Gallbladder & Pancreatic Disorders
Whipple Procedure =
* removal of proximal head of pancreatic, gallbladder and sometimes spleen * removal of duodenum, portion of the jejunum, and part or all of the stomach * anastomosis of ducts and stomach to jejunum
What medications can be given to gradually dissolve gallstones?
* ursodiol * chenodiol
What are some S/Sx of pancreatic cancer?
* jaundice * clay-colored stool, dark urine * abdominal pain * weight loss, anorexia, cachexia, weakness, fatigue * thrombophlebitis ( calf/leg pain)
What are some S/Sx of chronic cholecystitis?
* jaundice * clay-colored stools * steatorrhea * dark urine * pruritis
What 3 organs make up the biliary system?
* liver * gallbladder * pancreas
What are some RF for cholelithiasis?
* obesity * T2DM * insulin resistance * 4 F's * Rapid weight loss/intestinal diseases * high-fat diet
What assessment determines return of bowel function?
* passage of flatus * BM ** BS can be misleading **
In which populations is cholelithiasis the most prevalent?
* American Indian * Mexican-American
What are some nonbiliary causes of post-cholecystectomy syndrome?
* CAD * intercostal neuritis * psychiatric or neurologic disorder * unexplained pain syndrome
What are the 4 types of chronic pancreatitis?
* Calcifying * Obstructive * Autoimmune * Idiopathic
What are some possible RF for pancreatic cancer?
* DM * Chronic pancreatitis * high intake of red/processed meat * long-term chemical exposure * obesity * male gender/older age * cigarette smoking
Why might a patient experience N/V or diarrhea following a cholecystectomy?
* Fat is no longer broken down as well
What are the 4 F's associated with gallstones?
* Female * Fat * Forty * Fertile
What are some ways to identify if the patient's pancreatitis is resolving?
* Hunger returns * decreased pain med. usage * increased movement * lab values * pain assessment * tolerating dietary advancement
Why does acalculous cholecystitis affect critically ill patients?
* Increased bile viscosity due to fever & dehydration * Decreased gallbladder motility
What are the nursing considerations when administering Pancrelipase?
* Instruct the patient to drink a full glass of water, and to wipe lips to prevent skin irritation * Take with every meal/snack * Do not take with high-protein foods
Pancreatitis Diet:
* NPO until pain-free * start with small, frequent meals as tolerated * moderate-to-high carb, high protein, low fat
What are some biliary causes of post-cholecystectomy syndrome?
* New or retained stone * pseudocyst * common bile duct leak * SOD * pancreatic/liver mass * cholangitis
What are some major complications associated with acute pancreatitis?
* Shock * Hemorrhage * Renal failure / Multi-Organ Failure * Paralytic ileus * ARDS * DIC * T2DM
Post-Cholecystectomy Syndrome =
* abdominal/epigastric pain * N/V * Diarrhea * occurs after gallbladder has been removed
How might you position a patient with pancreatitis for comfort?
* fetal position * side-lying * HOB elevated * sitting up, leaning over
Describe the cycle of calculous cholecystitis.
* inflammation of the gallbladder * bile becomes trapped, is reabsorbed * irritates gallbladder wall * impaired circulation, edema, gallbladder distention
Even with a Whipple procedure, prognosis of pancreatic cancer is poor, usually ____________.
4-6 mo
A patient with pancreatitis needs __________________ calories per day for weight maintenance.
4000-6000
Pancreatitis Lab Values : Amylase = Lipase = WBC = Glucose =
A = increased within 12-24 hours and remains increased for 2-3 days L = Slowly increases but remains elevated for up to 2 weeks WBC = Increased due to infection G= Increased due to decreased insulin production by the pancreas
___________ is the primary cause of chronic pancreatitis.
Alcohol use
Describe the pain felt with acute pancreatitis.
Acute, severe, constant, knife-like pain in LUQ that may radiate to the back, L shoulder
Cullen's Sign =
Bluish-gray periumbilical discoloration * Associated with pancreatitis
What is the most common form of cholelithiasis seen in the US?
Cholesterol calculi
An ESWL can only be used to treat which types of gallstones?
Cholesterol-based
What kind of patients are affected by acalculous cholecystitis?
Critically Ill * septic * severe trauma/burns * long-term TPN * multi-organ failure * surgery * hypovolemia
Pancreatic insufficiency is a common complication in patients who have _________________, and they must include pancreatic enzymes in their diet.
Cystic fibrosis
Turner's Sign =
Ecchymosis on the flanks * Associated with pancreatitis
__________________ = Sphincterotomy with gallstone removal through an endoscope
ERCP
Acute Pancreatitis =
Early activation of pancreatic enzymes leads to self-destruction of the pancreas
What is the major nursing priority with a patient with acute pancreatitis?
Manage pain * NPO until pain-free * position for comfort
How will amylase and lipase present with chronic pancreatitis?
