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Adult Nursing Exam 5 > Assessment & Management of Biliary Disorders > Flashcards

Assessment & Management of Biliary Disorders Flashcards

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1
Q

What does the biliary tract do?

A

transports bile from liver to bile duct and then to duodenum

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2
Q

What does the gallbladder do?

A

Stores Bile which was originally made by hepatocytes or liver cells.

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3
Q

What is the purpose of bile?

A

Emulsifies fat for digestion and to be absorbed by small intestine

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4
Q

Sphincter that controls bile flow into intestine?

A

Sphincter of Oddi

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5
Q

Gallbladder contraction is regulated by _________ which secrete due to ______.

A

Hormones which secrete due to fat

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6
Q

What does the pancreas produce?

A

Endocrine and Exocrine Hormones for digestion

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7
Q

Endocrine hormones by the pancreas?

A

Insulin - released by beta cells. lowers blood glucose levels due to it being the key
Glucagon - released by alpha cells and raises blood glucose when called upon
Somatostatin - released by delta cells. hypoglycemic effect since it can interfere with glucagon

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8
Q

Exocrine hormones secreted by pancreas?

A

lipase - fat breakdown
amylase - carb breakdown
trypsin - protein breakdown
secretin - stimulates sodium bicarb and bile secretion to decrease GI movement

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9
Q

Two major gallbladder disorders

A

Cholecystitis

Cholelithiasis

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10
Q

Cholecystitis definition?

Calculous or acalculous meaning

A

Acute or chronic inflammation of the gallbladder

Means with or without stones.

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11
Q

How can acalculous cholecystitis develop?

A

Can occur after surgery, burn, or trauma

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12
Q

What is Cholelithiasis?

Why are they such a problem?

A

Means gallstones caused by bile or cholesterol
Can lead to a bile back up and inflamed GB
Could also block pancreatic duct too causing pancreatitis

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13
Q

How are pigment bile stones formed

What might trigger this?

A

Bile pigment precipitates to form stones which have to be surgically removed bc they do not dissolve

Cirrhosis
Bile tract infections

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14
Q

How do cholesterol stones form?

A

Decrease in synthesis of bile acid leading to more cholesterol which combines with bile and then forms the stone

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15
Q

Risk factors of cholelithiasis or stones

A

Yoyo diets

Female, fat, and fair

Hormone replacements

Obesity

Progesterone from pregnancy

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16
Q

Will cholelithiasis have a lot of symptoms that the patient notices?

What is the Murphy’s sign?

A

No, it is mostly asymptomatic.

There may be pain in the RUQ of the abdomen which radiates to the right shoulder or back.

Might have abdominal distention, N/V after fatty foods. Fever and flatulence could occur.

Murphy sign may happen due to contraction of the GB when breathing in and pain upon palpitation.

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17
Q

What could gallstones mimic?

A

A heart issue. Especially nitro doesn’t work.

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18
Q

Biliary Colic means

A

contraction of the GB and spasms

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19
Q

Upon physical examination, what is noticeable?

A 
Jaundice
Clay stool
Pruritus
Vitamin deficiency
Elderly may not have any pain or fever 
Steatorhea or fat in stool with bad smell
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20
Q

Lab trends that will increase

A

WBC due to infection
Bilirubin bc it is not being excreted and causes jaundice

Amylase and Lipase if pancreas involved
Cholesterol
AST and LDH if liver involved

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21
Q

Diagnostic tests done

3/4

A

ultrasound and CT

ERCP - looks at gallbladder through esophagus

Cholescintigraphy - heptabiliary scan to asses patency of bile duct

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22
Q

What is bowel rest?

What needs to be watched?

A

Taking a break from eating food by mouth, so NPO.

Watch for F&E

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23
Q

How can we get the stones out without surgery?

5

A

Gallstones can be dissolved

T-tube retrieval

ERCP - frequent

E Lithotripsy - breaks it up

E Shock Wave Lithotripsy - breaks it up using high energy sound waves

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24
Q

How can we get stones out WITH surgery?

A

Laparoscopic Cholecystectomy assisted with a robot

Open Cholecystectomy

Small incision

Choledochostomy

Cholecystostomy

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25
Q

What happens if the gallbladder is removed tho?

A

The hepatocytes will just continuously drain the liver. Body will adjust to it

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26
Q

Once a stone is removed, what will be done?

A

Stone Biopsy

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27
Q

After any surgery, will you probably have respiratory issues?

A

Yes.

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28
Q

Why might there be nutrition issues

A

They just don’t want to eat. But we don’t want them to develop an ileus.

