Chapter 48: Liver, Biliary Tract, and Pancreas Problems (Part 2- Gallbadder, Pancreas) Flashcards
in a patient with pancreatitis, a clear-liquid diet may be given (and then progressed) once these two things are present
bowel sounds have returned
no pain
in gallbladder disorders, direct bilirubin is _____________ and is indicative of _____________ process in liver and biliary system
increased, obstructive
if stones are located in the common bile duct, surgeons explore the duct and place ________ in common bile duct to maintain patency; this allows bile to pass from liver to duodenum until edema from surgery diminishes
T-tube
minimally invasive method to remove gallbladder
laparoscopic cholecystectomy
this type of surgery can be done if tumor is limited to the head of the pancreas with no node involvement or metastasis (pancreatic cancer)
Whipple resection
gallstones are more common in (men, women) and with age
women
bulky fatty stool from lack of pancreatic lipase
steatorrhea
predominant sign of cholecystitis
severe, steady RUQ pain that radiates to mid upper back or to right scapula/shoulder and lasts 12-18 hours
if asymptomatic and low risk for complications, treatment for gallbladder disorders may be _____________
conservative
these two pancreatic cancer treatments are palliative
chemotherapy, radiation
diagnostic method of choice for gallbladder disorders: checks for gallstones and dilated duct, wall inflammation, presence of abnormal fluid, and whether the gallbladder is emptying or not
ultrasound
this lab may be increased from inflammation (pancreatitis)
white blood cell (WBC)
client that experiences frequent symptoms, has acute cholecystitis, or has very large gallstones typically has this treatment
gallbladder and stones surgically removed
health promotion for pancreatitis should address these five things
alcohol, smoking, stress, diet, infection symptoms
two most common causes of pancreatitis
- gallbladder disease
- chronic alcohol use
to help prevent gallbladder disorders, teach about changing __________________, educate on dangers of ________ dieting, and possibly implement ____________________
modifiable risk factors, yo-yo, cholesterol-lowering drugs
cholelithiasis or cholecystitis: may present with fever and chills
cholecystitis
this type of procedure can be done for pancreatic cancer; connects the pancreatic duct, common bile duct, and/or stomach to the jejunum
anastomoses
this complementary therapy decreases gallbladder symptoms and stimulates bile secretion
goldenseal
pancreatitis usually occurs in this age group
50-60
complication of Whipple resection
leaking of digestive juices from healing and breakdown (will have drain)
first sign of pancreatic cancer
jaundice
maintain ___________ of T-tube site because bile is irritating
cleanliness
in a T-tube patient, if stool color is pale, do this
clamp tube per order and monitor response
if gallbladder is ___________ or ____________, may not be candidate for laparoscopic cholecystectomy and may require open surgical method
very large, infected
manifestations include epigastric pain and/or RUQ pain, intolerance to fatty foods, nausea, flatulence, bloating, abdominal distention, diarrhea, chest pain
cholelithiasis
what is Turner’s sign?
bruising on the side
seven risk factors for pancreatitis
- alcohol consumption
- biliary obstruction
- peptic ulcers
- trauma
- hypertriglyceridemia
- extreme hyperlipidemia
- some medications
if patient goes home with T-tube, teach about these two things
cannot have tub bath
manifestations of infection
ethnic group in which gallbladder disorders are more common
Native American
cholelithiasis gallstones are made up of these two things
cholesterol
calcium bilirubinate
gallstones result from a combination of factors, including these three
biliary stasis
abnormal composition and reabsorption
inflammation of gallbladder
to diagnose pancreatic cancer, a(n) ____________ or ____________ is done followed by _________________________
CT scan, needle aspiration, tumor marker staging
in pancreatitis, this electrolyte may be decreased
calcium
T-tube drainage is expected to be this color
bloody green brown
cholelithiasis pain occurs in these two areas (include any places pain radiates to and when pain may occur)
epigastric pain or RUQ pain
chest pain that may radiate to mid/upper back and right scapula (usually 1 hour after eating and can last 4-5 hours)
when flow of bile out of gallbladder is obstructed, gallbladder becomes ______________, and ________________ response is initiated
distended, inflammatory
this lab may be increased from possible pancreatic necrosis (pancreatitis)
C-reactive protein (CRP)
most gallbladder disorders result in _______________ bile flow from the liver to the gallbladder to the duodenum
obstructed
T-tube post-op patients should be placed in ____________ position to allow for drainage
Fowler’s
cholelithiasis or cholecystitis: does not present with fever or chills
cholelithiasis
during an acute gallbladder attack, patient should be kept _________ and may need a(n) _____________ to relieve nausea and vomiting
NPO, NG tube
gallstones may follow __________ surgery due to weight loss or from certain drugs such as ________________ and __________
bariatric, oral hypertensives, ceftriaxone (Rocephin)
most common cause of cholelithiasis inflammation
gallstone lodged in cystic duct
monitor T-tube drainage and record every _________
8 hours
what is Cullen’s sign?
bruising on the abdomen
in pancreatitis, these two lab work tests, when elevated, indicate an obstructed bile duct
bilirubin, alkaline phosphatase
pain presentation of pancreatitis: _______, ________, _________ gastric pain that
1. is worse when __________ or when __________
2. may radiate to left or right side of _______
3. may feel better in _________ position or _______________ with knees _______
sudden, severe, steady, lying supine, walking, back, sitting, leaning forward, bent
best imaging test for pancreatitis and related complications such as pseudocysts and abscesses
CT scan
two lab work tests that are expected to be elevated with pancreatitis
serum amylase (also urinary amylase)
serum lipase
most common cause of obstructed bile flow
gallstones
when caring for a patient with a T-tube, monitor stool ________
color
five risk factors for gallstones
obesity
diabetes
high estrogen states
hyperlipidemia
Crohn’s disease
it is not uncommon for T-tube drainage to be ______ in first day, then it decreases to _______ by day 3
0.5-1 L, 200 mL
patient with pancreatitis needs to be kept ________ to prevent normal secretions from stimulating pancreas to release pancreatic enzymes
NPO
when food is allowed, a pancreatitis patient should have a diet high in ____________ and low in _____________
carbohydrates, fats
jaundice may occur if gallstone becomes __________, causing hepatocyte damage from __________ into liver
lodged, bile reflux
if bile flow is obstructed, __________________ and ___________ may need to be administered (gallbladder problems)
fat soluble vitamins, bile salts
