- pear shaped muscular sac - stores bile from liver and concentrates it - essential for emulsification of fats - powerful antioxidant

BITTER, YELLOW FLUID - bile salts - cholesterol - calcium - acids - produces gallstones - liver manufactures 1-1.5 quarts /days

- more frequent in women (childbearing age) - more frequent over 40 years - more common in caucasions - high incidence in native americans/Mexican americans - familial tendency - sedentary lifestyle - obesity - 4 F's (female,fertile,fat, forty)

- solid crystalline precipitates - major component is cholesterol - same are from calcium salts - sand-like - usually form in gallbladder or bile duct - can cause life threatening infection of liver, bile duct and pancreas

inflammation of the gallbladder and or cystic duct - acute versus chronic ETIOLOGY - gallstones usually - bacterial infection - tumor of pancreas or liver - decreased blood supply to gallbladder - gallbladder "sludge"

- may be asymptomatic - attacks lasts 2-3 days - intense, sudden pain RUQ - pain may radiate up to right shoulder - recurrent attacks several hours after meals - nausea/vomiting/indigestion - rigid abdominal muscles or bloating - slight fever/chills/leukocytosis - loose, light colored stools

- abscess - pancreatitis - biliary cirrhosis - fistulas - rupture of the gallbladder - inflammation of biliary duct - bile peritonitis - empysema

GALLSTONE FORMATION: - bile stagnation - solid crystalline - changes in chemical composition - decrease bile flow - immobility - pregnancy - inflammation - obstructive lesions

- severe steady pain due to spasm - accompanied by tachycardia,diaphoresis and prostration - pain may last as long as 1 hour with residual RUQ tenderness - occurs 3-6hrs after heavy meals

- ULTRASONOGRAPHY - CY SCAN - RADIOLOGIC STUDIES

- gallbladder series oral contrast(pills) abdominal x-ray

- IV contrast - series of X rays

gallblader disease Flashcards by jasmine patterson

GALLBLADDER

pear shaped muscular sac
stores bile from liver and concentrates it
essential for emulsification of fats
powerful antioxidant

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BILE

BITTER, YELLOW FLUID

bile salts
cholesterol
calcium
acids
produces gallstones
liver manufactures 1-1.5 quarts /days

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COMPLICATIONS

CHOLELITHIASIS
-gallstone formation

CHOLECYSTITIS
-inflammation of the gallbladder or cystic duct

OBSTRUCTION
-caused by gallstones

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WHO’S AT RISK

more frequent in women (childbearing age)
more frequent over 40 years
more common in caucasions
high incidence in native americans/Mexican americans
familial tendency
sedentary lifestyle
obesity
4 F’s (female,fertile,fat, forty)

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GALLSTONES

solid crystalline precipitates
major component is cholesterol
same are from calcium salts
sand-like
usually form in gallbladder or bile duct
can cause life threatening infection of liver, bile duct and pancreas

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CAUSES OF GALL STONES

stasis/ stagnation of bile

incomplete emptying of the GB

bile coagulates and clumps together
imbablance of cholesterol and bile salts

Pure cholesterol stones
-"white " diet 
(sugar, white bread pasta)
-soda and lots of meat 
- not enough vegetables

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CHOLECYSITIS

inflammation of the gallbladder and or cystic duct

acute versus chronic ETIOLOGY
gallstones usually
bacterial infection
tumor of pancreas or liver
decreased blood supply to gallbladder
gallbladder “sludge”

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SYMPTOMS

may be asymptomatic
attacks lasts 2-3 days
intense, sudden pain RUQ
pain may radiate up to right shoulder
recurrent attacks several hours after meals
nausea/vomiting/indigestion
rigid abdominal muscles or bloating
slight fever/chills/leukocytosis
loose, light colored stools

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COMPLICATIONS

abscess
pancreatitis
biliary cirrhosis
fistulas
rupture of the gallbladder
inflammation of biliary duct
bile peritonitis
empysema

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CHOLELITHIASIS

GALLSTONE FORMATION:

bile stagnation
solid crystalline
changes in chemical composition
decrease bile flow
immobility
pregnancy
inflammation
obstructive lesions

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SYMPTOMS OF CHOLELITHIASIS

may be silent
dependent upon if stone are stationary or mobile
If obstruction is present
amber(tea) colored urine
clay colored stools
jaundice
pruritus
steatorrhea
bleeding tendencies

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BILARY COLIC

severe steady pain due to spasm
accompanied by tachycardia,diaphoresis and prostration
pain may last as long as 1 hour with residual RUQ tenderness
occurs 3-6hrs after heavy meals

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COMPLICATIONS OF STONES

inflammation of biliary ducts
obstruction
peritonitis
carcinoma
biliary cirrhosis

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DIAGNOSTIC TESTS

ULTRASONOGRAPHY
CY SCAN
RADIOLOGIC STUDIES

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CHOLECYSTOGRAM

gallbladder series
oral contrast(pills)
abdominal x-ray

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CHOLANGIOGRAM

IV contrast

- series of X rays

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ERCP( ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY)

use of endoscope
injection of dye
series of X rays

CT SCAN

with or without contrast

- 2 dimensional image

DIAGNOSTIC STUDIES

LABRATORY VALUES

LFT’s (liver function studies)
looks for obstruction
direct and indirect bilirubin
Serum enzymes(AST)
may be elevated
CBC
elevated WBC count
SERUM AMYLASE
pancreas involevement