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29
Q

Why might there be bleeding after surgery?

A

Always an issue after large surgery. May use a JP drain and suture it in. Or a t-tube drain.

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30
Q

DVT after surgery?

A

Very high. Due to age and obesity too

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31
Q

What are some routine post op things you need to do?

A

Deep breathing and coughing. Plus splinting
Repositioning.
Check vitals.
Check labs. Feel pulses and feel for all major assessments.
Input and Output.
Pain scales.

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32
Q

Why would the patient be having right shoulder pain after surgery?
How to help them?

A

CO2 inflation after lapcoly. It doesn’t have an outlet due to it rising now.
Get them a heating pad.

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33
Q

If there are respiratory issues what can you do?

A

Raise the HOB. Administer O2 with order. Check the tension lines

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34
Q

If there are a lot of NG drains and tubes what should you do?

A

Just assess for patency and make sure there’s no tension or mechanical issues with them if the patient can’t breath.

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35
Q

When a patient is post op, what should their fat intake be? The rest of their diet?
Recommendations for food tracking?

A

Very low fat
Otherwise a normal diet but just go very slow with it
Small meals
Keep a diary so you can keep track of what foods bother you

36
Q

What symptoms should you report if they are present after surgery?

A

Urine and stool changing color
N/V
Any issues with the surgical site of course too

37
Q

What type of activity can they do?

A

As tolerated.

38
Q

Why might we use a t-tube?
Where is it placed? Why?
And if the flow is established?
How soon before and after a meal do we use it?

A

To explore the bile duct.
Placed above the abdomen to avoid the bail draining all at once & re-establish normal flow
And if the flow is established we can give them food.
Use 1-2 hours before & after the meal

39
Q

What is peritonitis?
How is it treated?
Do you need to switch the dressing?
Symptoms of it?

A

When bile leaks.
Treat with long term antibiotics.
In this case , yes. The bile can hurt the skin.
Drainage, pain, fever, and jaundice.

40
Q

Disorders of the Pancreas :)

A

….

41
Q

What is pancreatitis characterized by?

What does it cause?

A

When the pancreas digests itself

Causes inflammation, necrosis, and hemorrhage

42
Q

In pancreatitis there is hyper-secretion of enzymes. What does hyper-secretion mean in this case?

A

Too much secretion of amylase and lipase

43
Q

Different types of pancreatitis

A

acute and chronic

44
Q

What is acute pancreatitis?
Most common enzyme?
How serious is this?

A

self digestion of pancreas by its own enzymes.
especially by trypsin (breaks down proteins)
Very serious can be life threatening.

45
Q

Acute pancreatitis mild presentation? severe presentation?

A

interstitial edema of pancreatitis is mild

necrosis is severe

46
Q

How does acute pancreatitis even happen?

A

It can start with gallstones causing an obstruction that backs all the way up to the pancreas. When this happens, the pancreas erodes and leads to hemorrhage.

47
Q

Why is the mortality rate high for acute pancreatitis?

Alcohol?

A

Bc people who have this issue usually have comorbid factors and bad health
Alcohol is one of the worst things that can be an issue here and make it worse.

48
Q

Risk factors for pancreatitis includes anything that can affect the flow of enzymes.

A

Alcohol
Bile tract disease (leading to obstruction)
Peptic ulcer disease
Meds

49
Q

Which meds are the ones who are risk factors for pacreatitis?

3

A

Jinuvia
Viatta
which cause inflammation

And Tetractyin which is a hyperglycemic drug

50
Q

What type of pain is present with acute pancreatitis?
When will it hurt more?
What will the patient most likely do?

A

Abdominal pain on the left that radiates to the stomach, back, and chest (or the trunk). very rigid.
Hurts more when laying down and after eating

Pt will try to protect their abdomen and not eat

51
Q

What are some other symptoms or cofactors of acute pancreatitis

3

A

N/V
Lowered BP from hemorrhage
respiratory issues & hypoxia

52
Q

When assessing the patient with these symptoms of pancreatitis what should you ask?

A

Do you have a history of
gallstones
alcohol abuse
viral infection

53
Q

Why will the serum amylase & lipase levels be increase in pancreatitis?

A

The increase of amylase and lipase shows their hyper-secretion

54
Q

What will the WBC be in pancreatitis? Why?
What will the liver enzymes in blood look like? why?
What will will bilirubin look like ? why?

A

WBC increase due to infection
Due to hyper-secretion enzymes increase
Bilirubin increase bc it cannot be cleared and therefore jaundice presents

55
Q

Why will BG be like in pancreatitis? and why?

