Exam 2: The GI System: Disorders Of The Gallbladder And Pancreas

Question 1

Cholecystitis

Answer 1

Inflammation of gallbladder or cystic duct

Question 2

Cholelithiasis

Answer 2

Gallstone formation -> can lead to obstruction

Gallstones are aggregate of substances in bile

Question 3

Risk Factors for Cholelithiasis

Answer 3

Obesity
Middle age
Female
Rapid weight loss
Native American ancestry
Genetic predisposition
Gallbladder, pancreatic, and ileal disease

Question 4

Gallstones are of 2 types

Answer 4

1. Made of cholesterol (most common)

2. Made of bilirubin “pigmented stones”

Question 5

Cholelithiasis: Pathophysiology

Answer 5

Cholesterol gallstones form in bile → saturated with cholesterol produced by liver → cholesterol crystal formation occurs ‘microstones’ → more crystals aggregate which grow to form ‘macrostones’ → may lie dormant or become lodged in cystic or common duct → pain and cholecystitis.

Question 6

Clinical Manifestations: Cholelithiasis

Answer 6

Abdominal pain (RUQ or middle upper)
Fever
Jaundice
N/V
Heartburn
Flatulence
Food intolerance (fats and cabbage)

Question 7

Cholelithiasis Treatment

Answer 7

Medication

Surgery: laparoscopic cholecystectomy

Question 8

Cholelithiasis: Medications

Answer 8

Ursodiol

Question 9

Ursodiol

Answer 9

Used to dissolve gallstones.

Question 10

Ursodiol: Serious Side Effects

Answer 10

Frequent urination or pain when urinating

Cough with fever

Question 11

Bile acid which is naturally produced in the body and stored in the gallbladder -> decreases

Answer 11

Production of cholesterol. Ursodiol dissolves the cholesterol in bile to prevent stone formation

Question 12

Laparoscopic Cholecystectomy

Answer 12

Endoscopic retrograde cholangiopancreatography (ERCP) may be done to find or treat gallstones in common bile duct

Question 13

Acute Cholecystitis

Answer 13

A sudden inflammation of gallbladder causes severe abdominal pain.

Question 14

What causes acute cholecystitis?

Answer 14

90% is caused by gallstone in the gallbladder.

Other causes include severe illness and (rarely) tumors.

Question 15

Acute Cholecystitis: Pathophysiology

Answer 15

Occurs when bile becomes trapped in gallbladder → buildup of bile causes irritation and pressure against distended wall of gallbladder → decreased blood flow and result in ischemia, necrosis, and perforation

Question 16

Clinical Manifestations of Cholecystitis

Answer 16

RUQ or upper middle abdominal pain with rebound tenderness
Clay-colored stools
Fever
N/V
Jaundice
Leukocytosis
Elevated serum bilirubin, LFT/alkaline phosphatase

Question 17

Cholecystitis Treatment

Answer 17

Pain medication (opioids)
Antibiotics
Low-fat diet
Surgery

Question 18

What antibiotics are used for cholecystitis treatment?

Answer 18

Gentamicin

Clindamycin

Question 19

What surgery is used for cholecystitis treatment?

Answer 19

Cholecystectomy for persistent symptoms or development of chronic cholecystitis accompanies by recurrent, acute attacks

Question 20

Pancreatic Insufficiency

Answer 20

Insufficient pancreatic enzyme production (lipase, amylase, trypsin or chymotrypsin)

Question 21

Causes of pancreatic insufficiency

Answer 21

Pancreatitis
Pancreatic carcinoma
Pancreatic resection
Cystic fibrosis

Question 22

What is the main problem with pancreatic insufficiency?

Answer 22

Fat maldigestion is the main problem, so the patient will exhibit fatty stools and weight loss

Question 23

Pancreatitis

Answer 23

Inflammation of the pancreas

Can be acute or chronic

Question 24

Pancreatitis is associated with

Answer 24

Alcoholism
Obstructive biliary tract disease (cholelithiasis)
Peptic ulcers
Trauma
Hyperlipidemia
Certain drugs

Question 25

Acute Pancreatitis

Answer 25

Sudden swelling and inflammation of the pancreas.

