Semester 4 - Exam 3 !!!! > Biliary > Flashcards

Biliary Flashcards

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1
Q

What is stored in the gallbladder?

A

Bile

Made in the liver, and stored and concentrated in Gallbladder.
Due to becoming more concentrated in the Gallbladder there is higher chance of precipitation and formation of gallstones.

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2
Q

What are the endocrine functions of the pancreas?

A
  • Insulin
  • Glucagon - raises blood sugar by converting glycogen to glucose in liver (fight or flight)
  • Somatostatin - exerts a hypoglycemic affect - lower blood sugar.
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3
Q

What are the exocrine functions of the pancreas?

A

Amylase: carbohydrate digestion
Trypsin: Protein digestion
Lipase: fat digestion
Secretin: bicarb secretion

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4
Q

What is another word for Cholelithiasis

A

gall stones

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5
Q

What are Cholelithiasis?

A

Stones formed in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition.
Two forms :
Pigment stones - cannot be dissolved and require surgery
Cholesterol stones - Its solubility depends on bile acids and lecithin (phospholipids) in bile

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6
Q

What genetic disease increases the risk of developing gallstones?

(Chart 44-1: Risk Factors – Cholelithiasis)

A

Cystic fibrosis

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7
Q

What metabolic disorder increases the risk of gallstones?

(Chart 44-1: Risk Factors – Cholelithiasis)

A

Diabetes

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8
Q

True / False

Frequent fluctuations in weight can increase the risk of gallstone formation.

A

True

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9
Q

What gastrointestinal condition increases gallstone risk due to impaired bile salt absorption?

(Chart 44-1: Risk Factors – Cholelithiasis)

A

Ileal disease or ileal resection

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10
Q

True / False

High and low-dose estrogen therapy affect gallstone risk

A

True - increases risk

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11
Q

What body composition factor increases the risk of cholelithiasis?

(Chart 44-1: Risk Factors – Cholelithiasis)

A

Obesity

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12
Q

Which demographic groups have a higher risk of developing gallstones?

(Chart 44-1: Risk Factors – Cholelithiasis)

A

Women

Women with multiple pregnancies

Native American populations

U.S. Southwestern Hispanic populations

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13
Q

What are the clinical manifestations of Cholelithiasis

A
  • None or minimal symptoms, acute or chronic
  • Pain
  • Biliary colic
  • Jaundice
  • Changes in urine or stool color: grayish stool, dark urine because of bile secretion - due to kidneys attempting to remove bile.
  • Vitamin deficiency,esp. fat soluble (vitamins A, D, E, and K): obstruction of bile flow and lipase interferes with absorption.
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14
Q

Why may patients with Gallstones develop jaundice?

A

Due to possible obstruction of the common bile duct. Bilirubin cannot drain into the GI for excretion.

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15
Q

What studies visualize the gallbladder and bile ducts?

(TABLE 44-1: Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease)

A
  • Cholecystogram
  • Cholangiogram

These imaging studies visualize the gallbladder and bile ducts.

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16
Q

What diagnostic procedure allows visualization of the liver, gallbladder, and mesentery using a trocar?

(TABLE 44-1: Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease)

A
  • Laparoscopy

Allows direct visualization of the anterior surface of the liver, gallbladder, and mesentery

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17
Q

What imaging study is commonly used to evaluate abdominal organ size and detect masses?

(TABLE 44-1: Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease)

A
  • Ultrasonography

Shows organ size
Detects masses or gallstones

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18
Q

What imaging studies detect tumors, cysts, pseudocysts, abscesses, hematomas, and assess severity of pancreatitis?

(TABLE 44-1: Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease)

A
  • Helical CT (computed tomography) and MRI

Used to:

Detect neoplasms

Diagnose cysts, pseudocysts, abscesses, hematomas

Determine severity of pancreatitis

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19
Q

What diagnostic test visualizes biliary structures and the pancreas through endoscopy?

(TABLE 44-1: Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease)

A
  • Endoscopic Retrograde Cholangiopancreatography (ERCP)

Combines endoscopy and fluoroscopy
Visualizes biliary ducts and pancreas

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20
Q

What lab test is used to detect biliary tract obstruction when bone disease is absent?

(TABLE 44-1: Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease)

A
  • Serum alkaline phosphatase

Elevated levels suggest biliary obstruction

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21
Q

What laboratory markers indicate biliary stasis and may also be elevated in alcohol abuse?

(TABLE 44-1: Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease)

A

Gamma-glutamyl transferase (GGT)

Gamma-glutamyl transpeptidase

Lactate dehydrogenase (LDH)

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22
Q

How do cholesterol levels change in biliary obstruction and liver disease?

(TABLE 44-1: Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease)

A

Elevated cholesterol → biliary obstruction
Decreased cholesterol → parenchymal liver disease

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23
Q

Is the following statement true or false?

Cholecystitis is when a patient has calculi in the gallbladder.

A

False

Rationale: Cholecystitis is inflammation of the gallbladder. Cholelithiasis is when a patient has calculi in the gallbladder

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24
Q

What are the medical managements of cholelithiasis?

