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70 Cards in this Set
- Front
- Back
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What is meant by biliary tract disorders?
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gallbladder and pancreatic dysfunction
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Where is the gallbladder and what is it attached to?
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interior surface of liver, attached to liver by loose connective tissue and common bile duct by cystic duct (which eventually attaches to duodenum)
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What is the function of the gallbladder? What is its capacity?
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to store bile that comes from the liver, during storage water is removed and bile is concentrated
-30-50 mL of bile |
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What happens when food enters the duodenum? What mediates this?
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gallbladder contracts, sphincter of oddi relaxes and bile enters intestine
-cholecystokinin-pancreozymin hormone |
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What is bile made of and what does it do?
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water, electrolytes (sodium, potassium, calcium, chloride, bicarb), lecithin, fatty acids, cholesterol, bilirubin and bile salts
-bile salts and cholesterol assist in emulsification of fats in ileum |
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What does enterohepatic circulation do?
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brings bile salts from liver to intestine then back into portal blood to return to liver
-only a small fraction of bile salts are excreted in feces |
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What is bilirubin and what breaks it down?
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broken down RBC, converted by intestinal flora into urobilinogen, which is either excreted or returned to portal circulation and re-excreted into bile
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What happens if the flow of bile is impeded?
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bilirubin does not enter intestine, blood levels increase, leading to an increase in renal excretion of urobilinogen
-indication of gallbladder disorder |
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What is the exocrine and endocrine functions of the pancreas?
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exocrine- secretion of pancreatic enzymes into GI tract
endocrine- secretion of insulin, glucagon, somatostatin into bloodstream |
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What are the secretions of the exocrine portions of the pancreas?
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digestive enzymes high in protein and electrolytes, highly alkaline (bicarb) to neutralize high acid in gastric juice
-amylase, trypsin, lipase |
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Where do the digestive enzymes of the pancrease come from?
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collected in the pancreatic duct, which joins the common bile duct and enters the duodenum
sphincter of oddi helps control rate of release |
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How is the secretion of digestive enzymes of the pancreas stimulated?
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hormones in GI tract, secretin- major stimulator of bicarb
CCK-PZ- major stimulator of enzymes |
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How much enzyme secretion is normal for the pancreas for one day?
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1500-2500 mL/day
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Where are the hormones insulin, glucagon, somatostatin produced?
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islets of langerhans (collection of embedded cells in pancreas)
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What does insulin do?
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lowers blood glucose by permitting entry of glucose into cells of liver, muscle, or other tissues to be store or used
-also promotes the storage of fat and synthesis of protein |
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What happens in the absence of insulin?
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DM, glucose cannot enter the cells and is excreted in the urine, stored fats and proteins are used for energy instead
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How is the insulin secretion from the pancreas regulated? What is normal blood glucose level?
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by the level of the glucose in the blood
-100 mg/dl |
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What does glucagon do?
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raise the blood glucose by converting glycogen to glucose in the liver
-pancreas secretes in response to dec levels of blood glucose |
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What is acalculous cholecystitis and what does it cause?
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acute gallbladder inflamation without the presence of gallstones, usually caused by surgery, trauma, burns, infections, blood transfusions
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What does somatostatin do?
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exerts hypoglycemic effect by interfering with release of growth hormone from pituitary and glucagon from pancreas, both raise blood glucose levels
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What hormones raise blood glucose levels and what hormones lower glucose levels?
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raise- insulin
lower- glucagon, epinephrine, adrenocorticosteroids, growth hormone, thyroid hormone |
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What is cholelithiasis?
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presence of calculi in gallbladder--gallstones
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How does age effect biliary function?
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arteriosclerosis changes, decrease rate of pancreatic secretion/insufficiency, inc bicarb output, impaired fat absorption, delayed gastric emptying
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What is cholecystitis?
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inflammation of the gallbladder
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What usually causes cholecystitis?
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calculous cholecystitis- gallstone obstructing bile outflow
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What are the 2 types of gallstones?
