Chapter 48: Liver, Biliary Tract, and Pancreas Problems (Part 2- Gallbadder, Pancreas)

Question 1

in a patient with pancreatitis, a clear-liquid diet may be given (and then progressed) once these two things are present

Answer 1

bowel sounds have returned
no pain

Question 2

in gallbladder disorders, direct bilirubin is _____________ and is indicative of _____________ process in liver and biliary system

Answer 2

increased, obstructive

Question 3

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

Answer 3

T-tube

Question 4

minimally invasive method to remove gallbladder

Answer 4

laparoscopic cholecystectomy

Question 5

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)

Answer 5

Whipple resection

Question 6

gallstones are more common in (men, women) and with age

Answer 6

women

Question 7

bulky fatty stool from lack of pancreatic lipase

Answer 7

steatorrhea

Question 8

predominant sign of cholecystitis

Answer 8

severe, steady RUQ pain that radiates to mid upper back or to right scapula/shoulder and lasts 12-18 hours

Question 9

if asymptomatic and low risk for complications, treatment for gallbladder disorders may be _____________

Answer 9

conservative

Question 10

these two pancreatic cancer treatments are palliative

Answer 10

chemotherapy, radiation

Question 11

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

Answer 11

ultrasound

Question 12

this lab may be increased from inflammation (pancreatitis)

Answer 12

white blood cell (WBC)

Question 13

client that experiences frequent symptoms, has acute cholecystitis, or has very large gallstones typically has this treatment

Answer 13

gallbladder and stones surgically removed

Question 14

health promotion for pancreatitis should address these five things

Answer 14

alcohol, smoking, stress, diet, infection symptoms

Question 15

two most common causes of pancreatitis

Answer 15

1. gallbladder disease
2. chronic alcohol use

Question 16

to help prevent gallbladder disorders, teach about changing __________________, educate on dangers of ________ dieting, and possibly implement ____________________

Answer 16

modifiable risk factors, yo-yo, cholesterol-lowering drugs

Question 17

cholelithiasis or cholecystitis: may present with fever and chills

Answer 17

cholecystitis

Question 18

this type of procedure can be done for pancreatic cancer; connects the pancreatic duct, common bile duct, and/or stomach to the jejunum

Answer 18

anastomoses

Question 19

this complementary therapy decreases gallbladder symptoms and stimulates bile secretion

Answer 19

goldenseal

Question 20

pancreatitis usually occurs in this age group

Answer 20

50-60

Question 21

complication of Whipple resection

Answer 21

leaking of digestive juices from healing and breakdown (will have drain)

Question 22

first sign of pancreatic cancer

Answer 22

jaundice

Question 23

maintain ___________ of T-tube site because bile is irritating

Answer 23

cleanliness

Question 24

in a T-tube patient, if stool color is pale, do this

Answer 24

clamp tube per order and monitor response

Question 25

if gallbladder is ___________ or ____________, may not be candidate for laparoscopic cholecystectomy and may require open surgical method

Answer 25

very large, infected

Question 26

manifestations include epigastric pain and/or RUQ pain, intolerance to fatty foods, nausea, flatulence, bloating, abdominal distention, diarrhea, chest pain

Answer 26

cholelithiasis

Question 27

what is Turner's sign?

Answer 27

bruising on the side

Question 28

seven risk factors for pancreatitis

Answer 28

1. alcohol consumption 2. biliary obstruction 3. peptic ulcers 4. trauma 5. hypertriglyceridemia 6. extreme hyperlipidemia 7. some medications

Question 29

if patient goes home with T-tube, teach about these two things

Answer 29

cannot have tub bath manifestations of infection

Question 30

ethnic group in which gallbladder disorders are more common

Answer 30

Native American

Question 31

cholelithiasis gallstones are made up of these two things

Answer 31

cholesterol calcium bilirubinate

Question 32

gallstones result from a combination of factors, including these three

Answer 32

biliary stasis abnormal composition and reabsorption inflammation of gallbladder

Question 33

to diagnose pancreatic cancer, a(n) ____________ or ____________ is done followed by _________________________

Answer 33

CT scan, needle aspiration, tumor marker staging

Question 34

in pancreatitis, this electrolyte may be decreased

Answer 34

calcium

Question 35

T-tube drainage is expected to be this color

Answer 35

bloody green brown

Question 36

cholelithiasis pain occurs in these two areas (include any places pain radiates to and when pain may occur)

Answer 36

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)

Question 37

when flow of bile out of gallbladder is obstructed, gallbladder becomes ______________, and ________________ response is initiated

Answer 37

distended, inflammatory

Question 38

this lab may be increased from possible pancreatic necrosis (pancreatitis)

Answer 38

C-reactive protein (CRP)

Question 39

most gallbladder disorders result in _______________ bile flow from the liver to the gallbladder to the duodenum

Answer 39

obstructed

Question 40

T-tube post-op patients should be placed in ____________ position to allow for drainage

Answer 40

Fowler's

Question 41

cholelithiasis or cholecystitis: does not present with fever or chills

Answer 41

cholelithiasis

Question 42

during an acute gallbladder attack, patient should be kept _________ and may need a(n) _____________ to relieve nausea and vomiting

Answer 42

NPO, NG tube

Question 43

gallstones may follow __________ surgery due to weight loss or from certain drugs such as ________________ and __________

Answer 43

bariatric, oral hypertensives, ceftriaxone (Rocephin)

Question 44

most common cause of cholelithiasis inflammation

Answer 44

gallstone lodged in cystic duct

Question 45

monitor T-tube drainage and record every _________

Answer 45

8 hours

Question 46

what is Cullen's sign?

Answer 46

bruising on the abdomen

Question 47

in pancreatitis, these two lab work tests, when elevated, indicate an obstructed bile duct

Answer 47

bilirubin, alkaline phosphatase

Question 48

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 _______

Answer 48

sudden, severe, steady, lying supine, walking, back, sitting, leaning forward, bent

Question 49

best imaging test for pancreatitis and related complications such as pseudocysts and abscesses

Answer 49

CT scan

Question 50

two lab work tests that are expected to be elevated with pancreatitis

Answer 50

serum amylase (also urinary amylase) serum lipase

Question 51

most common cause of obstructed bile flow

Answer 51

gallstones

Question 52

when caring for a patient with a T-tube, monitor stool ________

Answer 52

color

Question 53

five risk factors for gallstones

Answer 53

obesity diabetes high estrogen states hyperlipidemia Crohn's disease

Question 54

it is not uncommon for T-tube drainage to be ______ in first day, then it decreases to _______ by day 3

Answer 54

0.5-1 L, 200 mL

Question 55

patient with pancreatitis needs to be kept ________ to prevent normal secretions from stimulating pancreas to release pancreatic enzymes

Answer 55

NPO

Question 56

when food is allowed, a pancreatitis patient should have a diet high in ____________ and low in _____________

Answer 56

carbohydrates, fats

Question 57

jaundice may occur if gallstone becomes __________, causing hepatocyte damage from __________ into liver

Answer 57

lodged, bile reflux

Question 58

if bile flow is obstructed, __________________ and ___________ may need to be administered (gallbladder problems)

Answer 58

fat soluble vitamins, bile salts