Test 3/Gallbladder Flashcards
1
Q
Gallbladder and Exocrine Pancreas
A
*Bile is secreted by the liver and stored in the gallbladder
2
Q
Liver excretes-
A
Approximately 500 to 1000 mL/day. Most (95%) of the bile that has entered the intestines is reabsorbed in the last part of the small intestine (terminal ileum), and returned to the liver for reuse
3
Q
Composition of bile
A
- Water
- Conjugated billirubin
- Organic and inorganic ions
- Small amount of proteins
- 3 lipids (bile salts, lecithin, & cholesterol
- These three must remain intact and balanced or the cholesterol will precipitate and form cholesterol gall stones*
4
Q
Gallbladder has a capacity of
A
50 ml. It concentrates the bile 10 fold by removing water and stores it until a person eats
5
Q
Cholecystokinin stimulates:
A
the digestion of fat and protein
6
Q
Cholelithiasis
A
Stone formation in the gallbladder
7
Q
Cholecystitis
A
Acute or chronic inflammation
8
Q
Choledochrolithiasis
A
Stones form and migrate to the common bile duct
9
Q
Risk Factors for Cholelithiasis:
A
- Obesity
- Middle Age
- Pregnancy and use of oral contraceptives
- Rapid weight loss- 5 lbs a week
- Disease of Ileum
- Gender-twice as common in women
10
Q
Choledochrolithiasis stones form and-
A
migrate to the common bile duct
11
Q
Clinical manisfestations of choledochrolithiasis:
A
- Indigestion to severe pain
- Fever
- Nausea/vomiting
- diaphoresis
- Murphy’s sign- plapation of RUQ causes pain which causes temporary inspiratory arrest
- Depends on if stones are mobile dark urine, jaundice if hepatic ducts involved
12
Q
Complications of choledochrolithiasis:
A
- Gangrenous cholecystitis
- Subphrenic abscess
- Pancreatitis
- Gall bladder rupture: peritonitis
13
Q
Acute Cholecystitis
A
- Localized or diffuse RUQ pain.
- Radiation to right scapula. Vomiting/Constipation
- Low grade fever
14
Q
Radiation of abdominal pain:
A
- Perforated Ulcer
- Biliary Colic
- Renal Colic
- Dysmenorrhea/Labor
- Renal Colic (Groin)
15
Q
Diagnostics for Cholecystitis:
A
- Ultrasonography
- Cholecystography
- Cholangiogram
- ERCP
- Percutaneous transhepatic cholangiography
- WBC/CBC
- Direct and indirect Bilirubin
- ALT/AST
16
Q
Endoscopic Retrograde Cholangiopancreatography (ERCP)
A
A stent is protruding from the bile duct into the wall of the small intestine. The stent bypasses the leak and allow the bile duct to heal without the need for major surgery
17
Q
Cholecystography
A
- 6 tablets (1 at a time) are swallowed that contain the contrast medium
- Contrast media (dye) is injected in the cystic duct
18
Q
Liver Profile test includes:
A
- ALT
- AST
- Alkaline Phosphatase
- GGTP
- Bilirubin
- Prothrombin time
- Protein
- LDL
- Albumin
- Globulin
19
Q
Conservative Therapy:
A
- Fluid/electrolyte balance, pain control, NG if severe, ATB’s if indicated
- Endoscopy to place stents, remove stones
- Oral dissolution therapy with ursodeoxycholic acid (Actigal)
- Extracorporeal shock wave lithotripsy
20
Q
Surgery:
A
- Lap. cholecystectomy
- Open cholecystectomy with a T tube
- Transhepatic biliary catheter
21
Q
Extracorporeal Shock Wave Lithotripsy
A
Monitor—-Ultrasound transducer——Shock stone in gallbladder
- **There is an underwater spark discharge and ellipsoidal reflector
- Pt laying in a water bath
22
Q
Laparoscopic Cholesystectomy involves
A
Laparoscopic instruments, Gallbladder and Camera
23
Q
Medication
A
- Analgesics
- Anticholinergics: Robinal for spasm
- Fat soluble vitamins for chronic gallbladder disease
- Bile salts for chronic gallbladder disease
- Pruritus: Questran, moisturizers
24
Q
Nutrition:
A
- Low fat diet
* Reduced calorie if obese
25
Nursing Diagnoses for surgical pt:
* Acute pain
* Ineffective therapeutic
* regimen management
26
Planning
* Relief of pain and discomfort
* No post op complication
* No recurrent attacks of chlecystitis or cholelithiasis
27
Nursing Interventions/Health Promotion
* ID predisposing factors
* Chronic chol: when to seek care
* Early detection
28
Acute Interventions:
* Treat pain, N/V
* Comfort and emotional support
* Fluid and electrolyte balance
* Pruritis with jaundice: baking soda or alpha keri baths, lotions, soft old linen, temp control, short nails
* Assess progression of symptoms & development of complications
29
Nursing Care Post Laparoscopic Cholecystectomy
* Pain management from phrenic nerve irritation from carbon dioxide.
* Monitor for complications
* Left side-lying Sims position
* Deep breathing
* Dressing over small incisions
* Low fat diet
30
Nursing Care: Open Cholecystectomy
* Adequate ventilation and prevention of resp. complications
* T Tube: maintain drainage to closed gravity system. Monitor drainage q 2 hrs. for first day post at q shift after.
