Ch. 51: Biliary System and Pancreas

Cholecystitis Pathophysiology

Inflammation of the gallbladder, closely associated with cholelithiasis (gallstones).

Cholecystitis Causes

Gallstones (cholesterol/pigment accumulation causing duct obstruction) or acalculous (driven by biliary stasis).

Cholecystitis Risk Factors

Female, fat, fertile, forty, Sphincter of Oddi dysfunction, atrophied gallbladder.

Cholecystitis Assessment Findings

Intermittent RUQ pain radiating to the right shoulder, triggered by high-fat foods, plus GI distress and jaundice.

Cholecystitis Diagnosis

Elevated WBCs, AST, ALT, LDH, and bilirubin; imaged via abdominal x-ray, RUQ ultrasound, HIDA scan, or ERCP.

Cholecystitis Nursing Care & Management

IV fluids, antibiotics, pain/nausea medications, lithotripsy, biliary catheter, and cholecystectomy.

Cholecystitis Patient Education

Avoid fatty foods, perform deep-breathing exercises, incisional care, and postop leg exercises.

Pancreatitis Pathophysiology

Inflammatory process marked by premature activation of pancreatic enzymes that auto-digest acinar cells.

Pancreatitis Causes

Primarily alcoholism, gallstones, abdominal trauma, surgery, drug use, infection, hyperlipidemia, and cystic fibrosis.

Pancreatitis Assessment Findings

Severe, constant mid-epigastrium or LUQ pain, n/v, jaundice, weight loss, steatorrhea, and dark urine.

Pancreatitis Diagnosis

Elevated lipase and amylase, glucose, WBC, CRP, AST, ALT, bilirubin; low calcium and magnesium.

Pancreatitis Complications

Pancreatic necrosis, hemorrhage, shock, and hemorrhagic signs like Cullen's and Grey Turner's signs.

Pancreatitis Nursing Care & Management

Strictly NPO, NG tube for decompression, aggressive IV hydration, pain/nausea meds, and gastric acid suppression.

Pancreatitis Patient Education

Abstain from alcohol, maintain healthy triglycerides, eat high-carb/high-calorie frequent small meals, and take pancreatic enzymes.

Pancreatic Cancer Pathophysiology

Highly malignant tumor originating within pancreatic tissue with rapid progression.

Pancreatic Cancer Assessment Findings

Often slow and vague presentation; first sign may be jaundice indicating late disease.

Pancreatic Cancer Diagnosis

Endoscopic ultrasonography (EUS), ERCP, CT, PTC with biliary drain, and abdominal paracentesis.

Pancreatic Cancer Nursing Care & Management

Surgical resection (partial pancreatectomy or Whipple procedure), chemotherapy, and high-dose opioid pain control.

Pancreatic Cancer Patient Education

Avoid risk factors like smoking, obesity, heavy alcohol, and poor diet; educate on palliative care.

Whipple Procedure Definition

An extensive surgical resection (pancreaticoduodenectomy) used to treat tumors located in the head of the pancreas.

Whipple Procedure Anatomical Alterations

Removes head of pancreas, gallbladder, duodenum, portion of bile duct/stomach, and reconnects remaining structures to the jejunum.