A
  • ERCP: endoscopic retrograde cholangiopancreatography- extract gallstones.
  • Dietary management: low fat diet
  • Medications: ursodeoxycholic acid and chenodeoxycholic acid- dissolve small radiolucent gallstones made up of cholesterol

Laparoscopic cholecystectomy - surgically removal of gallbladder

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25
What are Intracorporeal or extracorporeal lithotripsy ?
Removal of gallstones with soundwaves.
26
What are the Assessment of the Patient Undergoing Surgery for Gallbladder Disease?
* Patient history * Knowledge and education needs - diet (high fat food?) * Respiratory status and risk factors for postoperative respiratory complications (ABCs) * Nutritional status * Monitor for potential bleeding - ensure any blood thinners are stopped prior to surgery. * GI symptoms: after laparoscopic surgery, assess for loss of appetite, vomiting, pain, distention, fever—potential infection or disruption of GI tract
27
What are possible complications that can happen after undergoing surgery for gallbladder disease?
* Bleeding * GI symptoms * Complications r/t surgery in general such as atelectasis and thrombophlebitis (inflammation in vein + clot formation). Encourage deep breaths, Incentive Spirometer, SCD's, Heparin subq injection q8h. Ambulation as soon as possible will help GI, prevent thrombophlebitis and atelectasis.
28
What are the Planning and treatment Goals for the Patient Undergoing Surgery for Gallbladder Disease ?
* Goals may include : relief of pain, adequate ventilation, intact skin, improved biliary drainage (often shoulder pain due to trapping of Co2) * Optimal nutritional intake - May take 3 to 4 days until optimal food intake. * Absence of complications * Understands self-care routines : Education on how to take care of themselves after discharge i.e not lift anything heavier than a gallon of milk, cough with a pillow on the abdomen or use abdominal binder, care for JP drain.
29
What are nursing Interventions for the Patient Undergoing Surgery for Gallbladder Disease ?
* Low Fowler position * NG or NPO until bowel sounds return. Once bowel sounds return they can start having liquids before moving on to a soft, low-fat, high-carbohydrate diet * Care of biliary drainage system * Analgesics, pain management - enough to alleviate enough pain but not so that they cannot walk. * Turn, cough, and deep breathing; splinting to reduce pain by using pillow or abdominal binder * Ambulation
30
What is Acute Pancreatitis?
pancreatic duct becomes obstructed, and enzymes back up, causing autodigestion and inflammation of the pancreas. 80% from cholethiasis or ETOH abuse
31
What is Chronic pancreatitis?
progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts
32
What causes acute pain in pancreatitis? (Chart 44-4)
Edema and distention of the pancreas, peritoneal irritation, and excessive pancreatic enzyme stimulation.
33
Why does uncontrolled pain worsen pancreatitis? (Chart 44-4)
Pain increases metabolism, which stimulates pancreatic and gastric enzyme secretion.
34
Which opioids are commonly used to treat pancreatitis pain? (Chart 44-4)
Morphine, fentanyl, and hydromorphone.
35
Why are patients with acute pancreatitis kept NPO? (Chart 44-4)
Food and fluid intake stimulate pancreatic secretions.
36
Why is bed rest recommended in pancreatitis? (Chart 44-4)
It decreases body metabolism and reduces pancreatic secretions.
37
When is a nasogastric tube used in pancreatitis? (Chart 44-4)
When paralytic ileus, nausea, vomiting, or abdominal distention are present.
38
What is the purpose of nasogastric suction in pancreatitis? (Chart 44-4)
To relieve nausea, vomiting, and abdominal distention.
39
Why must worsening abdominal pain be reported immediately? (Chart 44-4)
It may indicate pancreatic hemorrhage.
40
Why should patients be repositioned every 2 hours? (Chart 44-4)
To prevent pulmonary and vascular complications.
41
What non-pharmacologic methods can reduce pancreatitis pain? (Chart 44-4)
Relaxation techniques, focused breathing, and distraction.
42
Why are patients with pancreatitis at risk for malnutrition? (Chart 44-4)
Pancreatic dysfunction interferes with digestion and nutrient absorption.
43
Why must blood glucose levels be monitored in pancreatitis? (Chart 44-4)
Pancreatic endocrine dysfunction can cause hyperglycemia.
44
Why may enteral or parenteral nutrition be required in pancreatitis? (Chart 44-4)
Oral intake may be prohibited while the pancreas rests.
45
What diet is recommended once oral intake resumes? (Chart 44-4)
High-carbohydrate, low-fat, low-protein diet.
46
Why must alcohol be eliminated after pancreatitis? (Chart 44-4)
Alcohol further damages the pancreas and triggers attacks.
47
Why should patients avoid coffee and spicy foods? (Chart 44-4)
They stimulate pancreatic and gastric secretions.
48
Why are daily weights important in pancreatitis patients? (Chart 44-4)
They help monitor nutritional status and fluid balance.
49
Why can pancreatitis cause respiratory problems? (Chart 44-4)
Retroperitoneal edema elevates the diaphragm and decreases lung ventilation.
50
