care of patients with problems of the biliary system Flashcards
cholecystitis
inflammation of the gallbladder
acute cholecystitis symptoms
- persistent epigastric or RUQ pain. lasting >8hr
acute cholecystitis physical exam
may be febrile or afebrile; usually localized gallbladder tenderness
acute cholecystitis ultrasongraphy
- gallstones in gallbladder
- may have perichikecystic fluid
- may not have cbd dilation
acute cholecystitis lab studies
- normal or elevated wbc count
- may have normal or midley elevated LFT values
chronic cholecystitis symptoms
persustent recurrent ruq pain
chronic cholecystitis physical exam
afebrile
- may have localized tenderness over a palpable gallbladder
chronic cholecystitis ultrasound
stones in gallbladder
- thickened gallbladder wall
- advanced cases contracted gallbladder
chronic cholecystitis lab studies
normal WBC count; may have mild elevation in LFT values
cholecystitis history
- Diet and foods; diet high in fat, high in calories, low in fiber, and high in refined carbs places the patients at high risk for developing gallstones
- Does intake of certain foods cause PAIN?
- GI symptoms with fatty foods like flatulence (gas), dyspepsia (heartburn), eructation (belching), anorexia, nausea, vomiting, and abdominal pain
physical assessment s/s cholesysitis
- Abdominal pain
- Rebound tenderness and deep palpation performed by primary health care provider, may indicate peritoneal inflammation
- Chronic cholecystitis symptoms: jaundice, clay-colored stools, and dark urine from biliary obstruction, icterus, steatorrhea (fatty stools)
cholecystitis lab assessment
***Increased WBC Alkaline phosphatase ***AST- elevated ***LDH- elevated ***Serum bilirubin levels- elevated
cholecystitis diagnostic test
X-rays
Ultrasound- best test
ERCP or MRCP
hematobillary- visulaized gallbladder
cholecystitis analyze cues
- acute or persistent pain due to gallbladder inflammation and or gallstones
- weight loss due to decreased intake because of pain, nausea and anorexia
cholecystitis generate solutions
- Avoid fatty foods, withhold food and fluid if nausea and vomiting occur
- IV therapy
- ***Ketorolac (potent NSAID) used for mild to moderate pain= can cause GI bleeds
- Antiemetics for nausea
- IV antibiotic therapy
- **Oral bile acid dissolution or gallstone-stabilizing agents Extracorporeal shock wave lithotripsy (ESWL) to break up gallstones
- Percutaneous transhepatic biliary catheter (drain) to open the blocked duct(s)
- ***Cholecystectomy- surgical removal of the gallbladder
- ***Teach patient about post-cholecystectomy syndrome symptoms (PCS)
cholecystits outcomes
- Report control of abdominal pain, as indicated by self-report and pain scale measurement
- Have adequate nutrition available to meet metabolic needs
acute pancreatitis patho
- Can be life-threatening inflammation of pancreas
- Autodigestion and fibrosis of pancreas
- caused by exsessive pancreatic enzymes
complications of acute pancreatitis
- hemorrhage
- acute kidney failure
- paralytic illius
- hypovolemic shocl
- ARD
- pneuomonia
- atlectasis
- type 2 diabetes
acute pancreatitis hisotry
Collect history after pain is controlled
Ask about *alcohol usage and medical problems
Any abdominal surgical interventions
Any recent viral infections
Over the **counter medications (opioids and steroids)
acute pancreatitis physical assessment & s/s
Severe abdominal pain, often mid-epigastric or LUQ
Relief of pain by assuming the fetal position or by sitting upward and bending forward
**Generalized Jaundice
***Gray-blue discoloration of abdomen and periumbilical area
Peritonitis, paralytic ileus, pancreatic ascites
acute pancreatitis lab
**Amylase: elevated
**Lipase: elevated
Serum bilirubin and alkaline phosphatase: elevated
ALT: elevated
WBC: elevated
ESR: elevated
calcium and magnesium: decreased
acute pancreatitis diagnostic procedures
- abdominal ultrasound
- contrast-enhanced ct
- abdominal xray
acute pancreatitis prioritize hypothesis
- Severe acute pain due to pancreatic inflammation and enzyme leakage
- Weight loss due to inability to ingest food and absorb nutrients
acute pancreatitis managing pain
- Severe continuous ”boring” abdominal pain is the most common symptom of pancreatitis!