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pigment
cholesterol |
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What happens with calculous cholecystitis?
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bile is obstructed causing edema, blood vessel compression, dec in vascular supply, eventually gangrene
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What are the s/s of cholecystitis?
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pain, tenderness, rigidity of upper rt. abd, N/V
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What are the characteristics and occurance % of pigment stones?
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25%, do not dissolve must be surgically removed, often found in cirrhosis, hemolysis, and infections of biliary tract
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What are the characteristics and occurance % of pigment stones?
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75%, decrease in bile salt and an increase in cholesterol results in supersaturated bile salts that form stones
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What are the risk factors for cholelithiasis?
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obesity, women, freq changes in weight, estrogen, ileal resection, cystic fibrosis, DM
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What are the s/s of cholelithiasis?
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none, epigastric distress, fullness, abd distention, fever, upper right abd pain, N/V, gray feces, dark urine
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What are the complications of cholelithiasis?
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continual obstruction can lead to abscess, necrosis, perforation, peritonitis, jaundice, vit deficiency (A,D,E,K)
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What diagnositic techniques are used for cholelithiasis?
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ab xray, ultrasonography, cholescintigraphy, oral cholangiography, endoscopic retrograde cholangiopancreatography, fluoroscopy, percutaneous transheptic cholangiography
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What are some of the nursing considerations for endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography?
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NPO, VS, IV fluids, resp, vomiting, oversedation, prophalaxic antibiotics, bleeding, peritonitis, septicemia, pain
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What is the main treatment for cholecystitis?
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rest, IV fluids, nasogastric suctioning, analgesia, antibiotics, low fat liquids
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What is the pharmacologic treatment for gallstones?
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USCA, CDCA- over 6-12 months, can dissolve small stones and prevent
-used for those where surgery is too risky |
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What are 3 main nonsurgical techniques for gallstone removal?
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dissolving stones, use of T-tube and endoscope (basket), laser pulse, lithotripsy (shockwaves)
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What the difference between laparoscopic cholecystectomy and a regular cholecystectomy and a mini cholecystectomy?
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All remove gallbladder:
laparscopic- 4 small incisions regular- small abd incision mimi-very small abd incision |
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What is choledochostomy?
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incision and removal of stones in common bile duct
-cholecystectomy at later date |
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What is surgical cholecystostomy?
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gallblader surgically opened and stones are removed and bile or pus is drained
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What is percutaneous cholecystostomy?
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needle and catheter insertion into gallbladder to decompress biliary tract
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What are the post op nursing interventions for gallbladder disease?
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low fowlers, NG suctioning, soft diet after bowel sound return, analgesics, deep breathing, coughing, incentive spirometry, early ambulation, signs of infection/complications, I/O, bile drain output, low fat diet, VS
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What are s/s of complications of gallbladder disease surgery?
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fever, jaundice (sclerae), upper abd pain, N/V, gray stool, VS change, bile color change, incision redeness, abd rigidity/tenderness, loss of appetite
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What is pancreatitis?
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inflammation of pancreas, obstruction of pancreatic duct causes enzymes to back up inside and activate, leading to them attacking and damaging the pancreatic tissue(esp trypsin)
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What is acute pancreatitis?
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minimal organ dysfunction that heals within 6 months
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What are the risk factors of acute pancreatitis?
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long-term alcohol use, bacterial/viral infection (mumps), duodentitis, abd trauma, corticosteriods, oral contraceptives, peptic ulcer disease, hyperlipidemia, hypercalcemia, ischemic vascular disease
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What are the complications of acute pancreatitis?
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shock, anoxia, hypotension, tachycardia, cyanosis, cold/clammy skin, f/e imbalance (hypovolemia), renal failure, GI bleeding, pulm insufficiency, necrosis of pancreas
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What are the s/s of acute pancreatitis?
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rigid or board like abdomen, N/V, abdominal distention, poorly defined pain, unrelieved by vomiting or antacids
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How is acute pancreatitis diagnosed?
