Gallbladder and Pancreas Disorders

The Gall Bladder stores ________

Bile

Cholecystitis

Inflammation of gallbladder

Cholelithiasis

Stones in the gallbladder (gallstones)

Risk Factors for Gallbladder Disease

Fat, Forty, Female, Fertile, sedentary lifestyle

Early Symptoms of Cholecystitis/Cholelithiasis

+ Murphy’s Sign

Late Symptoms of Cholecystitis/Cholelithiasis

Jaundice, icterus, clay-colored stools, RUQ/right shoulder pain, pain worsening after eating/breathing

Labs for Cholecystitis/Cholelithiasis

Elevated WBC, bilirubin, amylase/lipase, liver enzymes

Diagnostics for Cholecystitis/Cholelithiasis

Ultrasound, CT, ERCP

Cholelithiasis can lead to ____________

Cholecystitis

Nursing Interventions for Cholecystitis/Cholelithiasis

Pain control, infection prevention via antibiotics, maintain fluid/electrolyte balance, NG tube or NPO until bowel sounds return, frequent oral care, turn/cough/reposition

What Diet is ordered Post Cholecystectomy

NPO initially, then soft, low-fat, high-carb diet

Nursing Interventions Post Cholecystectomy

Assess for bleeding/infection, position patient on L side with R knee flexed, encourage deep breathing, AMBULATE, ensure that heart-attack symptoms (R shoulder pain) is normal

Exocrine Functions of the Pancreas

Secretion of Amylase, Trypsin, Lipase, Secretin

Function of Amylase

Carb/glucose digestion

Function of Lipase

Fat digestion

Function of Trypsin

Protein digestion

Endocrine Functions of the Pancreas

Secretion of Insulin, Glucagon, Somatostatin

Acute Pancreatitis

Obstruction of pancreatic duct and backup on enzymes leading to indigestion, inflammation, and abdominal pain

Auto Digestion of the Pancreas leads to…

Tissue damage, phospholipidase → fat necrosis → hypocalcemia, vascular damage, hemorrhage, increase capillary permeability, hypotension

Causes of Acute Pancreatitis

Alcoholism, gallstones, abdominal trauma, medication, infection, tumors, genetics, high triglyceride/calcium levels

Symptoms of Acute Pancreatitis

Acute pain, fluid imbalance, hypocalcemia, impaired nutritional intake

Symptoms of Pancreatitis

LUQ pain, pain worsens when lying down, N/V, fever, hypotension, tachycardia, jaundice, absent bowel sounds, fluid in lungs, weight loss, Steatorrhea, Cullens sign, Turners Sign

What is Steatorrhea?

Foul smelling, fatty/oily, stools

Cullens Sign

Bruising patches around the umbilicus (front)

Turners Sign

Bruising patches along the flank around kidney/pancreas (back)

Labs for Pancreatitis

Elevated amylase, lipase, glucose, bilirubin, liver enzymes, WBC / Low calcium, HgB, hematocrit

Diagnostics for Pancreatitis

Ultrasound, X-ray, CT, ERCP

Nursing Interventions for Acute Pancreatitis

PAIN RELIEF, fluid resuscitation, NPO/NG tube to control stomach acid, correct electrolyte imbalance, prevent infection, remove cause

What Diet is ordered for Pancreatitis

NPO initially, then small frequent feedings, then bland, high protein, low-fat diet, w/ no stimulants (caffeine)

Chronic Pancreatitis

Progressive inflammation of pancreas resulting in irreversible damage and increased pressure that obstructs pancreas and common bile ducts; Obstructive or Non-Obstructive

Obstructive Pancreatitis

Inflammation of sphincter of Oddi, cancer of ampulla of Vater/duodenum/pancreas

Non-Obstructive Pancreatitis

Inflammation and sclerosis in head of pancreas and around duct, commonly caused by alcohol

Most Common Cause of Chronic Pancreatitis

Alcohol

Symptoms of Chronic Pancreatitis

Abdominal pain not relieved by food/antacids, weight loss, jaundice/dark urine, steatorrhea, diabetes

Nursing Interventions of Chronic Pancreatitis

Educated about refraining from smoking/alcohol/caffeine, control diabetes w/ insulin and teach about blood sugar monitoring