Disorders of gallbladder, pancreas, bile duct

Question 1

Question 1 of 9

Laura is a 48-year-old woman who recently appeared at the clinic complaining of right upper quadrant (RUQ) pain that worsens after eating. From her records, you see that Laura has been in poor health for some time. She is obese and leads a sedentary lifestyle. Her medical history shows prolonged alcohol abuse, although Laura reports that she has been attending Alcoholics Anonymous meetings “on and off” for the past 2 years. She states that when she stops attending AA meetings, she has “at most” two to three alcoholic drinks two to three times per week.

You want to evaluate Laura’s reported pain further. Upon palpation of the right abdomen, Laura cringes as you press down while asking her to breathe in deeply. You consider this to be positive for \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Cullen sign
Grey Turner sign
Murphy’s sign
Chvostek’s sign

Answer 1

Murphy’s sign

Murphy’s sign is considered positive if pain is elicited on the right side, but not the left side. A positive test may indicate cholecystitis. Cullen and Grey Turner signs may be present in pancreatitis, whereas Chvostek’s sign appears with abnormal calcium levels.

Question 2

Question 2 of 9

Laura finds it strange when you ask if she feels any pain in her \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. You tell her you are asking this question because you suspect she may have inflammation of her gallbladder and the pain from this condition often radiates.
Right hip
Shoulder
Knee
Heart

Answer 2

Shoulder

Pain from the gallbladder often refers to the shoulder area, commonly the right shoulder.

Question 3

Question 3 of 9

Inflammation of the gallbladder is known as \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and most commonly is caused by gallstones, known as \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
biliary stasis, cholecystitis
biliary colic, cholangitis
cholecystitis, cholangitis
cholecystitis, cholelithiasis

Answer 3

cholecystitis, cholelithiasis

Cholecystitis refers to inflammation if the gallbladder, whereas cholelithiasis is the presence of gallstones. Gallstones are the most common cause of inflammation in the gallbladder. Being female, older than 40, and obese increases the risk of gallstone formation.

Question 4

Question 4 of 9

When you speak with Laura to review her symptoms further, you ask what type of food she eats that tends to result in pain. You know that \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ foods tend to worsen gallbladder pain.
High-glycemic
High-protein
simple carbohydrate
High-fat

Answer 4

High-fat

Eating foods high in fat can increase the sensation of pain in patients with gallbladder issues. Bile is stored in the gallbladder and is released into the small intestine to aid in fat digestion. When high-fat foods are consumed, the gallbladder is signaled to contract and release bile. In individuals with an inflamed gallbladder, pain may occur.

Question 5

Question 5 of 9

CT scans later reveal the presence of gallstones in Laura’s gallbladder. Most gallstones are comprised of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
cholesterol
uric acid
oxalic acid
calcium

Answer 5

Cholesterol

Cholesterol is the most common component of gallstones, as cholesterol is a primary substance in bile. Almost 80% of gallstones are made of cholesterol. The remaining 20% are pigment stones.

Question 6

Question 6 of 9

Given Laura’s history of alcohol abuse and the current condition of cholelithiasis, you are worried about the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ being affected.
stomach
pancreas
heart
duodenum

Answer 6

Pancreas

Both the gallbladder and pancreas have ducts that enter the duodenum near the opening from the stomach. Because of the proximity of these structures, problems in either the gallbladder or pancreas may affect the other organ. Laura’s gallbladder issues may eventually compromise pancreatic functioning.

Question 7

Question 7 of 9

Acute pancreatitis may cause autodigestion of the pancreas and result in elevation in the serum of pancreatic \_\_\_\_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
AST, ALT
bilirubin, bile salts
amylase, lipase
Hct, Hb

Answer 7

Amylase, lipase

In addition to producing the hormones glucagon and insulin, the pancreas creates and secretes several digestive enzymes. Normally, these enzymes are released into the small intestine where they are activated. In the case of pancreatitis, cell damage may result in the release of these enzymes into the bloodstream. Thus, a key sign for pancreatitis is the elevation in the serum of the digestive enzymes from the pancreas, amylase and lipase.

Question 8

Question 8 of 9

Bleeding in the peritoneal and retroperitoneal areas may present as \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_\_\_\_\_ signs in patients with acute pancreatitis.
Chvostek, Trousseau
Cullen, Grey Turner
Murphy, McBurney
Psoas, Obturator

Answer 8

Cullen, Grey Turner

Cullen and Grey Turner signs occur when internal hemorrhage is present in the abdominal area. Cullen sign appears around the umbilicus area, whereas Grey Turner sign appears on the flanks. These signs are often considered a hallmark of acute pancreatitis.

Question 9

Question 9 of 9

\_\_\_\_\_\_\_\_\_\_\_ criteria are used to evaluate severity of acute pancreatitis by examining five characteristics at admission and six additional characteristics within 48 hours.
Cullen
Grey Turner
Ranson
Murphy
Check Answer

Answer 9

Ranson

Ranson criteria are used to assess prognosis of acute pancreatitis. Criteria such as age, blood glucose levels, and white blood cell count are evaluated at admission. Additional criteria are assessed 48 hours after admission.

Question 10

Question 1 of 5

A nurse finds that the diagnostic report of a patient shows gallstones in the cystic duct. Which substance is most commonly found in gallstones?

Calcium
Oxalic acid
Cholesterol
Uric acid

Answer 10

Cholesterol

Question 11

Question 2 of 5

A patient complains of nausea and vomiting after eating, along with right upper quadrant pain that radiates to the right shoulder. What condition do you suspect?

Pancreatic cancer
Peptic ulcer disease
Cholecystitis
Liver cancer

Answer 11

Cholecystitis

Question 12

Question 3 of 5

A biliary duct obstruction may cause _______________.

decreased bile production
liver cancer
increased blood clotting time
increased serum bilirubin levels

Answer 12

increased serum bilirubin levels

Question 13

Question 4 of 5

Laboratory values for a patient reveal elevated serum amylase and lipase. What condition do you suspect?

Cholecystitis
Cholelithiasis
Pancreatitis
Grey Turner disease

Answer 13

Pancreatitis

Question 14

Question 5 of 5

Ranson criteria are used to evaluate _______________.

severity of gallstones
severity of acute pancreatitis
severity of liver cancer
severity of pancreatic cancer

Answer 14

severity of acute pancreatitis