Hepatobiliary Disorder Flashcards
ductless system
endocrine gland
secretes hormones directly into the blood
endocrine gland
tells body to do or not do something
absorbed into capillaries around cells
hormone
this decreases blood sugar
inslun
this increases blood sugar
glucagon
beta cells of the pancreas secrete what
insulin
alpha cells of endocrine secrete what
glucagon
duct system
exocrine gland
secretes products ie/ digestive enzymes/juices
secreted via ducts
exocrine gland
these release ENZYMES to digest food
gallbladder and pancreas
this enzymes breaks down starches
amylase
this enzymes breaks down fat
lipase
this enzymes breaks down protein
trysin
this is inflammation of pancreas
amylase
what can acute pancreatitis affect
gall stones-blocks enzymes
how does being a chronic alcoholic affect acute pancreatitis
Changes structures of pancreatic duct Forms strictures (scar tissue)
describe what occurs during acute pancreatitis
once activated, the enzymes will break down the cells/organs
if blocked, the enzymes will autodigest the pancreas
what does autodigestion cause
extreme pain immune response (swelling, bleeding out, decreased proteins)
acute and chronic pancreatitis have…
different outcomes
S/S of acute pancreatitis
severe pain (increases when eat) abdominal distention palpable abdominal mass (pancreas) rigid abdomen (guarding) bruising, fever, N/D, jaundice
what happens to fluid during acute pancreatitis
fluid leaves the vascular space due to body responding to decrease in protein
what does a rigid and board like abdomen indicate***
BLEEDING
this can occur during acute pancreatitis
bruising around umbilical cord
Cullen’s sign
this can occur during acute pancreatitis
back pain
Turner’s sign
what happens to the BP during acute pancreatitis
LOW BP (hypotension) due to bleeding and ascites (larger abdomen will decrease BP)
lab diagnoses for acute pancreatitis
ultrasound
blood work
what blood work indicates acute pancreatitis
elevated serum: lipase and amylase
elevated WBC, glucose, bilirubin, ACT+ AST
decrease in Ca and Mg
why does lipase in blood indicate pancreatitis
lipase is not supposed to be in blood
should be in PANCREAS
what do ACT and AST indicate
liver function
what are acute pancreatitis interventions
goal: control pain
decrease gastric secretions, hydrate (IV fluids), replace Ca and Mg, assess for return of bowel sounds, pain meds
how do you decrease gastric secretions of pancreatitis pt
*keep stomach empty and dry
keep NPO, NGT to suction, bed rest
what pain meds are given for acute pancreatitis
Fentanyl patch
morphine and dilaudid
PCA( pt controlled analgesic) is commonly used
what other meds are commonly given for pancreatitis
steroids- decrease inflammation
Zantac- decrease acid production
anticholinergics- antiSLUDGE (dry up pt)
anything that enters the stomach triggers..
pancreas
when you start eating after acute pancreatitis
small frequent meals moderate increase in carbs increase in protein low fats AVOID GI stimulants (ie/ coffee or alcohol)
what is important for post acute pancreatitis pt
WEIGH client daily
same clothes, same scale, same time
education for post acute pancreatitis pt
avoid caffeine
initially avoid alcohol use
S/S of acute biliary disease
jaundice, clay colored stools, dark urine
most common cause of CHRONIC pancreatitis
ALCOHOL
what occurs to pancreas in chronic pancreatitis
calcified pancreas-permanent damage
describe chronic pancreatitis
loss of exocrine and endocrine function
- cant digest food which leads to fatty stool (steatorrhea)
- wt loss, muscle wasting, foul smelling stool
what do chronic pancreatitis pts need
lifelong insulin and meds for loss of function and malabsorption
Chronic pancreatitis is a major risk factor for
pancreatic cancer
what is given daily to chronic pancreatitis pts
pancreatic enzyme replacement (PER)=
daily meds to replace enzymes not being made
type of PER
do NOT crush or chew
take with ALL meals and snacks
pancrilipase (Creon)
management of chronic pancreatitis is effective if
weight goes back to normal, no fatty food, not malnourished, no steatorrhea, no alcohol, increased calorie count (4000-6000 cal a day)
what did TPN stand for
Total parenteral nutrition (Intravenous feeding that provides patients with all the fluid and the essential nutrients they need when they are unable to feed themselves by mouth)
what can spike BS in chronic pancreatitis pt
TPN and steroids
how are acute and chronic pancreatitis the same
same stabilization but outcomes are different because chronic is long term
