Ch. 44 - Biliary Disorders - week 2 -pancreatitis Flashcards
MS4 - rotation 2
Amylase is a pancreatic enzyme that aids in the digestion of_______.
carbohydrates
Cholecystectomy is the removal of the ___________.
Gallbladder
Acute or chronic inflammation of the gallbladder is____________.
Cholecystitis
Which hormone stimulates the release of digestive enzymes and stimulate contraction in the gallbladder?
CCK - cholecystokinin
What is the procedure of making a surgical opening for the gallbladder to drain?
cholecystostomy
Cholelithiasis is caliculi in the gallbladder, what is it called when there are stones in the common bile duct?
choledocholithiasis
What is a choledochostomy?
this is a opening in the common bile duct
If there is expected pancreatitis, what 2 labs will you look at?
Amylase and Lipase
Dissolution therapy is when you use medication to ________ gallstones.
dissolve
Lipase is a pancreatic enzyme that helps digest _______.
fat
Lithotripsy is the disintegration of gallstones via ___________.
shock waves
Acute or chronic inflammation of the pancreas is __________.
pancreatitis
What does the hormone secretin stimulate the release of in the pancreas?
Bicarbonate
what is the frothy, foul smelling, greasy stool associated with pancreatitis?
steatorrhea
what is causing steatorrhea in a patient with pancreatitis?
impaired fat + protein digestion and lack of pancreatic juices
Trypsin is a pancreatic enzyme that digests _______.
protein
What is Zollinger - Ellison Syndrome?
this is when tumors caused by pancreatic cells cause the stomach to hyper-secrete gastric acid, which causes ulcers
what is the difference between interstitial edematous pancreatitis and necrotizing pancreatitis?
interstitial edematous pancreatitis involves only inflammation and swelling of the pancreatic tissue without cell death (necrosis), while necrotizing pancreatitis is a more severe form where actual pancreatic tissue dies due to necrosis
pancreatitis is the self/ autodigestion of the pancreas by its own _______. They are released too early which causes the ___________.
-Enzymes
-Inflammation
what are some less common causes of pancreatitis? (4)
-infection (mumps)
-ABD trauma or surgery
-meds. - steroids or NSAIDs
-cystic fibrosis
What does alcohol do to cause pancreatitis?
-stimulate production of digestive enzymes
-increase sensitivity of cholecystokinin
-which, stimulates pancreatic enzyme production, and causes the autodigestion
Where will a patient with acute pancreatitis have pain? (3)
-LUQ
-midepigastrum
-radiates to the back
How would a patient describe their pain, who is experiencing acute pancreatitis? (4)
-sudden onset
-severe/ deep
-aggravated by eating
-vomiting does not relieve it
Which sign of Acute Pancreatitis is bluish discoloration of the flanks?
grey-turner’s sign
Which sign of acute pancreatitis is the bluish discoloration around the umbilicus?
Cullen’s sign
What are the 2 classic symptoms of chronic pancreatitis?
jaundice and weight loss
What are the 3 most common causes of acute pancreatitis?
-biliary tract disease
-gallbladder disease
-alcoholism
What should you teach your patient about diet, related to their pancreatitis if they’re not NPO? (4)
-small, frequent meals
-bland, easy to digest foods
-low fat/ high protein/ high carb.
-NO ALCOHOL
Clinical Manifestations of Pancreatitis:
Frank Caught Dinner Every Night while drinking Beer
** Leslie Loves Happy-hour, Tequila, Jack + Apple martinis**
F-flushing
C-cyanosis
D-dyspnea
E-edema
N-n/v
B-bowel sounds = decreased/absent
L- low grade fever
L- leukocytosis (high WBCs)
H-hypotension
T- tachycardia
J- jaundice
A- ABD tenderness/pain
The 2 significant complications of pancreatitis include __________ (outside pancreas)+ _________(inside pancreas). This occurs because pancreatic fluid leaks out of the damaged pancreatic duct.
-pseudocysts occur outside the pancreas
-abscesses occur inside the pancreas
If a patient with pancreatitis develops a fever, a palpable epigastric mass that is filled with liquid, necrotic secretions, N/V, ELEVATED AMYLASE, what complication are they probably experiencing?
a pseudocyst
How is a pseudocyst treated? and what happens if it perforates?
-it will be internally drained
-peritonitis
An abscess is a fluid filled cavity within the pancreas as a result of necrosis. What will you observe in your patient experiencing this? (4)
these have to be SURGICALLY drained
-upper ABD pain
-ABD mass
-high fever
-leukocytosis
What are 3 complications to your respiratory system, secondary to pancreatitis?
-pleural effusion
-atelectasis
-pneumonia
Acute pancreatitis will cause tetany due to hypocalcemia. What 2 signs will you see in your patient?
-Trousseau’s sign (spasm W/ bp cuff)
-Chvostek’s sign (twitch when facial nerve is tapped)
True or False?
pancreatic enzymes will be elevated especially AMYLASE
true
on a CBC, WBCs, liver enzymes, bilirubin and glucose will all be ________.
elevated
on a CBC, platelets, calcium and magnesium will all be ____________.
decreased
what are the 5 objectives when treating a patient for Acute Pancreatitis?
-relieve pain
-prevent/ treat shock
-decrease pancreatic secretions
-fluid/ electrolyte balance
-remove/ treat cause
What are the 2 orders a dr. will put in for the suppression of pancreatic enzymes?
-NPO diet order
-NGT suction order
What is it called when you have excessive amounts of fat in your stool, and how does pancreatitis cause this?
-steatorrhea
- the pancreatic enzymes aren’t doing their job and breaking down fat
in chronic pancreatitis what replaces pancreatic tissue after it’s destroyed from the constant inflammation? and what can it also lead to? (2)
fibrotic tissue - this is hardened tissue due to the constant inflammation
-strictures
-calcifications
this tissue leads to stiffening + loss od function of that organ
What are the 2 types of CHRONIC pancreatitis?
- calcifying
- obstructive
what is obstructive pancreatitis most commonly associated with?? (the cause)
biliary disease, cholelithiasis
Where in the pancreas does calcification occur?
in the head and around the pancreatic duct
Chronic calcifying pancreatitis is the most common form, and it may also be referred to as what?
alcohol induced pancreatitis
What are the clinical manifestations of chronic pancreatitis? (7)
-ABD pain + tenderness
-weight loss
-constipation
-jaundice w/ dark urine
-steatorrhea
-frothy urine + stools
-diabetes
Some complications of chronic pancreatitis include:
Polly Anne Anderson Picked Strawberries, Plums + Papaya
P- pseudocyst
A - ascites
A - abscesses
P - pleural effusion
S - splenic vein thrombosis
P -pseudoaneurysms
P -pancreatic cancer
What will a patients labs look like if they have chronic pancreatitis?
-amylase/lipase may be slightly increased or not at all
-phosphate is increased
-mild leukocytosis
What is an ERCP and what does it do?
Endoscopic Retrograde Cholangiopancreatography
this will visualize the common bile duct and the pancreatic duct
What other diagnostic tests are used for pancreatitis? (3)
-ultrasounds
-CT
-MRI
what is an MRCP? and what is it used for?
Magnetic resonance cholangiopancreatography
this is an MRI specific to the pancreatic and biliary systems
What 2 things do Bile Salts do?
-help absorb fat soluble vitamins, which helps to prevent further fat loss
What 2 enzymes are used for pancreatic enzyme replacement?
pancreaze and viokace
If surgery is needed, what 2 things is it going to do?
divert bile flow or relieve the obstruction
