bleed from pressure on portal vein Ascites Leg or calf pain Weakness Back pain
Interventions pancreatic CA
Prevent spread Decrease pain- opioids Palliative tx Chemo or radiation Biliary stent if obstruction Surgery if small tumor <3 cm Whipper procedure for CA of the head