PROTHROMBIN TIME
*prolonged clotting due to lack of vit.K absorption

MEDICATIONS

control infection
*antibiotics

correct/maintain balance

pain control
-Narcotics: dilaudid, morphine, can increase biliary colic

Antispasmotics: (anticholinergics) atropine
Antiemetics: Phenergan,zofran
Give fat soluble vitamins (a,d,e,k) *chronic GB disease
any type of obstruction

UROSO (URSODIOL)

naturally occurring bile acid

small quatities in humans
large quatities in certain species of bears

ACTIONS

replace/displace toxic bile acids
cytoprotection of injured bile duct epithelial cells
assists to shrink gall stones

DIAGNOSTIC TESTS: LITHOTRIPSY

extracorporeal shock wave lithotripsy:

pulverizes stones
passes into duodenum
passed in stool

SURGERY:LAPROSCOPIC CHOLESYSTECTOMY

less invasive
3-4 small incisions
same day surgery (90%) over night
return to normal ADL’s in 2-3 days

DISCHARGE INSTRUCTIONS

incision care
when to call doctor
activity
diet

SURGERY: INCISIONAL/OPEN CHOLEYCYCTECTOMY

- invasive with skin incision - hospital stay 4-7 days - may require T-Tube insertion

T-TUBE

- used if common bile duct is explored - used pre op for biliary obstruction - attached to dosed drainage system

OPEN CHOLEYCYCTECTOMY

COMPLICATIONS: * bleeding * common bile duct injury * infection POST OP: * monitor for bleeding/complications * difficulty breathing * pain control * monitor I&O, NG tube drainage * IV therapy

THE PANCEAS

ENDOCRINE -release insulin EXOCRINE -release of potent enzymes to digest fat, protein and carbohydrates - LIPASE acts on fats - AMYLASE acts on starches - inactive enzymes:act on protein - secrets NA and Biacarb to neutralize acid

ACUTE PANCREATITIS

inflammation that occurs when pancreatic ductal flow becomes obstructed and digestive enzymes escape from the duct and start to digest the pancreas itself.

ACUTE PANCREATITIS ETIOLOGY

- biliary tact disease - alcoholism - other trauma -viral, hereditary , abscess,hypercalcemia, hypertriglyceridemia,idiopathic

DEGREE OF REACTION PANCREATITIS

Pain - sudden onset LUQ radiating to the back - severe (deep and boring) - food worsens pain - if alcoholic may last for days and is associated with anorexsia ,nausea, vomiting - flushing,fever,tachycardia - dyspnea - hypotension(shock),cyanosis - jaundice - muscle guarding, abdominal rigidity - diminished or absent bowel sounds

DEGREE OF REACTION PANCREATITIS

- ileus, abdominal distention,ascites - grey's turner's sign - Cullen's sign

COMPLICATIONS OF PANCREATITIS

PSEUDOCYST -a cavity outside the pancreas filled with necrotic waste and fluid rupture causes peritonitis ABSCESS - fluid filled cavity within the pancreas assosicated with high fever. requires prompt surgical intervention , can cause sepsis with rupture PULMONARY -pneumonia, atelectasis,pleural effusions

DIAGNOSTIC STUDIES PANCREATITIS

- elevated serum amylase/lipase - other lab findings - x-rays of chest and abdomen - pancreatic ultrasound - CT/scan/MRI - ERCP

MANAGEMENT OF ACUTE PANCREATITIS

PAIN CONTROL - dilaudid - nitroglycerin (releases smooth muscles and relieves pain) FLUID RESUSCITATION -IVF, albumin, plasma, volume expanders NUTRITIONAL SUPPORT

ACUTE PANCREATITIS MANAGEMENT

- pain management - reduce/ suppress pancreatic enzymes - monitor serum electrolytes - monitor respiratory function - administer antibiotics as ordered - surgery for absecess, pseudocyst or peritonitis

DISCHARGE TEACHING PANCREATITIS

- avoid alcohol - avoid caffeine - avoid smoking - avoid stressful situations - restrict fats - encourage carbohydrates - avoid crash or binge diets - monitor elevated BS/fatty stools - take pain meds/H2 receptor blockers

CHRONIC PANCEATITIS

-progressive destruction of the pancreas with replacement of scar tissue - irreversible damage - exacerbations - chronic inflammation - decrease digestive enzymes - malabsorption of nurtients, fats,and calories

CHRONIC PANCREATITIS DEGREE OF REACTION

- intense abdominal pain - weight los with ascites - jaundice - dark urine - diabetes - dyspnea,diminshed breth sounds, orthopnea - steatorrhea

CHRONIC PANCREATITIS DIAGNOSTIC TESTS

LABS - serum amylase/lipase - serum bilirubin - alkaline phosphatase TESTS biopsy of pancreas ULTRASOUND ERCP

MEDICAL MANAGEMENT CHRONIC PANCREATITIS

ENZYME REPLACEMENT | INSULIN THERAPY