Week 10: Caring for People with Biliary and Pancreatic Disorders

Ursodeoxycholic acid (ursodiol)

• long term therapy for cholelithiasis

• dissolves cholesterol in gallstone, -oral bile duct dissolution therapy

-Must have a patent cystic duct, ultra sound q6 mo in first year to determine effectiveness

-report diarrhea, vomiting, abdominal pain (radiating to shoulders) IMMEDIATELY

-take with food and milk

Pancrelipase

• pancreatic enzyme replacement for chronic pancreatitis

-administer with every meal or snack

-monitor for steatorrhea

-control diabetes w insulin if developed

Gallstones

stones that develop when stored bile crystallizes

-mostly made of cholesterol

Hepatolothiasis

The presence of gallstone in the biliary ducts of the liver

Choledocholithiasis

the presence of gallstones within the common bile duct

Cholelithiasis

The presence of one or more gallstone in the gallbladder or biliary ducts

Cholecystitis

inflammation of the gallbladder

-caused by gallstone obstruction or stasis

Cholecystectomy

surgical removal of gallbladder

-indicated for cholelithiasis or cholecystitis

Lithogenic state of gallstone disease

conditions set to favor gallstone formation

-estrogen meds/female

-over age 40

-pregnancy

-overweight

-rapid weight loss

-having diabetes

4 stages of gallstone disease

Lithogenic state

Asymptomatic

Symptomatic

Complicated cholelithiasis

S/s of Cholelithiasis

-usually asymptomatic

-episodes of moderate to severe pain (biliary colic)

-RUQ epigastric pain may go to shoulder

-lasts LESS than 6 hrs

-occurs after fatty meal

-nausea, vomiting

-unreliavable pain

-belching and bloating

S/s of Choledocholithiasis

-moderate to severe pain

-RUQ or epigastric pain may go to shoulder

-lasts LONGER than 6 hrs

-pain, belching, nausea, vomiting

S/s of Choledocholithiasis if gallstone completely blocks common bile duct:

-jaundice

-clay colored stool

-dark/brown amber urine

-fat in stool (steatorrhea)

S/s of cholecystitis

-moderate to severe pain

-RUQ or epigastric pain may go to shoulder

-lasts LONGER than 6 hrs

-pain, belching, nausea, vomiting

-possible jaundice

-fever

-tachycardia

-rebound tenderness

Laboratory Tests for Cholelithiasis

-Conjugated= ELEVATED

-Unconjugated= ELEVATED

-liver function= ELEVATED

-amylase= ELEVATED

Laboratory Tests for Cholecystitis

-WBC ELEVATED

-Conjugated= ELEVATED

-Unconjugated= ELEVATED

-liver function= ELEVATED

-amylase= ELEVATED

Treatment for Asymptomatic cholelithiasis:

no treatment needed

Treatment for Symptomatic cholelithiasis:

-cholecystectomy is recommended

-for patients no surgery:

-antibiotics

-opioids

-Urosdeoxycholic acid

-ERCP

What is Endoscopic Retrograde Cholangiopancreatography (ERCP):

diagnosis and removal of gallstones

Nursing considerations for cholecystectomy:

-NPO

-IV antibiotics

-often same day surgery

-pain management

-antiemetic management (clear liquids once awake)

Open Cholecystectomy:

-hospital stay is longer

-avoid heavy lifting 4 to 6 weeks

-t tube placed for patency

Nursing considerations for life without gallbladder:

-liver will still make bile

-patients may experience chronic diarrhea

-gradually increase food from clear liquids to regular diet

-eat smaller more frequent meals

Pancreatitis

inflammation of the pancreas

-pancreas enzymes become activated while still in the pancreas causing digestion of the pancreas

How does pancreatitis occur?

-choledocholithiasis

-alcohol use

Pain associated w/Pancreatitis:

-dull, boring, deep, piercing pain

-LUQ or epigastric pain may radiate for back

-severe 8 to 10

-sudden but persistent pain

S/s of pancreatitis:

-hypoactive bowel sounds

-LUQ epigastric pain

-nausea, vomiting

-abdominal distention

-mild jaundice

-hypocalcemia = hyperreflexia

Cullen sign

Bluish peri umbilical discoloration from blood in the peritoneal cavity

PANCREATITIS SIGN

Grey turner sign

Bluish discoloration of the flanks from retroperitoneal hemorrhage

PANCREATITIS SIGN

Lab values for pancreatitis:

-WBC= ELEVATED

-Liver enzymes (AST/ALT)= ELEVATED

-ALP= ELEVATED

-Bilirubin= ELEVATED

-Amylase= ELEVATED

-Lipase= ELEVATED

Nursing considerations for pancreatitis:

-pain management

-balance electrolytes and volume due to vomiting

-anti nausea meds

-monitor for acute substance withdrawl syndrome

-place patient on NPO (surgery)

Psudocyst

an encapsulated collection of pancreatic secretions that forms in or around the pancreas

S/s of pseudocyst

-persistent abdominal pain

-nausea and vomiting

-elevated amylase

-low grade fever

ASSOCIATED WITH ACUTE PANCREATITIS

Chronic pancreatitis

-a long-standing inflammation of the pancreas that alters the normal structure and functions of the pancreas

-often associated with chronic alcohol abuse

S/s of chronic pancreatitis:

-chronic abdominal pain (upper abdomen or back pain)

-nausea and vomiting

-mild jaundice

-may develop diabetes

-fatty stools and weight loss

Nursing considerations for chronic pancreatitis:

-pain management

-no alcohol

-no smoking or caffeine

-bland low fat diet

-small frequent meals

-if diabetes: use insulin

Nursing considerations for t-tube:

-the drainage in the t-tube should be yellow/green

-t tube should be placed in common bile duct

-bag should be below or at patients waist level