NG+ NUR 144 - WEEK 3 - BILIARY & EXOCRINE PANCREAS Flashcards
(20 cards)
Describe exocrine functions of the Pancreas
What are the products?
Where are they collected?
What is it stimulated by?
(Endocrine = into bloodstream, exocrine = external ducts of body)
- Exocrine productions:
- High alkaline secretion (d/t high sodium bicarb) which neutralizes highly acidic stomach acid in the duodenum
- Amylase: digests carbs
- Trypsin: digests proteins
- Lipase: Digests fats - Exocrine secretions are collected in pancreatic duct
- GI tract hormones stimulate this secretion
- Hormone Secretin: Major stimulus for increase bicarb secretion
- Hormone Cholecystokinin (CCK): Major stimulus for digestive enzyme secretion
- Vagus nerve
Describe bile
Bile - Produced by the liver hepatocytes, aids in digestion of fats; also neutralizes stomach acid in duodenum (d/t it containing high amounts of bicarb)
- When in the gallbladder between meals, a large amount of water is drawn out of the bile. This makes bile in the gallbladder 5x-10x more concentrated than what’s created by the hepatocytes
Describe Gallblader
Storage unit for bile, holds roughly 30-50 mL. Attaches to duodenum
Bile release is stimulated by Cholecystokinin which is produced & released by the small intestine
Bile - Produced by the liver, aids in digestion of fats; also neutralizes stomach acid in duodenum (d/t it containing high amounts of bicarb)
Describe the Bile Ducts
Common hepatic duct connects liver/hepatocytes which creates bile to the Cystic Duct and Common Bile Duct.
Bile flows from liver/hepatocytes down Common hepatic Duct –> Cystic Duct for storage –> Common Bile Duct for secretion into duodenum
What is the Sphincter of Oddi?
Controls secretion of bile and pancreatic enzymes, where the common bile duct and pancreatic duct merge
Lab Tests / Diagnostic Tools for Biliary System Dysfunction
- Pancreatic Enzymes: (Amylase, Lipase)
- LFT (Liver Function Test): AFT, ALT,
- Bilirubin (direct and indirect):
- Ultrasound
- Computed Telemetry (CT)
- Magnetic Resonance Imagery (MRI)
- Endoscopy
- ERCP
Describe Cholecystitis
What is it
What causes it
S/S
Inflammation of the gallbladder; can be acute or chronic
Secondary infection of bile may occur, may lead to empyema (buildup of pus)
Cause:
- Usually Calculous cholecystitis = i.e. “gallstone obstructs bile flow and compresses blood vessels”
- If Acalculous (no gallstones) cause may be: bile stasis, high bile viscosity, torsion
S/S: Pain-tenderness of upper right abdomen may radiate to midsternal or right shoulder, nausea, vomiting
Complication: Gangrene (necrosis), perforation, infection
Describe Cholelithiasis
What is it
What causes it
S/S
Complications
Stones that form in gallbladder; can be chronic or acute
Cause: Excess bilirubin OR cholesterol
s/s: discomfort d/t inflammation & contractile spasms, digestive issues d/t inadequate bile
Complication: Necrosis or rupture d/t untreated swelling/distention; digestive problems d/t reduced/absent bile
Two Types of Cholelithiasis:
Describe Pigment Type:
What is it?
Risk factors?
Small dark stones of bilirubin and calcium salts; 10%-25% of cases
Cholelithiasis may lead to cholecystitis
- Look for dark colored urine & grayish colored feces
Risk factors
- Cirrhosis
- Hemolysis; “Excess breakdown of RBCs = excess bilirubin”
- Biliary tract infection
Two Types of Cholelithiasis
Describe Cholesterol Type:
What is it?
Risk factors?
s/s?
Usually green/white/yellow; roughly 75% of cases
Cholelithiasis may lead to cholecystitis
” Decreased bile acid synthesis + increased cholesterol synthesis in the liver = leads to bile saturated w/ cholesterol “
LDL: causes atherosclerosis
HDL: Carries cholesterol to liver
Risk Factors:
- Cystic Fibrosis
- Estrogen therapy
- Diabetes
- Fatty diet, hypocholesteremia (high cholesterol in the blood)
- Sedentary lifestyle
s/s: RUQ pain (esp. after fatty meal), fullness, abdominal distention, biliary colic (pain d/t gallstone)
Medical Management of Cholelithiasis
- ERCP
- Dietary management
Medication: Ursodeoxycholic Acid
Laparoscopic: Cholecystectomy
Nursing interventions for the biliary system
Post surgery, assess for:
- Loss of appetite
- Vomiting
- Pain
- Distention
Post-Surgery goals:
- Pain relief
- Intact skin
- Improved biliary drainage
Post-Surgery Interventions:
- Low Fowlers
- NPO / NG Tube
- Care of biliary drainage system
- Pain management
Describe Acute Pancreatitis
What it is
What Causes it
S/S
Inflammation of the pancreas
- Acute: Obstruction of pancreatic duct & backed up enzymes
Cause:
- Cholelithiasis, alcohol abuse
S/S:
- Acute: Autodigestion (Digestive enzymes breakdown its own tissues), and inflammation of pancreas
Interstitial Pancreatitis vs. Necrotizing Pancreatitis
Both are Acute Pancreatitis
Interstitial Pancreatitis:
Pancreas becomes swollen d/t inflammation
- Majority of patients
- Minimal organ dysfunction; normal function returns in 6 months
- Risk for: hypovolemic shock, sepsis
Necrotizing pancreatitis:
Pancreas’ enzymes digests itself (enzymes get activated early
- Damage to local blood vessels; bleeding and thrombosis
- Severe, resistant to treatment, rapidly fatal
- Necrosis in pancreas, or surrounding tissue
- Can be sterile or infected
S/S, assessment for acute pancreatitis
- Severe abdominal pain, worsens after meals
- Distended & rigid abdomen
- Nausea / vomiting
- Fever
- Jaundice
- Ill appearance
- Hypoactive bowel
Diagnosis of pancreatitis
- Hx of upper abominal pain
- Serum amylase or lipase levels = 3x upper limit
- Abnormal imaging (CT, MRI, ultrasound)
Treatment for pancreatitis
- Initially, NPO
- Then, Enteral feeding
- NG suctioning to relieve nausea/vomiting, distention
- Analgesia
- Removal of blockage
Describe Chronic Pancreatitis
What is it
What causes it
S/S
Inflammatory disorder with destruction of pancreases
Pancreatic cells are replaced by fibrous tissue (scarring i.e. dead cells) = leads to obstruction of pancreatic/bile ducts, atrophy of duct epithelium
Cause:
- Excess alcohol consumption
- Malnutrition
Assessment-S/S:
- Upper abdominal and back pain
- Vomiting
- Weight loss, anorexia
- Frothy, frequent, foul stools
- Calcium stones in ducts
Medical Management of Chronic Pancreatitis
- Prevent acute attacks, pain management
- Nonsurgical: Endoscopy (stone removal, widen structures with stents, drain cysts)
- Surgical: Pancreatojejunostomy (Drainage of pancreatic secretions into jejunum)
True/False:
Patients with acute pancreatitis require a high-carbohydrate, low-protein, and low-fat diet.
True
Rationale: In patients with acute pancreatitis, a high-carbohydrate, low-protein, and low-fat diet increases caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond.
