Inflammation: Pancreatitis and Cholecystitis

Pharmacology in Cholecystitis

-Pain management with analgesics -Antibiotics for infection control -Medications to dissolve gallstones

Assessment Findings in Cholecystitis

-Severe right upper abdominal pain -Fever and chills -Nausea and vomiting -Abdominal tenderness -Positive Murphy's sign (pain upon palpation of the gallbladder)

Identifying Risk Factors

-gallstones -alcohol consumption -genetic predisposition -high levels of triglycerides in the blood

Populations at Risk for cholecystitis

-middle-aged women -obesity -rapid weight loss -pregnant women

Pharmacology of pancreatitis

-pain management with analgesics -use of enzyme supplements that aid with digestion -intravenous fluids for hydration and electrolyte imbalance

Assessment findings for pancreatitis

-severe ULQ abdominal pain -N/V -fever -tachycardia -hypotension -diarrhea/greasy stool

Pathophysiology of pancreatitis

-Autodigestion of the pancreas due to premature activation of digestive enzymes -Inflammation and tissue damage in the pancreas -Release of inflammatory mediators causing systemic effects

Physiologic Processes in Cholecystitis

-Blockage of the cystic duct by gallstones -Inflammation of the gallbladder wall -Possible infection due to bile stasis

Populations at Risk

-Individuals with a history of gallstones -People who excessively consume alcohol -Patients with a family history of pancreatitis

Pathophysiology of Cholecystitis

-Obstruction of the cystic duct by gallstones leads to bile buildup and inflammation -Ischemia and necrosis of the gallbladder wall in severe cases

Diagnostic tests for pancreatitis

Blood tests: These may include amylase and lipase levels, which are often elevated in acute pancreatitis. Other markers of inflammation, such as C-reactive protein (CRP) and white blood cell count, may also be measured. Imaging tests: Ultrasound: This can visualize the pancreas and surrounding structures to look for signs of inflammation or other abnormalities. Computed Tomography (CT) scan: Provides detailed images of the pancreas and surrounding structures, often used to diagnose acute pancreatitis and assess its severity. Magnetic Resonance Imaging (MRI): Particularly useful for detecting complications and assessing chronic pancreatitis. Endoscopic Retrograde Cholangiopancreatography (ERCP): Sometimes performed if there is suspicion of gallstone pancreatitis or to investigate pancreatic duct abnormalities. Endoscopic ultrasound (EUS): This combines endoscopy and ultrasound to obtain detailed images of the pancreas and surrounding structures, often used to detect small stones or tumors.

Surgical Procedures:

Cholecystectomy: The definitive treatment for cholecystitis is often surgical removal of the gallbladder. This can be done through either open surgery or minimally invasive laparoscopic surgery. Laparoscopic cholecystectomy is the preferred approach due to its lower complication rates and quicker recovery times. Cholecystostomy: In cases of severe cholecystitis or if a patient is not a candidate for surgery, a cholecystostomy tube may be inserted to drain bile from the gallbladder. Exploratory Laparotomy: In rare cases where laparoscopic cholecystectomy is not feasible or if there are complications such as gangrene or perforation, an open surgical procedure known as exploratory laparotomy may be performed to remove the gallbladder and address any associated complications. Intraoperative Cholangiography: This procedure involves injecting contrast dye into the bile ducts during surgery to visualize the anatomy and ensure there are no stones or other obstructions present. It can help guide the surgeon in safely removing the gallbladder and may reduce the risk of postoperative complications.

Cholecystitis

Cholecystitis is the inflammation of the gallbladder, often caused by gallstones blocking the bile duct.

Labs for Cholecystitis

Complete Blood Count (CBC): Elevated white blood cell count may indicate an inflammatory response. Liver Function Tests (LFTs): AST and ALT levels may be elevated due to inflammation and possible obstruction of the biliary system. Amylase and Lipase: These enzymes may be measured to rule out pancreatitis, which can sometimes present with similar symptoms

Clinical Management

Pain Management: Pain is a common symptom of cholecystitis and is typically managed with analgesic medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids. NPO Status: Patients may be advised to avoid oral intake to rest the gallbladder and reduce symptoms. Intravenous fluids may be administered to maintain hydration. Antibiotics: If there is evidence of infection, such as fever or leukocytosis, antibiotic therapy may be initiated to control the infection. Commonly used antibiotics include cephalosporins, fluoroquinolones, or metronidazole in combination with beta-lactam antibiotics. Nasogastric Tube: In cases of severe vomiting or ileus, a nasogastric tube may be inserted to decompress the stomach and relieve symptoms. Observation: In some cases, particularly if the symptoms are mild and there are no signs of complications, patients may be monitored closely in the hospital for improvement with conservative management. Pain Management: Adequate pain control is important postoperatively to promote early mobilization and recovery. Dietary Guidance: Patients are typically advised to gradually resume a normal diet as tolerated, starting with clear liquids and advancing to solid foods as bowel function returns. Monitoring for Complications: Patients should be monitored for potential postoperative complications such as bleeding, infection, bile duct injury, or retained stones. Follow-up: Regular follow-up appointments with healthcare providers are important to monitor recovery, address any concerns, and assess for long-term sequelae such as post-cholecystectomy syndrome or bile duct strictures.

Clinical management for pancreatitis

Pain Management: Pain is a common symptom of pancreatitis and may require medication, such as analgesics or opioids, to manage effectively. Fluid and Electrolyte Management: Intravenous fluids are often administered to maintain hydration and correct electrolyte imbalances, especially in cases of severe pancreatitis where there may be significant fluid loss. Nutritional Support: Patients with pancreatitis may need to temporarily withhold oral intake to allow the pancreas to rest. In severe cases or when oral intake is not possible, enteral or parenteral nutrition may be required. Treatment of Underlying Causes: If pancreatitis is caused by gallstones, surgery to remove the gallbladder (cholecystectomy) may be necessary. If caused by alcohol abuse, cessation of alcohol consumption is critical. Management of Complications: Complications of pancreatitis, such as pancreatic necrosis, pseudocysts, infection, or organ failure, may require specific interventions, including drainage procedures, antibiotics, or intensive care management. Monitoring and Follow-up: Patients with pancreatitis often require close monitoring of their condition, including regular assessments of pain, nutritional status, and pancreatic function. Follow-up visits with healthcare providers are important to assess progress and prevent recurrent episodes.

Definition of Pancreatitis

Pancreatitis is the inflammation of the pancreas, a gland located behind the stomach.

Acute pancreatitis signs

Turners (bruising flanks) and Cullen's (bruising around umbilicus)

Diagnostic tests for Cholecystitis

Ultrasound: This is often the initial imaging modality of choice for diagnosing cholecystitis. It can visualize gallstones, gallbladder wall thickening, and signs of inflammation. Computed Tomography (CT) scan: Sometimes performed if ultrasound findings are inconclusive or to evaluate for complications such as perforation or abscess formation. Hepatobiliary iminodiacetic acid (HIDA) scan: This nuclear medicine test involves injecting a radioactive tracer that is taken up by the liver and excreted into the bile. It can assess gallbladder function and detect obstruction of the cystic duct. Blood tests: Blood work may show elevated levels of white blood cells, C-reactive protein (CRP), and liver enzymes (AST and ALT) in cases of cholecystitis.