Why does H&H fall?

A

Bc the pancreas cannot regulate insulin and glucagon anymore

H&H falls due to hemorrhage

56
Q

What will calcium and magnesium look like in pancreatitis? and why?

A

Calcium and magnesium are decreased due to fat necrosis

57
Q

Why might shock occur with pancreatitis?
What about hypotension?

How to treat?

A

Both due to hemorrhage

May need to do blood replacement therapy

58
Q

How to decrease the obstruction of the bile tract?

A

Do a biliary drain.

59
Q

What is chronic pancreatitis?

Major cause?

A

When there are years of acute episodes
It is progressive and causes necrosis

Major cause is alcohol

60
Q

What will pain in chronic pancreatitis feel like?

But is pain always present?

A

Upper left abdominal pain and back pain that reoccurs and gets worse

No, pain is not always present. the person may not feel anything and feel ok

61
Q

Will this person with chronic pancreatitis gain or lose weight? why?

A

Lose weight due malabsorption due to impaired fat and protein digestion

62
Q

What will their stool be like?

A

Steatorrhea or fatty stool

63
Q

What lab values are present in chronic pancreatitis?

Same as acute

A

Increase in amylase and lipase

Increase BG

Decrease H&H

WBC increase

Bilirubin increase

Low calcium
Low magnesium

64
Q

What is an ERCP and why might they use it

A

Goes down esophagus to get a better look .

Could find and remove a gallstone or just observe

65
Q

Why use a CT, MRI or ultrasound?

A

It can show a stone or other issue

66
Q

Why get a fecal fat sample?

A

Will show steatorrhea or fat in stool which is a symptom of biliary/pancreatic disorder

67
Q

When managing pancreatitis of any kind, how will we allow the organ to rest?
How do we get rid of N/V?
What should the diet be like?

A

NPO , no food by mouth. Instead do tube feedings.
Give antiemetics for N/V
Diet needs to be bland, low fat so avoid fatty foods. no stimulants.
Avoid stress!

68
Q

How do we monitor their hydration status?

A

Check BP
I&O
Labs

69
Q

What type of fluid might we run for pancreatitis?

A

Lactated ringers due to its electrolyte concentration

70
Q

What position should we allow them to take?

What class of meds do we give?

A

Any position they want really. Let them do whatever they gotta do. Just don’t let them sit in one spot forever if they don’t move due to pressure

Parental opioids (give by injection)

71
Q

Why should we get them a spirometer?

A

They will be uncomfortable so by giving them a spirometer it is more incentive and real for them to breath

72
Q

What should diet look like between pancreatic episodes

A

Get the protein up

low fat

73
Q

Why are these patient more prone to patient ulcers?

A

Bc they lay in bed and don’t want to eat anything

74
Q

Why do we give morphine sulfate for Pancreatitis ?

A

for pain

75
Q

Why do we give antibiotics for Pancreatitis?

A

the necrosis of the pancreas

76
Q

Why do we give anticholinergics for Pancreatitis?

A

Decreases intestinal motility and flow of pancreatic enzymes

77
Q

why give Zantac or Prisolec for Pancreatitis?

A

decreases gastric secretions

78
Q

Why give insulin for Pancreatitis?

A

Bc the pancreas can’t produce it bc of beta cells not working

79
Q

When do we give pancreatic enzymes?

A

In between attacks

80
Q

Main surgical procedures done for Pancreatitis?

A

ERCP
Cholecystectomy

RouxenY (pancreaticojejunostomy)
Whipple resection (pancreaticoduodenectomy)
81
Q

RouxenY (pancreaticojejunostomy)

A

Creates an egg-like stomach pouch. Attaches to small intestine and bypasses stomach to attach to small intestine

82
Q

Whipple resection (pancreaticoduodenectomy)

A

This removes head of the pancreas, duodenum, and gallbladder and re-stitches what is left to side of the pancreas?

83
Q

How to manage hypovolemia complication of pancreatitis?
ascites
suction
hemorrhage

A

ascites with diuretics
gastric suction
hemorrhage so blood replacement and surgery

84
Q

Should patients with chronic pancreatitis drink alcohol and cafeeine

A

no and we need to educate them

85
Q

What is a pseudocyst?

abscess?

A

a fake cyst filled with fluids
a pus filled lesion.

Both are risk for infection

86
Q

What is complication of Diabetes with pancreatitis

A

insulin and BG. also not wanting to eat

87
Q

What might you see if there is a left lung effusion(more fluid) and atelectasis (collpase)

A

ascites

coughing

Adult Nursing Exam 5 (6 decks)

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