* ***NOTE***** 500-1000 ml/day should decrease with healing
* Protect surrounding skin: bile irritation
* Monitor stool- may be clay colored but should regain pigmentation as bilirubin returns to the duodenum
* Low fat diet
31
Disorders of the Pancreas
* Pancreatitis
| * Pancreatic cancer
32
Exocrine Functions of Pancreas
* Acid must quickly and efficiently neutralize to prevent damage to the duodenal mucosa
* Macromolecular nutrients- proteins, fats and starch- must be broken down much further before their constituents can be absorbed through the mucosa into blood.
33
Pancreatic juice
digestive enzymes and bicarbonate
34
Digestive enzymes
Trypsinogen and Chymotrypsin (protein digestions, Amylase (starch digestion), Lipase (fat digestion)
35
Pancreas is innervated by the
vagus nerve, which applies a low level stimulus to secretion in response to anticipation of a meal.
* **However the most important stimuli for pancreatic secretion comes from three hormones:
* Cholecystokinin
* Secretin
* Gastrin
36
Acute Pancreatitis:
Inflammation in the gland as a result of obstruction of the outflow of pancreatic secretions
37
Etiology of acute pancreatitis
* Biliary tract disease
* Alcoholism
* Trauma
* Viral infections
* Certain drugs
* Neoplastic growth
* Unknown
38
Pathogenic mechanism of acute pancreatitis
* Autodigestions of the pancreas
* Obstruction of pancreatic ducts
* Trypsinogen activated in the pancreas not in the duodenum
* Elastase: Hemorrhage
* Phospholipase A: fat necrosis
39
Involvement extends from
edematous pancreatitis to necrotizing pancreatits
40
Interstitial Form:
is swollen and inflamed. Neither hemorrhage nor necrosis is present
41
Hemorrhage Form:
inflammation, hemorrhage, and necrosis is present
42
Clinical manifestations of acute Pancreatitis
* Pain- Extreme, left upper abdominal radiating to back, aggravated by eating, sudden onset
* Persistent vomiting
* Low grade fever
* Guarding
* Dyspnea
* Ileus, abdominal distention
* Hypovolemia
43
Local complications for acute pancreatitis:
Pancreatic Pseudocyst, Pancreatic abscess
44
Systemic Complications for acute pancreatitis:
Pulmonary (pleural effusion, atalectasis, pneumonis , Cardiovascular (hypotension) Hypocalcemia
45
Diagnostic Studies for acute Pancreatitis
* History with physical exam
* Elevated serum amylase and lipase
* Urinary amylase
* WBC-leukocytosis
* Hyperglycemia (500-1000 mg/dl)
* **Calcium drops less than 8 mg/dl
* x-rays to rule out other GI disorders
46
Collaborative Care for acute pancreatitis
Conservative therapy
| Surgical therapy
47
Conservative Therapy for acute pancreatitis
* Pain control with morphine
* Antispasmodic agents
* Correct fluid and electrolytes
* NPO
* NG
* Prophylactic antibiotics
* Peritoneal lavage
48
Surgical Therapy for acute pancreatits
if pancreatitis related to gall stones
* ERCP
* Lap cholecytectomy
* Removes abscess, or pseudocyst
49
Medication for acute pancreatitis:
* No drug treatment to cure pancreatitis
* Pain management: Opioids- morphine
* G.I. motility- decrease vagal stimulation
* Fluid and electrolyte replacement- monitor calcium and potassium loss
50
Diet therapy for acute pancreatitis
* NPO until abdominal pain subsides and amylase levels return to normal- rest the pancreas
* TPN depending on situation
* J tube feeding
* Diet resumed no alcohol and caffeine low fat- bland diet- progress as tolerated
* No alcohol
51
Nursing diagnosis for acute pancreatitis
* Acute pain
* Imbalance nutrition
* Fluid volume deficit
* Ineffective therapeutic regimen management
52
Planning for acute pancreatitis
* Relief of pain
* Fluid and electrolyte balance
* Minimal to no complication
* No recurrent attacks
53
Acute intervention for acute pancreatitis
* Monitor vitals
* Amin. IV fluids
* Monitor for respiratory failure
* Monitor for hypocalcemia
* Pain control
* Manage NG
* Monitor blood sugars
* Diet teaching: restrict fats, alcohol
54
Chronic Pancreatitis Etiology
* Chronic obstructive pancreatitis
| * Chronic calcifying pancreatitis: usually alcoholics
55
Collaborative Care for chronic pancreatitis:
* Diet
* Pancreatic enzyme replacement (Viokase)
* Control of DM
56
Clinical manifestations of chronic pancreatitis
* Acute pain
* Recurrent attacks
* Weight loss
* Constipation
* Mild juandice with dark urine
* Steatorrhea
* DM
57
Cancer of the Pancreas Etiology
* Over 50 yrs
* More common in men
* Cigarette smoking/ETOH abuse/Drug Abuse
* High fat diet
* Theory that there is a genetic link
58
Clinical Manifestations of pancreatic cancer
* Pain-earliest and most common symptom
* Rapid weight loss
* G.I. upset
* Jaundice
* Pruritus
59
Diagnostic tests for pancreatic cancer
* Ultrasound
* CT scan
* MRI
* Fine needle aspiration
* Tumor markers
60
Collaborative Care for pancreatic Cancer
* Neither radiation or chemotherapy is effective ---extend life one year only
* Surgical: Whipple Procedure- need to take pancreatic enzymes for life. i.e. Viokase
