gallblader disease Flashcards
GALLBLADDER
- pear shaped muscular sac
- stores bile from liver and concentrates it
- essential for emulsification of fats
- powerful antioxidant
BILE
BITTER, YELLOW FLUID
- bile salts
- cholesterol
- calcium
- acids
- produces gallstones
- liver manufactures 1-1.5 quarts /days
COMPLICATIONS
CHOLELITHIASIS
-gallstone formation
CHOLECYSTITIS
-inflammation of the gallbladder or cystic duct
OBSTRUCTION
-caused by gallstones
WHO’S AT RISK
- more frequent in women (childbearing age)
- more frequent over 40 years
- more common in caucasions
- high incidence in native americans/Mexican americans
- familial tendency
- sedentary lifestyle
- obesity
- 4 F’s (female,fertile,fat, forty)
GALLSTONES
- solid crystalline precipitates
- major component is cholesterol
- same are from calcium salts
- sand-like
- usually form in gallbladder or bile duct
- can cause life threatening infection of liver, bile duct and pancreas
CAUSES OF GALL STONES
stasis/ stagnation of bile
incomplete emptying of the GB
- bile coagulates and clumps together
- imbablance of cholesterol and bile salts
Pure cholesterol stones -"white " diet (sugar, white bread pasta) -soda and lots of meat - not enough vegetables
CHOLECYSITIS
inflammation of the gallbladder and or cystic duct
- acute versus chronic ETIOLOGY
- gallstones usually
- bacterial infection
- tumor of pancreas or liver
- decreased blood supply to gallbladder
- gallbladder “sludge”
SYMPTOMS
- may be asymptomatic
- attacks lasts 2-3 days
- intense, sudden pain RUQ
- pain may radiate up to right shoulder
- recurrent attacks several hours after meals
- nausea/vomiting/indigestion
- rigid abdominal muscles or bloating
- slight fever/chills/leukocytosis
- loose, light colored stools
COMPLICATIONS
- abscess
- pancreatitis
- biliary cirrhosis
- fistulas
- rupture of the gallbladder
- inflammation of biliary duct
- bile peritonitis
- empysema
CHOLELITHIASIS
GALLSTONE FORMATION:
- bile stagnation
- solid crystalline
- changes in chemical composition
- decrease bile flow
- immobility
- pregnancy
- inflammation
- obstructive lesions
SYMPTOMS OF CHOLELITHIASIS
- may be silent
- dependent upon if stone are stationary or mobile
- If obstruction is present
- amber(tea) colored urine
- clay colored stools
- jaundice
- pruritus
- steatorrhea
- bleeding tendencies
BILARY COLIC
- severe steady pain due to spasm
- accompanied by tachycardia,diaphoresis and prostration
- pain may last as long as 1 hour with residual RUQ tenderness
- occurs 3-6hrs after heavy meals
COMPLICATIONS OF STONES
- inflammation of biliary ducts
- obstruction
- peritonitis
- carcinoma
- biliary cirrhosis
DIAGNOSTIC TESTS
- ULTRASONOGRAPHY
- CY SCAN
- RADIOLOGIC STUDIES
CHOLECYSTOGRAM
- gallbladder series
- oral contrast(pills)
- abdominal x-ray
CHOLANGIOGRAM
- IV contrast
- series of X rays
ERCP( ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY)
- use of endoscope
- injection of dye
- series of X rays
CT SCAN
- with or without contrast
- 2 dimensional image
DIAGNOSTIC STUDIES
LABRATORY VALUES
- LFT’s (liver function studies)
- looks for obstruction
- direct and indirect bilirubin
- Serum enzymes(AST)
- may be elevated
- CBC
- elevated WBC count
- SERUM AMYLASE
- pancreas involevement
PROTHROMBIN TIME
*prolonged clotting due to lack of vit.K absorption
MEDICATIONS
control infection
*antibiotics
correct/maintain balance
pain control
-Narcotics: dilaudid, morphine, can increase biliary colic
- Antispasmotics: (anticholinergics) atropine
- Antiemetics: Phenergan,zofran
- Give fat soluble vitamins (a,d,e,k) *chronic GB disease
- any type of obstruction
UROSO (URSODIOL)
naturally occurring bile acid
- small quatities in humans
- large quatities in certain species of bears
ACTIONS
- replace/displace toxic bile acids
