Week 6 Cholecystitis/pancreatitis/hepatitis/cirrohsis Flashcards
What are the symptoms of both acute and chronic Cholecystitis?
- Sometimes none
- Abd pain
- N&V
- Dyspepsia, eructation, flatulence
- Rebound tenderness (blumberg’s sign)
- Fever
- Jaunice/ clay-coloured stool/dark urine
- Steatorrhea (fatty poops)
- Biliary colic
What are some non-surgical interventions for cholecystitis?
- no fatty foods - high fibre
- Antiemetics for N&V
- IV fluids if dehydrated
- hydropmorph or morphine for acute pain
- Ketorolac/NSAIDS for mild to mod pain (watch bleeding)
What are non-surgical interventions for gall bladder stone management?
- ESWL - shock wave lithotripsy
- Percutatneous Transhepatic catheter (drain) -it’s a stent that diverts bile around the duct
What two conditions is Percutatneous Transhepatic catheter (drain) -(it’s a stent that diverts bile around the duct), most typically used?
- cancers
- chronic cholecystitis
What is the gold standard for surgical interventions for cholecystectomy?
Lacproscopic cholecystectomy (Lap Chole)
What is the difference in hospital discharge between Lap chole or open chole?
Lap chole - discharge same day
Open chole- discharge 1-2 days after
What are the 3 things we need to give/monitor in someone with open chole that is different than lap chole?
- Antibiotics to prevent infection
- Assess surgical site
- Jackson Pratt drain- JP drain (bulb drain) - patient usually goes home with this
What are the symptoms of acute pancreatitis?
boring/tunneling pain
severe abd pain
weight loss
jaundice
tender
rigid abdomen
decreased/absent bowel sounds
grey/blue flanks
What are the symptoms of chronic pancreatitis?
- gnawing/burning
- episodes of abd pain
- ascites
- LUQ mass
- Steatorrhea
- Weight loss
- Jaundice
- Dark urine
- DM
What are the complications of pancreatitis?
- Jaundice
- intermittent hyperglycemia
- multisystem organ failure
- Coagulation defects
- Shock
- Paralytic ileus
Where does pancreatitis pain start and move to?
starts left upper quad then to back and sometimes left shoulder
What 3 drugs types are used in acute pancreatitis?
- Opioids (maybe PCA)
- Ranitidine and PPI to lower gastric secretions
- Antibiotics if inflammation is really severe for acute necrotizing
How many hours do we want to have someone NPO min with acute pancreatitis?
24-48 hours
What kind of oral care does someone with pancreatitis need?
brush teeth and swishes (NPO)
If someone is very ill with pancreatitis how do we avoid further pancreas inflammation?
NG to low suction them
What is preferred in someone with acute pancreatitis? IV TPN or jejunal tube feed?
jejunal tube feed after 1-2 days NPO
Do we give someone with acute pancreatitis food right away or wait?
wait- gradually resume food
What lab are we most concerned about in acute pancreatitis and why?
calcium
hypocalcemia
b/c calcium binds to free acids
What sign do we see if someone is experiencing hypocalcemia?
muscle twitching (tetany)
What do we do with someone experiencing hypocalcemia?
calcium
Why do we monitor resp. status for someone with acute pancreatitis?
because pancreatic enzymes and juices impact the diaphragm. swelling, edema, pain b/c patient can’t take deep breaths
What 3 things do we monitor for in someone with acute pancreatitis?
- Respiratory status
- hypocalcemia
- daily weights b/c poor nutrition
What 3 drugs do we give to people with chronic pancreatitis?
- opioids and non-opioid analgesics
- Ranitadine and PPI
- Pancreatic enzymes (d/t loss of funtion of the pancreas)
What are the 4 nutritional interventions for someone with chronic pancreatitis?
- TPN or jejunostomy (if cal need can’t be kept up with)
- 4000-6000 cal/day
- avoid high fat foods
- alcohol cessation
What are early signs of Cirrhosis?
Fatigue
maybe weight change
maybe N&V
pain
What are the symptoms of later stage cirrhosis?
- jaundice
- dry/itchy skin
- rashes
- purpuric lesions
- vascular lesions
- ascites/edema
- blood in stool/emesis
- fetor hepaticus
- neuro changes
- asterixis
How do we know our interventions for liver cirrhosis are working?
- decrease in ascites and edema
- BP- adequate circulatory volume
What are the 4 interventions we need to do for someone with liver cirrhosis?
- manage fluid volume - avoid fluid overload
- Manage bleeding
- Prevent & manage confusion
- Manage pruritis
What are the 5 possible interventions to help someone manage fluid volume with liver cirrhosis?
- Low Na diet
- Vitamin suppliments
- Diuretics
- Paracentesis if respiratory distress
- monitor peritonitis - IV antibiotics if needed
- TIPS - transhepatic portal-systemic shunt procedure - portal & hepatic vein shunt reduces pressure in portal vein = reduces pressure/ascities
What are the 7 interventions to help manage bleeding in someone with liver cirrhosis?
- watch for esophageal varices
- Betablockers - lower BP
- Treat infections
- Avoid straining
- Vasocative drugs like octreotide
- Endoscopic therapies
- TIPS procedure
What are the 2 ways we help prevent and manage confusion in liver cirrhosis?
- Neuro assessment - baseline & trends
- Monitor ammonia levels
How do we manage ammonia levels?
- moderate protein intake
- Drugs used sparingly so we don’t mask decrease in LOC
- lactulose to decrease ammonia levels (PO or NG)
- need 2-3 soft stools to lower confusion
- hypokalemia & dehydration risk - monitor for asterixis and fetor hepaticus
What are 5 interventions to manage pruritis from liver cirrhosis?
- avoid warm temps
- Moisturize skin
- Avoid irritants
- Cool compresses
- corticosterioid creams - sertraline (SSRI tricks the brain that you are not itchy)
What do we teach patients about living at home with Cirrhosis?
- bathroom access is important d/t lactulose
- Sleeping position d/t ascities
- Nutrition & drug therapy
- ETOH abstinence
- family monitor for encephalopathy
- Avoid hepatotoxic meds like tylenol
- Liver transplant possibility
- discuss end of life plans
Where is viral hepatitis felt on the body?
Upper right quadrant pain
What are the complications of viral hepatitis?
- depression
- polyarthritis
- myalgia
- Renal insufficiency
- Cognitive impairment
- Heart disease
What are the 2 goals for viral hepatitis?
- promote nutrition
- Manage fatigue
What diet should someone with viral hepatitis have?
high carb and calories
moderate fat & protein
small frequent meals
high calorie snacks
supplimental vitamins
Why do people with viral hepatitis become fatigued?
infection and decreased metabolic energy production
encourage periods of rest and activity
What device is used for acute pancreatitis and why?
NG Gomco suction machine
to reduce gastric secretions and reduce pain
What intervention is used in ascites (Liver cirrhosis) and why?
Paracentesis
to remove excess fluid and decrease symptoms
What do we use for nutritional management in someone with chronic pancreatitis and why?
TPN
to bypass the GI tract and reduce secreations from the pancreas to give that area a rest
What device is used post surgery after an open cholecystectormy and why?
JP drain
to drain fluid accumulation
What procedure is done for GERD and why?
nissen fundoplication
it acts as a belt to strengthen the LES and prevent acid reflux
What procedure is done for esophageal cancer and why?
Esophageal dilation
to dilate a constricted esophagus
nutritional management
