N232 Med/Surge > Lec 7 > Flashcards

Lec 7 Flashcards

(56 cards)

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1
Q

Where does bile come from ?

A

the liver ( produces it)

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2
Q

Why is bile needed ?

A
  • digest fat
  • absorb fat soluble Vitamins ADEK
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3
Q

Before bile goes into the duodenum, what system does it go through?

A

the ductal system

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4
Q

What makes up the biliary system?

A
  • liver
  • gallbladder
  • pancreas
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5
Q

What causes gallstones?

A
  • fatty diet
  • genetics
  • pregnancy ( cause cholestasis(slowing down), enlarged gallbladder)
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6
Q

What are the 4 F’s for getting gallstones?

A
  • female
  • forty
  • fat
  • fertile
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7
Q

What organ is not apart of the biliary tree?

A

gallbladder

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8
Q

What is cholangitis?

A

inflammation of the common bile duct (CBD)

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9
Q

What is cholecystitis ?

A

inflammation of gallbladder

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10
Q

What are the 2 types of acute cholecystitis?

A
  • Calculous cholecystitis
  • acalculous cholecystitis
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11
Q

which cholecystitis is more common?

A

calculous cholecystitis

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12
Q

What is calculous cholecystitis?

A

inflammation of gallbladder with stones

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13
Q

What is peritonitis?

A

infection of the peritoneum

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14
Q

What plays a part of gallstone formation?

A
  • abnormal metabolism of cholesterol
  • bile salts
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15
Q

What is acalculous cholecystitis?

A

inflammation of gallbladder without gallstones

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16
Q

What causes acalculous cholecystitis?

A
  • decrease blood flow to gallbladder
  • twisting, kinking of gallbladder neck or cystic duct
  • Sphincter of Oddi dysfunction (SOD)
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17
Q

What type of patients get acalculous cholecystitis?

A
  • sepsis pt
  • severe trauma, burn pt
  • TPN pt
  • multiple organ dysfunction pt
  • major surgery pt
  • hypovolemia pt
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18
Q

What 2 types of scans help diagnose gallstones?

A
  • ultrasound
  • HIDA scan
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19
Q

What is chronic cholecystitis?

A
  • repeated episodes of cystic duct obstruction causing gallbladder inflammation
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20
Q

What are 2 complications that come from chronic cholecystitis?

A
  • pancreatitis
  • cholangitis ( bile duct inflammation)
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21
Q

What does bile obstruction lead to ?

A

jaundice

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22
Q

What are two problems that are more common in chronic cholecystitis but can happen in acute cholecystitis as well?

A
  • jaundice
  • icterus ( yellow sclera)
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23
Q

What are the main risks for developing cholelithiasis ( gallstones)?

Study These Flashcards
A
  • obesity
  • DM II
  • dyslipidemia
  • insulin resistance
24
Q

Who’s at high risk for developing cholelithiasis(gallstones)?

Study These Flashcards
A
  • indian
  • mexican
25
What are some symptoms for a patient with cholecystitis?
- episodic, vague upper abdominal pain that may radiate to right shoulder - pain triggered by high fat or high volume meal - n/v - dyspepsia ( indigestion issues) - jaundice - clay colored stools - dark urine - steatorrhea ( fatty stool)
26
How is cholecystitis diagnosed?
- s/sx - US to visualize edema/stones - elevated bile salts - elevated total bilirubin - urine bilirubin - elevated alkaline phosphates - elevated WBC
27
what lab distinguishes the dx between cholecystitis vs pancreatitis?
serum amylase = pancreatitis
28
What are the 2 main planning/outcomes for patients with cholecystitis?
- pt maintain appropriate weight - pt will report decrease in abdominal pain/discomfort
29
What are some interventions for patients with cholecystitis?
- high fiber and low fat diet - reduce gas producing foods - small frequent meals - regular weight monitoring - labs for BUN, prealbumin, albumin, and total protein
30
What's a procedure they can do to break up stones?
extracorporeal shock wave lithotripsy (ESWL)
31
Whats a treatment option for those who cannot have surgery for cholecystitis?
percutaneous transhepatic biliary catheter ( drain)
32
How do biliary catheters work?
they divert bile from the liver to the duodenum to bypass the stricture
33
After an open cholecystectomy, what type of drain is used to drain out excess fluid for the first 24hrs after surgery?
Jackson pratt
34
What causes acute pancreatitis? ACRYNOM
I G.E.T. S.M.A.S.H.E.D. - Idiopathic - Gallstones - Ethanol - Trauma - Steroids - Mumps/malignancy - Autoimmune - Scorpion sting - Hypercalcemia/hypertriglyceridemia - ERCP ( endoscopic retrograd cholangiopancreatography) - Drugs
35
What are the signs of retroperitoneal bleeding?
- generalized jaundice - grey/blue discoloration of abdomen/periumbilical area ( Cullen's sign) - gray/blue discoloration of the flanks ( side of body)( Grey Turners sign)
36
When there is a biliary obstruction, what labs will you see increased?
- amylase - lipase - ALT
37
What medication is a H2 receptor blocker?
famotidine
38
What is a PPI medication that decreases gastric acid secretion?
pantoprazole
39
What is the normal body fat percentage for men and women?
- men 15-20 - women 18-32
40
Overweight BMI range is?
25-29
41
Obesity BMI range is ?
more than > 30
42
Class I BMI is?
30-35
43
Class II BMI is ?
35-40
44
Class III BMI is?
more than > 40
45
What are some hormones that affect body weight?
- leptin - adiponectin - resistin - inflammatory cytokines - apolipoprotein E - cholecystokinin - ghrelin
46
When obese, what complications are associated with cardiovascular?
- HTN - hyperlipidemia - CAD - stroke - PAD
47
When obese, what complications are associated with endocrine?
- metabolic syndrome - insulin resistance - DM II
48
When obese, what complications are associated with gastrointestinal?
cholelithiasis ( gallstones)
49
When obese, what complications are associated with genitourinary/reproductive?
- erectile dysfunction - menstrual irregularities - urinary incontinence
50
When obese, what complications are associated with musculoskeletal?
- chronic back pain - early osteoarthritis
51
When obese, what complications are associated with neurologic?
stroke
52
When obese, what complications are associated with psychiatric?
depression
53
When obese, what complications are associated with respiratory?
- obesity hypoventilation syndrome - OSA
54
What genetic factor makes the body feel like its starving?
leptin
55
What are some long term drugs that cause obesity?
- corticosteroids - estrogens and certain progestins - NSAIDS - antihypertensives - antidepressants, psychoactive drugs - antiepileptic drugs
56
Patients can get surgical treatment for obesity only if?
- repeated failure of nonsurgical interventions - BMI greater than 40 or = - weight more than 100% above IBW
N232 Med/Surge
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