Question 26

Acute pancreatitis: Pathophysiology

Answer 26

Develops d/t obstruction to outflow of pancreatic enzymes (amylase and lipase) → trapped in pancreas→ swelling and inflammation

Question 27

What are the clinical manifestations of acute pancreatitis?

Answer 27

``` Epigastric or mid-abdominal pain radiating to back Fever N/V Sweating Abdominal distention Low blood pressure and hypovolemia Enzymes increase vascular permeability Tachycardia Tachypnea Increased amylase and lipase levels Leukocytosis ```

Question 28

Acute Pancreatitis Goals

Answer 28

To alleviate pancreatic inflammation and to correct underlying cause.

Question 29

Acute Pancreatitis Treatment

Answer 29

NPO -> TPN Medications IV fluids

Question 30

What types of medications are used to treat acute pancreatitis?

Answer 30

Antibiotics Antidiarrheals Antiemetic

Question 31

Antibiotics used to treat acute pancreatitis include

Answer 31

``` Ampicillin Imipenem-cilastatin (Primaxin) Cefuroxime (Zinecef) Ceftazidime (Ceptaz) Metronidazole (Flagyl) ```

Question 32

What antidiarrheal medication is used to treat pancreatitis?

Answer 32

Flagyl

Question 33

What antiemetics are used to treat acute pancreatitis?

Answer 33

Phenothiazines: Promethazine (Phenergan) - affects dopamine | Serotonin Receptor Antagonists: Ondansetron (Zofran) - affects serotonin

Question 34

Chronic Pancreatitis

Answer 34

Inflammation of pancreas that does not heal or improve and gets worse over time → permanent damage.

Question 35

Chronic Pancreatitis occurs when

Answer 35

digestive enzymes attack the pancreas and nearby tissues → causing pain.

Question 36

Causes of Chronic Pancreatitis

Answer 36

``` Hereditary disorders of pancreas Cystic fibrosis—most common inherited disorder Hypercalcemia Hyperlipidemia or hypertriglyceridemia Some medications Autoimmune conditions ```

Question 37

Clinical Manifestations of Chronic Pancreatitis

Answer 37

Abdominal pain greatest in upper abdomen may last from hours to days; radiate to back Digestive problems → chronic weight loss (unintentional), diarrhea, N/V, fatty or oily stools, pale or clay-colored stools

Question 38

Chronic Pancreatitis: Goal Treatment

Answer 38

Goal is to help relieve pain, improve pancreatic function and manage complications

Question 39

Chronic Pancreatitis: Treatment

Answer 39

Avoid alcohol Low-fat meals (helps greasy stools) Pain medication (NSAIDS or opioids) Pancreatic enzyme replacement

Question 40

Pancreatic Enzyme Replacement Drugs include

Answer 40

Pancrelipase (lipacreatin, pamcrease, zymase)

Question 41

Mechanism of Action: Pancrelipase

Answer 41

Contains lipase, protease and amylase of pork origin. 1. Facilitate conversion of lipids into glycerol and fatty acids 2. Convert starches into dextrin and sugars 3. Convert proteins into peptides

Question 42

Primary use of pancrelipase

Answer 42

As replacement therapy for clients with insufficient pancreatic exocrine secretions

Question 43

Adverse Effects of Pancrelipase

Answer 43

GI symptoms of nausea, vomiting and or diarrhea | Can use metabolic symptom of hyperuricosuria.

Question 44

Pancreatic Enzyme Replacement Therapy: Assessment

Answer 44

Assess for use of foods that stimulate gastric and pancreatic secretions. Assess for and monitor presence, amount, type of pain. Assess respiratory status.

Question 45

Pancreatic Enzyme Replacement Therapy: Monitoring

Answer 45

Monitor for elevated serum and urinary amylase and elevated serum bilirubin. Monitor client’s nutritional and hydration status and for signs of infection. Check for pork allergy.