Ch. 54 Patients w/ Problems in Biliary System and Pancreas

Question 1

Biliary System Functions

Answer 1

Promotes food digestion in stomach and small intestine

Impairment in biliary system impairs digestion leading to inadequate nutrition

Question 2

Biliary System Causes of Inflammation & Obstruction

Answer 2

Gall stones

Edema (vessel, organ, vascular)

Strictures

Tumors

Question 3

Acute Cholecystitis

Answer 3

Chemical irritation and inflammation from gallstones and calculi that obstructs the cystic duct, gallbladder neck, or common bile duct

Edema in the gallbladder and pericholecystic fluid

Question 4

Cholelithiasis

Answer 4

Gall stones/calculi

Question 5

Choledocolithiasis

Answer 5

Common bile duct problem or stone

Question 6

Cholecystitis

Answer 6

Gallbladder infection or inflammation

Question 7

Acute Cholecystitis Rick Factors or Co-Morbidities

Answer 7

Female, Obesity, Estrogen, Age

Crohn’s, Gastric bypass, SCD, DM, pregnancy

Question 8

Gall Stones

Answer 8

Cholesterol calculi/cholesterol stones (bile salts, cholesterol metabolism, calcium, protein)

Mixed w/ mucous and viscous bile builds gall stones

Question 9

Gall Stones Causes

Answer 9

Obesity
Genetics
High Cholesterol
60-70% American Indians
Pregnancy & HRT decreasing bile emptying

Question 10

The 4 F’s in Gall Stone Causes

Answer 10

Female
Fat
Forty
Fertile

Question 11

Cholecystitis Physical Assessment

Answer 11

Abdominal pain (RUQ)
Atypical s/s w/ diabetics and age-related
Rebound tenderness
Jaundice, dark urine, icterus, steatorrhea (late)
Inflammation: fever, tachycardia, dehydration (late)

Question 12

Cholecystitis Clinical Manifestations

Answer 12

Episodic or vague upper abd pain or discomfort that can radiate to right shoulder (RUQ)

Pain triggered by high-fat or high-volume meal

Dyspepsia, Eructation
Flactulence, Steatorrhea, N/V

Question 13

Acute Cholecystitis Lab

Answer 13

WBC > 10K
Elevated AST/LDH
Elevated bilirubin
Elevated amylase/lipase

Question 14

Acute Cholecystitis Diagnostic

Answer 14

Abdominal XR
US (most reliable)
HIDA scan
ERCP, MRI

Question 15

Acute Cholecystitis Interventions

Answer 15

Managing acute pain (opioids, NSAIDs)

Hydration or IV fluids, pain meds, NSAIDs, antiemetics, ABX, lithotripsy (ultrasonic waves to break stones)

Monitor for infection or peritonitis

Lap Chloe - removal of GB

Question 16

Gallbladder (GB) Motility Issues

Answer 16

Lead to stone formation by delaying bile emptying and causes biliary stasis

Twist or kinking of gallbladder neck or cystic duct

Question 17

Inflamed Gallbladder Complications

Answer 17

Sepsis
Severe trauma or burns
Long-term total parenteral nutrition (TPN)
MODS
Major abdominal surgery
Hypovolemia

Question 18

Acute Cholecystitis Pt Education

Answer 18

Promoting nutrition - high fiber, low fat diet

Prevention

Diet controlled w/ GB attacks

Question 19

Chronic Cholecystitis

Answer 19

Recurrent episodes of cystic duct obstruction caused by chronic inflammation

Calculi present

GB becomes weak, fibrotic atrophy, decreased motility, deficient absorption

Question 20

Chronic Cholecystitis Causes

Answer 20

Diet low in fat, vegetarian diet

Pancreatitis or Cholangitis

Back up bile = obstruction & jaundice

Question 21

Acute Pancreatitis

Answer 21

An inflammatory process due to activated pancreatic enzymes auto digesting the pancreas

Question 22

Acute Pancreatitis Risk Factors/Causes

Answer 22

Alcohol abuse/smoking
Gall stones
Obstructive pancreatitis
Kidney failure
Trauma
Cholecystitis

Question 23

Acute Pancreatitis Physical Assessment

Answer 23

Sudden onset of severe abdomen pain

Epigastric pain

Abdominal assessment - jaundice, decreased BT, palpation/rigid abdomen, N/V, wt loss

Respiratory and cardiac assessment - shock, sepsis, fever, VS trends (late)

Question 24

Acute Pancreatitis Labs

Answer 24

Increased amylase, lipase, trypsin, elastase

Increased glucose, bilirubin, ALT, AST

Increased WBC, CRP

Increased BUN, triglycerides

Decreased Ca, Mg

Decreased platelets

Decreased albumin

Question 25

Complications of Acute Pancreatitis

Answer 25

Type 1 DM Pancreatic infection Hypovolemic shock Multi-organ system failure DIC Atelectasis Pneumonia

Question 26

Acute Pancreatitis Interventions

Answer 26

Pain management Decrease inflammation Nutrition therapy NPO, no food until pain free; then bland, high protein, low fat Position of comfort NG tube - enteral or TPN IV fluids, electrolyte replacement therapy

Question 27

Acute Pancreatitis Drug Therapy

Answer 27

Opioid medication - Morphine or Hydromorphone Ketorolac (Toreador) - NSAID PPI, H2 receptors Pancreatic enzymes - Pancrelipase ABX Calcium or Magnesium Replacement

Question 28

Chronic Pancreatitis

Answer 28

Progressive, destructive disease of the pancreas that has remissions and exacerbations "flare-ups" Inflammation w/ tissue fibrosis Pancreatic insufficiency

Question 29

Chronic Pancreatitis Clinical Manifestations

Answer 29

Intense abd pain - continuous and burning or gnawing Ascites Abdominal tenderness Possible LUQ mass Steatorrhea Jaundice

Question 30

Chronic Pancreatitis Interventions

Answer 30

Drug therapy - same as acute Long-term dietary management Calories up to 4000/day to maintain wt. Foods high in carbs/protein Avoid high fat foods No alcohol

Question 31

Chronic Pancreatitis Pt Education

Answer 31

Discharge and follow up planning No cure, prevention/symptom focused Avoid: caffeine, alcohol, nicotine Eat bland, small meals

Question 32

Pancreatic Cancer

Answer 32

Vague manifestations and diagnosed in late stages after liver or gallbladder involvement - 5 yr survival rate Palliative Interventions - pain management and decreasing symptoms Rapid growing tumor w/ rapid metastasis to lymph and vascular systems Spreads to lung, breast, thyroid, kidney, and skin

Question 33

Pancreatic Cancer Risk Factors

Answer 33

Age, smoking, genetic, family hx, processed red meat diet High risk - DM, cirrhosis, chronic pancreatitis

Question 34

Pancreatic Cancer Clinical Manifestations

Answer 34

Asymptomatic (early) Abdominal pain (late) Clay stools, GI bleed Jaundice Weakness and wt loss (late)

Question 35

Pancreatic Cancer Labs

Answer 35

No direct labs Increase LFT, amylase, lipase, Alk phos, bilirubin