Normal or moderately elevated
HIDA Scan =
Nuclear medicine test that assesses the potency of the biliary system after administrating IV contrast
Name the Complication: * Epigastric Mass * Presents as epigastric pain radiating to back * High T, patient appears very ill * Abx necessary
Pancreatic Abscess
What is the most serious complication from acute necrotizing pancreatitis?
Pancreatic abscess
____________ is the leading cause of cancer death in the US.
Pancreatic cancer
___________ is given to help aid in the digestion of fats and proteins in a patient who has pancreatitis.
Pancrelipase
What is the function of the gallbladder?
Stores bile ( fat emulsification)
Name the Disorder: = Obstruction, inflammation & pyogenic infection of the biliary tract * Marked by fever, jaundice, pain, shock and CNS depression * Life-threatening
Suppurative Cholangitis
A nurse is caring for a client who has acute pancreatitis. Which of the following serum laboratory values should the nurse anticipate returning to the expected reference range within 72 hr after treatment begins? a. Aldolase b. Lipase c. Amylase d. Lactic dehydrogenase
c
_______________ = Surgical procedure to treat cancer in the head of the pancreas
Whipple
A nurse is caring for a client who is 4 hr post-op following a lap chole. Which of the following findings should the nurse expect? a. R shoulder pain b. Urine output 20mL/hr c. T 38.4 (101.1F) d. O2 92%
a
A nurse is caring for a client who is 4 hr post-op following a laparoscopic cholecystectomy. Which of the following findings should the nurse expect? a. Right shoulder pain b. Urine output 20mL/hr c. T 38.4 d. O2 92%
a
A nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices can trigger cholecystitis? a. Brownie with nuts b. Bowl of mixed fruit c. Grilled turkey d. Baked potato
a
A nurse is completing nutritional teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? ( Select all that apply.) a. " I plan to eat small, frequent meals." b. " I will eat easy-to-digest foods with limited spice." c. " I will use skim milk when cooking." d. " I plan to drink regular cola." e. " I will limit alcohol intake to 2 drinks per day."
a b c
Chronic calcifying pancreatitis is most often caused by _______________.
alcoholism
A nurse is completing pre-op teaching for a client who is scheduled for a lap chole. Which of the following should be included in the teaching? a. " The scope will be passed through your rectum." b. " You might have shoulder pain after surgery." c. " You will have a Jackson-Pratt drain in place after surgery." d. " You should limit how often you walk for 1 to 2 weeks."
b
A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take first? a. Instruct the client to chew the medication before swallowing b. Offer a glass of water following medication administration c. Administer the medication 30 min before meals d. Sprinkle the contents on peanut butter
b
A nurse in a clinic is reviewing the lab reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? a. Serum amylase 80 units/L b. WBC 9.000 c. Direct bilirubin 2.1 mg/dL d. Alkaline phosphatase 25 units/L
c
A nurse is providing discharge teaching to a client who is post-op following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching ( Select all that apply.) a. Take baths rather than showers b. Clamp T-tube for 1 hr before and after meals c. Keep the drainage system about the level of the abdomen d. Expect to have the T-tube removed 3 days post-op e. Report brown-green drainage to the provider
b c
A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to assess the presence of Cullen's sign? a. Tap lightly at the costovertebral margin on the client's back b. Palpate the right lower quadrant c. Inspect the skin around the umbilicus d. Auscultate the area below the scapula
c
A nurse is caring for a client who has acute pancreatitis. Which of the following serum lab values should the nurse anticipate returning to the expected reference range within 72 hr after tx begins? a. Aldolase b. Lipase c. Amylase d. Lactic dehydrogenase
c
Calculous cholecystitis is caused by _________________.
cholelithiasis
Chronic obstructive pancreatitis is most often caused by __________________.
cholelithiasis
A nures is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? a. Pain in RUQ radiating to R shoulder b. Report of pain being worse when sitting upright c. Pain relieved with defecation d. Epigastric pain radiating to the L shoulder
d
A nures is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to report? a. Hx of cholelithiasis b. Elevated serum amylase level c. Decrease in bowel sounds upon auscultation d. Hand spasms present when BP is checked
d
A nurse is completing a H&P assessment for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? a. High-calorie diet b. Prior gastrointestinal illnesses c. Tobacco use d. Alcohol use
d
A nurse is completing a H&P for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? a. High-calorie diet b. Prior GI illnesses c. Tobacco use d. Alcohol use
d
A nurse is reviewing a new prescription for ursodiol with a client who has cholithiasis. Which of the following information should the nurse include in the teaching? a. This medication is used to decrease acute biliary pain b. This medication requires thyroid function monitoring every 6 months c. This medication is not recommended for clients who have DM d. This medication dissolves gallstones gradually over a period of up to 2 years
d
An internal bile drain empties into the ______________.
duodenum
TCDB =
turn, cough, deep breathe
Sphincter of Oddi =
valve that controls release of bile into duodenum from biliary system