What position improves breathing in pancreatitis? (Chart 44-4)
Semi-Fowler’s position.
51
Why are coughing and deep breathing exercises encouraged? (Chart 44-4)
To prevent atelectasis.
52
Why should pancreatitis patients be repositioned frequently? (Chart 44-4)
To promote lung expansion and drainage.
53
Why may oxygen therapy be necessary? (Chart 44-4)
To treat hypoxia and reduce respiratory workload.
54
Why are pancreatitis patients at risk for hypovolemia? (Chart 44-4)
Blood and plasma may shift into the abdominal cavity.
55
What urine output goal indicates adequate perfusion in pancreatitis? (Chart 44-4)
≥0.5 mL/kg/hr or ≥400 mL/day.
56
Why may blood or plasma transfusions be required? (Chart 44-4)
Hemorrhagic pancreatitis can cause significant blood and plasma loss.
57
Why should calcium gluconate be readily available? (Chart 44-4)
Hypocalcemia can occur due to calcium loss into peripancreatic tissues.
58
Why is abdominal girth measured daily in pancreatitis? (Chart 44-4)
To detect ascites from fluid accumulation.
59
What life-threatening complication must nurses monitor for in severe pancreatitis? (Chart 44-4)
Multiple Organ Dysfunction Syndrome (MODS).
60
What is the priority nursing intervention in acute pancreatitis?
Keep the patient NPO to rest the pancreas.
61
What is the most common symptom of acute pancreatitis?
Severe epigastric pain radiating to the back.
62
What position often relieves pancreatitis pain?
Leaning forward or sitting upright.
63
Explain the Patho of Acute Pancreatitis.
Self digestion of the pancreas by own proteolytic enzymes. Gallstones may enter the common bile duct and block the Vater Ampulla which causes reflux of pancreatic juices which starts to digest the pancreas.
64
Apart from self-digestion of pancreas, what are other causes for acute pancreatitis?
* Bacterial/viral * Blunt trauma * Peptic ulcer disease * Hyperlipidemia * Hypercalcemia * Corticosteroids * ETOH/ Tobacco use
65
What are the clinical manifestations of Acute Pancreatitis?
* Severe abdominal & back pain - 24-48 hours post heavy meal or ETOH * Ecchymosis in flank or umbilicus * N/V - emestis have gastric origin but is bile stained - yellow * Fever * Jaundice - may be due to gallstones and blockage of common bile duct. * Mental confusion
66
What are late / severe signs of Acute Pancreatitis?
* Hypotension * Tachycardia * Cyanosis * Cold, Clammy skin * AKI * Resp. Distress * Myocardial depression * Hypocalcemia * Hyperglycemia * DIC
67
Explain the Patho of Chronic Pancreatitis.
Inflammatory disorder leading to progressive destruction of pancreas. Pancreatic cells are replaced by fibrous tissue which ↑ pressure in pancreas leading to obstruction of pancreas, common bile duct , and duodenum
68
What are the causes of Chronic Pancreatitis?
* ETOH in Western world * Malnutrition worldwide
69
What are the clinical manifestations of Chronic Pancreatitis?
* Recurring attacks of abdominal/pack pain * Vomiting * Severe pain even opioids can’t relieve * Weight loss * Malabsorption * Impaired protein/fat digestion * Steatorrhea=fatty stools * Calcification of pancreas glands
70
What are the medical managements for both acute and chronic pancreatitis?
* Pain management * ICU * Resp. Care * Biliary drainage * Surgery
71
What are the nursing managements for both acute and chronic pancreatitis?
* Relieving pain/discomfort * Improving breathing pattern * Nutritional status * Skin Integrity * Monitoring and Manage Potential Complications - Fluid/electrolyte imbalances - Panc Necrosis - Shock/MODS (multiple organ dysfxn syndrome)
72
What are the collaborative problems that can occur with Acute Pancreatitis?
* Fluid and electrolyte disturbances * Necrosis of the pancreas * Shock * Multiple organ dysfunction syndrome * DIC
73
What is a major symptom of chronic pancreatitis? a) Recurrent attacks of severe upper abdominal and back pain accompanied by vomiting b) Fever, jaundice, confusion, and agitation c) Ecchymosis in the flank or umbilical area d) Abdominal guarding
a) Recurrent attacks of severe upper abdominal and back pain accompanied by vomiting Rationale: Chronic pancreatitis is characterized by recurrent attacks of severe upper abdominal and back pain accompanied by vomiting. Acute pancreatitis presents with fever, jaundice, confusion, agitation, ecchymosis in the flank or umbilical area, and abdominal guarding.
74
Is the following statement true or false? Patients with acute pancreatitis require a high-carbohydrate, low-protein, and low-fat diet.
True Rationale: In patients with acute pancreatitis, a high-carbohydrate, low-protein, and low-fat diet increases caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond.
75
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) yellow sclarea b) light amber urine c) circumoral pallor d) black tarry stool
a) yellow sclarea
76
A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? a) malnutrition and acute pancreatitis b) alcohol consumption and smoking c) caffeine consumption and acute pancreatitis d) acute hepatitis and alcohol consumption
b) alcohol consumption and smoking
Semester 4 - Exam 3 !!!!
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