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abd pain, increased serum amylase, lipase, WCB, hyperglycemia, glucosuria, increased urinary amylase, elevated bilirubin, hypocalcemia, bulky/fatty stool, CT/ultrasound/xray
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How is acute pancreatitis treated?
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PN or EN feeding, NG suctioning, morphine, fluid vol maintainence, ABG monitoring, insulin, antibiotics, humidified O2, biliary drains, low fat diet, removal of thiazide diuretics, corticosteroids, oral contraceptive, alcohol, caffeine, rest
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What are nursing considerations for acute pancreatitis?
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pain management, bedrest, f/e balance, semi-fowlers, turn Q2, pulmonary assessment, ABGs, coughing, deep breathing, incentive spirometry, NPO, glucose monitoring, I/O, VS, blood admin, low serium calcium levels, shock
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What is chronic pancreatitis?
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progressive anatomic and functional destruction of the pancreas
-cells are replaced with fibrous tissue with repeat attacks |
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What causes chronic pancreatitis?
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alcoholism- causes hypersecretion of protein resulting in plugs and calculi
diets low in protein and fat |
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What are the s/s of chronic pancreatitis?
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recurring attacks of severe upper abdominal and back pain, vomiting, weight loss, steatorrhea (high fat content in stool)
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What are the diagnositic tests for chronic pancreatitis?
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ERCP, MRI, CT scan, ultrasound, glucose tolerance test, increased serum amylase levels, fecal fat content
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What is the treatment for chronic pancreatitis?
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endoscopy to remove stones and strictures, avoiding alcohol, DM mangement, enzyme replacement, proton pump inhibitor, pancreaticojejunostomy, pancreaticodudenectomy, revision of the sphincter of ampulla of vater, drainage of pancreatic cyst, distal pancreatectomy, longitudinal decompression
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What are pancreatic cysts?
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local necrosis causes fluid to collect in pseudocyst. Requires drainage and digestive ezymes must be kept away from the skin when drained
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What are risk factors for pancreatic cancer?
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smoking, toxins in the environement, industrial chemicals, diet high in fat, meat, DM, chronic pancreatitis, heredity pancreatitis
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What are the s/s of pancreatic cancer?
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vague abd pain, jaudince, weight loss, ascites, insulin deficiency, glucosuria, hyperglycemia, DM
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How is pancreatic cancer diagnosed?
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spiral CT, MRI, ERCP, biopsy, angiography, tumor markers, laparoscopy
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How is pancreatic cancer treated?
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usually diagnosed too late, may surgically remove tumor, chem/rad for pallative
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What occurs with tumors of the head of the pancreas?
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obstrution of the common bile duct, causing jaudice, gray stool, dark urine, malabsorption, abd pain, weight loss
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How are tumors of the head of the pancreas treated?
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biliary enteric shunt, total pancreatectomy, pancreaticoduodenectomy (removal of gallbladder, distal portion of the stomach, duodenum, head of the pancreas, common bile duct, anastomosis), cholecystomjejunostomy
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What are the nursing considerations for a post op pancreatic surgery patient?
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pain control, complications- hemorrhaging, blood replacement, VS, ABGs, I/O, malabsorption, hypergylcemia, low fat diet with vit supp and enzyme replacement, skin care
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What are the islets of Langerhans?
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small nest of cells in the pancreas that secrete hormones directly into the blood stream
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What are the 2 types of pancreatic islet tumors?
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insulinoma and those that do not increase insulin production
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What do insulinomas cause and how are they treated?
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excess rate of glucose metabolism, hypoglycemia
-must remove tumor |
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What is hyperinsulinism?
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overproduction of insulin by pancreatic islets, may be caused by over growth of islets of Langerhans, or tumor
-removal of tumor is treatment |
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What is Zollinger-Ellison syndrome?
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hypersecretion of gastric acid that produces ulcers
-treated with excision |
