Week 6: Pancreas and Biliary Conditions

role of pancreas in digestion

bicarb and digestive enzymes secreted by exocrine portion of duodenum

what are secreted by endocrine portion into the bloodstream that regulate glucose levels

insulin, glucagon, hormones

dx tests for pancreas issues

scans, amylase, lipase, carbohydrate antigen

amylase serum

30-220, dx of acute pancreatitis and trraumatic injury

lipase

over 160, dx pancreatitis and disease, if elevated may indicate onset of acute pancreatitis

carbohydrate antigen 19-9

tumor markers

pancreatitis

inflammation of pancreas, acute or chronic

causes of pancreatitis

gallstones, alcohol and drug abuse

signs and symptoms of pancreatitis

dull epigastric/LUQ pain, radiates back and lower abdomen, pain exacerbated by food/alcohol, nausea, vomiting, fever, tachycardia, hypotension

dx of pancreatitis

serum amylase rises in first 12-24 hours and drops after 48 hours, serum lipase rises, hypocalcemia, leukocytosis

management of acute pancreatitis

opioids, iv fluid/electrolytes, NPO to reduce pancreatis stimulation, treat cause

primary pain for liver and gallbladder

epigastric and RUQ, t7-t9

referred pain for glalbladder

r shoulder, r interscapular region

gallbladder functio

reservoir for bile, sends to to duodenum via hepatic duct

what 3 things does the gallbladder do to fat

emulsification, absorption, digestion

dx studies for gallbladder

scans, MRCP, ERCP, HIDA scan

what lab values are related to gallbladder function

serum bilirubin, liver enzymes

serum bilirubin 3 levels

total: 0.3-1

direct: 0.1-0.3

indirect: 0.2-0.8

what is serum bilirubin

yellow pigment formed by breakdown of Hgb and excreted in bile

function of serum bilirubin

evaluate liver function, jaundiceto dx and progression

total bilirubin

sum of direct and indirect

direct and indirect bilirubin function

determine cause of jaundiace

increased levels of indirect indicate

hemolysis (rbc destruction)

increased levels of direct indicate

obstruction fo duct

both levels (direct/indirect) are elevated in

liver disease pts

what causes increase of serum bilirubin

cirrhosis, hepatitis, hemolytic anemia, jaundice, bile duct occlusion, chemo, transfusion

presentation if they have serum bilirubin elevation

fatigue, anorexia, nausea, fever, loose stool

clinical implications of serum bilirubin

adapt education if decreased cognition, symptoms based approach in treatment

pts with advance disease are at risk of

osteoporosis and bleeding due to deficiencies of fat soluble vitamins

critical value of bilirubin

over 12

cholelithiasis

stones in bile (too much cholesterol)

risk factor of cholelithiasis

age, obesity, rapid weight loss, high cholesterol, multiparity, oral contraceptives, estrogen supplement

symptoms of cholelithiasis

pain in RUQ after meals, nausea, vomiting, bloating, gas

cholecysitis

gallstones block bile from getting out, cause inflammation

symptoms of cholecystitis

nausea, vomiting, weight loss, pain worse with movement, positive murphy sign

treatment of cholecystitis

surgically removed

murphys sign

supine, palpate r subcostal area while taking deep breath and hold it. if pain is on inspiration its positive

acute cholangitis

adverse consequence of cholelithiasis, ducts become completely blocked and infected and cause jaundice

treatment of acute cholangitis

antibiotics, biliary drainage, surgery

how to live without gallbladder

storage is lost, but still constantly secreted bile into duodenum from liver

-may have diarrhea, pain, gas

implications of PT will gallbladder diease

recognize pain patterns, if pain patterns are associated with gi symptoms send to MD, many may have had cholecystectomy (healthy diet, scar tissue mobs)