- Main focus of nursing care is aimed at pain control by interventions that decrease GI tract activity, which *decreases pancreatic stimulation
- Fasting and rest, drug therapy, and comfort measures used to **decrease pain
acute pancreatitis promoting nutrtion
- **NPO status maintained in early stages of pancreatitis
- Antiemetics prescribed for nausea and vomiting
- Patients with severe pancreatitis who are unable to eat for 24-48 hours will need jejunal **tube feeding, patient should be weighed daily
- Once food is tolerated, patient should ***small, frequent, moderate to high carb, high-protein, low-fat meals, food should be bland with little spice, avoid caffeine containing foods and alcohol
- ***Monitor the patient beginning to resume oral food intake for nausea, vomiting, and diarrhea (if any of these symptoms occur, notify the PCP immediately)
- Nutritional supplements may be used to ***boost caloric intake, doctor may prescribe vitamin and mineral supplements
acute pancreatitis outcome
- has control of abdominal pain
- has adequate nutrition
chronic pancreatitis patho
- Progressive destructive disease of pancreas characterized by remissions and exacerbations
- Inflammation and fibrosis of tissue contribute to pancreatic insufficiency
chronic pancreatitis assessment
Abdominal pain Ascites Respiratory compromise ***Steatorrhea and gray color Weight loss ****Jaundice ****Dark urine Polyuria, polydipsia, polyphagia
chronic pancreatitis managing acute persistent pain
Initially opioid analgesia is used more frequently, but dependency may occur, so nonopioid analgesics may be considered
maintain adequate nutrition chronic pancreatitis
- Pancreatic enzyme replacement therapy (PERT)- standard of care to prevent malnutrition, malabsorption, and excessive weight loss; drug therapy to decrease gastric acid may be prescribed (such as PPIs)
- Same treatment as acute pancreatitis; patient often avoids food intake to avoid pain; TPN or TEN, including vitamin and mineral replacement
chronic pancreatitis prevent disease recurrance
- Registered dietitian nutritionist teaches the patient long-term dietary management
- Foods high in carb and protein assist in the healing process, avoid foods high in fat because it causes or increases diarrhea
Alcohol cessation
chronic pancreatitis surgical management
Surgery is not a primary treatment for chronic pancreatitis, may be indicated for ongoing abdominal pain, incapacitating relapses of pain, or complications such as pancreatic abscess or pancreatic pseudocyst
pancreatic cancer
- Difficult to diagnose
- Treatment has limited results
- 5-year survival rates are low
- VTE is a common complication
risk factors for pancreatic cancer
- obestity
- chronic pancreatitis
- diabetses
- chirrohis
- smoking
pancreatic cancer asssessment
Slow, vague presentation
**Jaundice (late, advanced disease)
***Icterus
Weight loss
Anorexia, nausea, vomiting
No specific lab tests are diagnostic of pancreatic cancer, however, **serum amylase and **lipase levels and **alkaline phosphatase are increased, elevated carcinoembryonic antigen **(CEA) and billirubin will increase
Abdominal ultrasound and contrast-enhanced CT are most commonly used
pancreatic cancer interventions
- Chemotherapy
- Radiation
- Surgery
- Complete surgical resection of the pancreatic tumor is the most effective treatment, but only used when patients have small tumors
- Partial pancreatectomy- preferred surgery for tumors smaller than 3 cm in diameter, depending on location and length of time since diagnosis
- For larger tumors, the surgeon may perform a radical pancreatectomy or the Whipple procedure (pancreaticoduodenectomy)