- cytoprotection of injured bile duct epithelial cells
- assists to shrink gall stones
DIAGNOSTIC TESTS: LITHOTRIPSY
extracorporeal shock wave lithotripsy:
- pulverizes stones
- passes into duodenum
- passed in stool
SURGERY:LAPROSCOPIC CHOLESYSTECTOMY
- less invasive
- 3-4 small incisions
- same day surgery (90%) over night
- return to normal ADL’s in 2-3 days
DISCHARGE INSTRUCTIONS
- incision care
- when to call doctor
- activity
- diet
SURGERY: INCISIONAL/OPEN CHOLEYCYCTECTOMY
- invasive with skin incision
- hospital stay 4-7 days
- may require T-Tube insertion
T-TUBE
- used if common bile duct is explored
- used pre op for biliary obstruction
- attached to dosed drainage system
OPEN CHOLEYCYCTECTOMY
COMPLICATIONS:
- bleeding
- common bile duct injury
- infection
POST OP:
- monitor for bleeding/complications
- difficulty breathing
- pain control
- monitor I&O, NG tube drainage
- IV therapy
THE PANCEAS
ENDOCRINE
-release insulin
EXOCRINE
-release of potent enzymes to digest fat, protein and carbohydrates
- LIPASE acts on fats
- AMYLASE acts on starches
- inactive enzymes:act on protein
- secrets NA and Biacarb to neutralize acid
ACUTE PANCREATITIS
inflammation that occurs when pancreatic ductal flow becomes obstructed and digestive enzymes escape from the duct and start to digest the pancreas itself.
ACUTE PANCREATITIS ETIOLOGY
- biliary tact disease
- alcoholism
- other trauma -viral, hereditary , abscess,hypercalcemia, hypertriglyceridemia,idiopathic
DEGREE OF REACTION PANCREATITIS
Pain
- sudden onset LUQ radiating to the back
- severe (deep and boring)
- food worsens pain
- if alcoholic may last for days and is associated with anorexsia ,nausea, vomiting
- flushing,fever,tachycardia
- dyspnea
- hypotension(shock),cyanosis
- jaundice
- muscle guarding, abdominal rigidity
- diminished or absent bowel sounds
DEGREE OF REACTION PANCREATITIS
- ileus, abdominal distention,ascites
- grey’s turner’s sign
- Cullen’s sign
COMPLICATIONS OF PANCREATITIS
PSEUDOCYST
-a cavity outside the pancreas filled with necrotic waste and fluid rupture causes peritonitis
ABSCESS
- fluid filled cavity within the pancreas assosicated with high fever. requires prompt surgical intervention , can cause sepsis with rupture
PULMONARY
-pneumonia, atelectasis,pleural effusions
DIAGNOSTIC STUDIES PANCREATITIS
- elevated serum amylase/lipase
- other lab findings
- x-rays of chest and abdomen
- pancreatic ultrasound
- CT/scan/MRI
- ERCP
MANAGEMENT OF ACUTE PANCREATITIS
PAIN CONTROL
- dilaudid
- nitroglycerin (releases smooth muscles and relieves pain)
FLUID RESUSCITATION
-IVF, albumin, plasma, volume expanders
NUTRITIONAL SUPPORT
ACUTE PANCREATITIS MANAGEMENT
- pain management
- reduce/ suppress pancreatic enzymes
- monitor serum electrolytes
- monitor respiratory function
- administer antibiotics as ordered
- surgery for absecess, pseudocyst or peritonitis
DISCHARGE TEACHING PANCREATITIS
- avoid alcohol
- avoid caffeine
- avoid smoking
- avoid stressful situations
- restrict fats
- encourage carbohydrates
- avoid crash or binge diets
- monitor elevated BS/fatty stools
- take pain meds/H2 receptor blockers
CHRONIC PANCEATITIS
-progressive destruction of the pancreas with replacement of scar tissue
- irreversible damage
- exacerbations
- chronic inflammation
- decrease digestive enzymes
- malabsorption of nurtients, fats,and calories
CHRONIC PANCREATITIS DEGREE OF REACTION
- intense abdominal pain
- weight los with ascites
- jaundice
- dark urine
- diabetes
- dyspnea,diminshed breth sounds, orthopnea
- steatorrhea
CHRONIC PANCREATITIS DIAGNOSTIC TESTS
LABS
- serum amylase/lipase
- serum bilirubin
- alkaline phosphatase
TESTS
biopsy of pancreas
ULTRASOUND
ERCP
MEDICAL MANAGEMENT CHRONIC PANCREATITIS
ENZYME REPLACEMENT
INSULIN THERAPY
