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med surg 2 > gallblader disease > Flashcards

gallblader disease Flashcards

1
Q

GALLBLADDER

A
  • pear shaped muscular sac
  • stores bile from liver and concentrates it
  • essential for emulsification of fats
  • powerful antioxidant
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2
Q

BILE

A

BITTER, YELLOW FLUID

  • bile salts
  • cholesterol
  • calcium
  • acids
  • produces gallstones
  • liver manufactures 1-1.5 quarts /days
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3
Q

COMPLICATIONS

A

CHOLELITHIASIS
-gallstone formation

CHOLECYSTITIS
-inflammation of the gallbladder or cystic duct

OBSTRUCTION
-caused by gallstones

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4
Q

WHO’S AT RISK

A
  • 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)
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5
Q

GALLSTONES

A
  • 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
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6
Q

CAUSES OF GALL STONES

A

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
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7
Q

CHOLECYSITIS

A

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”
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8
Q

SYMPTOMS

A
  • 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
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9
Q

COMPLICATIONS

A
  • abscess
  • pancreatitis
  • biliary cirrhosis
  • fistulas
  • rupture of the gallbladder
  • inflammation of biliary duct
  • bile peritonitis
  • empysema
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10
Q

CHOLELITHIASIS

A

GALLSTONE FORMATION:

  • bile stagnation
  • solid crystalline
  • changes in chemical composition
  • decrease bile flow
  • immobility
  • pregnancy
  • inflammation
  • obstructive lesions
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11
Q

SYMPTOMS OF CHOLELITHIASIS

A
  • 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
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12
Q

BILARY COLIC

A
  • 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
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13
Q

COMPLICATIONS OF STONES

A
  • inflammation of biliary ducts
  • obstruction
  • peritonitis
  • carcinoma
  • biliary cirrhosis
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14
Q

DIAGNOSTIC TESTS

A
  • ULTRASONOGRAPHY
  • CY SCAN
  • RADIOLOGIC STUDIES
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15
Q

CHOLECYSTOGRAM

A
  • gallbladder series
  • oral contrast(pills)
  • abdominal x-ray
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16
Q

CHOLANGIOGRAM

A
  • IV contrast

- series of X rays

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17
Q

ERCP( ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY)

A
  • use of endoscope
  • injection of dye
  • series of X rays
18
Q

CT SCAN

A
  • with or without contrast

- 2 dimensional image

19
Q

DIAGNOSTIC STUDIES

A

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

20
Q

MEDICATIONS

A

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
21
Q

UROSO (URSODIOL)

A

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
22
Q

DIAGNOSTIC TESTS: LITHOTRIPSY

A

extracorporeal shock wave lithotripsy:

  • pulverizes stones
  • passes into duodenum
  • passed in stool
23
Q

SURGERY:LAPROSCOPIC CHOLESYSTECTOMY

A
  • less invasive
  • 3-4 small incisions
  • same day surgery (90%) over night
  • return to normal ADL’s in 2-3 days
24
Q

DISCHARGE INSTRUCTIONS

A
  • incision care
  • when to call doctor
  • activity
  • diet
25
Q

SURGERY: INCISIONAL/OPEN CHOLEYCYCTECTOMY

A
  • invasive with skin incision
  • hospital stay 4-7 days
  • may require T-Tube insertion
26
Q

T-TUBE

A
  • used if common bile duct is explored
  • used pre op for biliary obstruction
  • attached to dosed drainage system
27
Q

OPEN CHOLEYCYCTECTOMY

A

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
28
Q

THE PANCEAS

A

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
29
Q

ACUTE PANCREATITIS

A

inflammation that occurs when pancreatic ductal flow becomes obstructed and digestive enzymes escape from the duct and start to digest the pancreas itself.

30
Q

ACUTE PANCREATITIS ETIOLOGY

A
  • biliary tact disease
  • alcoholism
  • other trauma -viral, hereditary , abscess,hypercalcemia, hypertriglyceridemia,idiopathic
31
Q

DEGREE OF REACTION PANCREATITIS

A

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
32
Q

DEGREE OF REACTION PANCREATITIS

A
  • ileus, abdominal distention,ascites
  • grey’s turner’s sign
  • Cullen’s sign
33
Q

COMPLICATIONS OF PANCREATITIS

A

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

34
Q

DIAGNOSTIC STUDIES PANCREATITIS

A
  • elevated serum amylase/lipase
  • other lab findings
  • x-rays of chest and abdomen
  • pancreatic ultrasound
  • CT/scan/MRI
  • ERCP
35
Q

MANAGEMENT OF ACUTE PANCREATITIS

A

PAIN CONTROL

  • dilaudid
  • nitroglycerin (releases smooth muscles and relieves pain)

FLUID RESUSCITATION
-IVF, albumin, plasma, volume expanders

NUTRITIONAL SUPPORT

36
Q

ACUTE PANCREATITIS MANAGEMENT

A
  • pain management
  • reduce/ suppress pancreatic enzymes
  • monitor serum electrolytes
  • monitor respiratory function
  • administer antibiotics as ordered
  • surgery for absecess, pseudocyst or peritonitis
37
Q

DISCHARGE TEACHING PANCREATITIS

A
  • 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
38
Q

CHRONIC PANCEATITIS

A

-progressive destruction of the pancreas with replacement of scar tissue

  • irreversible damage
  • exacerbations
  • chronic inflammation
  • decrease digestive enzymes
  • malabsorption of nurtients, fats,and calories
39
Q

CHRONIC PANCREATITIS DEGREE OF REACTION

A
  • intense abdominal pain
  • weight los with ascites
  • jaundice
  • dark urine
  • diabetes
  • dyspnea,diminshed breth sounds, orthopnea
  • steatorrhea
40
Q

CHRONIC PANCREATITIS DIAGNOSTIC TESTS

A

LABS

  • serum amylase/lipase
  • serum bilirubin
  • alkaline phosphatase

TESTS
biopsy of pancreas

ULTRASOUND

ERCP

41
Q

MEDICAL MANAGEMENT CHRONIC PANCREATITIS

A

ENZYME REPLACEMENT

INSULIN THERAPY

med surg 2 (17 decks)

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