Wk. 10 - Caring for People with Biliary and Pancreatic Disorders Flashcards

What is cholelithiasis?

The presence of gallstones in the gallbladder or biliary ducts formed from crystallized cholesterol or bile pigments.

What are the major risk factors for cholelithiasis?

Female gender, age >40, obesity, pregnancy, rapid weight loss, prolonged fasting, estrogen therapy, diabetes, and certain ethnicities (Native American, Hispanic).

What is choledocholithiasis?

The presence of gallstones within the common bile duct, leading to possible obstruction and jaundice.

What is the primary cause of cholecystitis?

Obstruction of the cystic duct by gallstones or biliary sludge, leading to inflammation and bacterial growth.

Describe the classic pain pattern of gallbladder disease.

Right upper quadrant or epigastric pain that may radiate to the right scapula, often occurring after a fatty meal.

What are common symptoms of cholecystitis?

RUQ pain >6 hours, fever, tachycardia, nausea, vomiting, and possible jaundice.

Which diagnostic test is the gold standard for detecting gallstones?

Abdominal ultrasound—it visualizes stones and gallbladder wall thickening.

Elevated bilirubin, alkaline phosphatase (ALP), and liver enzymes (AST, ALT) suggest what?

Biliary obstruction or choledocholithiasis.

What is the purpose of an Endoscopic Retrograde Cholangiopancreatography (ERCP)?

It is both diagnostic and therapeutic, used to visualize and remove bile duct stones.

What nursing diagnoses are common in cholelithiasis and cholecystitis?

Acute pain, nausea, risk for fluid volume deficit, and anxiety related to disease or treatment.

                        What is the mechanism of action of ursodeoxycholic acid (ursodiol)?                          

                        It reduces cholesterol content in bile by decreasing hepatic cholesterol secretion and dissolving cholesterol gallstones.                          

                        What is ursodiol used for?                          

                        To dissolve small cholesterol gallstones in patients who are poor surgical candidates or to prevent gallstone formation in rapid weight loss.                          

                        What are common side effects of ursodiol?                          

                        Nausea, diarrhea, constipation, abdominal discomfort, or rash.                          

                        What nursing consideration is essential when administering ursodiol?                          

                        Ensure the cystic duct is patent; otherwise, bile can’t flow and the medication will be ineffective.                          

                        How long does ursodiol therapy typically take to dissolve gallstones?                          

                        6 to 24 months of continuous therapy; recurrence may occur if discontinued early.                          

                        What should the nurse teach the patient taking ursodiol?                          

                        Take with food or milk to reduce GI upset, report severe abdominal pain, and follow up for periodic liver function tests.                          

                        What is a laparoscopic cholecystectomy?                          

                        Minimally invasive surgical removal of the gallbladder; preferred treatment for symptomatic gallstones.                          

                        What postoperative instruction is most important after laparoscopic cholecystectomy?                          

                        Begin with clear liquids, advance to a low-fat diet, and gradually return to normal eating.                          

                        What is the purpose of a T-tube after an open cholecystectomy?                          

                        It drains bile from the common bile duct and maintains duct patency postoperatively.                          

                        What nursing interventions are important for T-tube care?                          

                        Keep drainage bag below waist level, do not clamp unless ordered, and assess for bile leakage or infection.                          

                        What are the two most common causes of acute pancreatitis?                          

                        Gallstones (choledocholithiasis) and chronic alcohol use.                          

                        Describe the typical pain pattern in acute pancreatitis.                          

                        Severe LUQ or epigastric pain radiating to the back; described as “boring,” worsened by eating, and relieved by sitting forward.                          

                        What laboratory findings are diagnostic of acute pancreatitis?                          

                        Elevated amylase and lipase (lipase more specific); possible elevated ALT, AST, bilirubin, and ALP.                          

                        What electrolyte imbalance is common in pancreatitis and why?                          

                        Hypocalcemia due to fat necrosis binding calcium in the tissues.                          

                        What are the goals of care in acute pancreatitis?                          

                        Relieve pain, maintain fluid/electrolyte balance, rest the pancreas (NPO), and prevent complications such as sepsis or pseudocyst formation.                          

                        Why is the patient kept NPO during acute pancreatitis?                          

                        To rest the pancreas and decrease secretion of digestive enzymes.                          

                        What IV fluid is typically used for pancreatitis, and why?                          

                        Lactated Ringer’s (LR)—helps correct fluid losses and prevent renal failure.                          

                        Which medications are commonly used for symptom management in acute pancreatitis?                          

                        Opioids (hydromorphone) for pain, PPIs (pantoprazole) to reduce acid, and antiemetics (ondansetron) for nausea.                          

                        What nursing interventions help manage pain in acute pancreatitis?                          

                        Administer analgesics, position in fetal or sitting forward position, and maintain NPO status.                          

                        What complications should the nurse monitor for in pancreatitis?                          

                        Hypocalcemia, hypovolemia, ARDS, sepsis, acute kidney injury, and pseudocyst formation.                          

                        What is the most common cause of chronic pancreatitis?                          

                        Long-term alcohol abuse leading to fibrosis and loss of pancreatic function.                          

                        What are the hallmark symptoms of chronic pancreatitis?                          

                        Chronic upper abdominal pain, steatorrhea, weight loss, mild jaundice, and possible diabetes.                          

                        Why does steatorrhea occur in chronic pancreatitis?                          

                        Due to loss of exocrine function and lack of lipase needed for fat digestion.                          

                        What dietary modifications are recommended for chronic pancreatitis?                          

                        Small, frequent, low-fat, bland meals; avoid alcohol, caffeine, and smoking.                          

                        What is the mechanism of action of pancrelipase (Creon)?                          

                        It replaces deficient pancreatic enzymes—lipase, protease, and amylase—to aid digestion of fats, proteins, and carbohydrates.                          

                        What are the indications for pancrelipase therapy?                          

                        Exocrine pancreatic insufficiency due to chronic pancreatitis, cystic fibrosis, or surgical removal of the pancreas.                          

                        What are key nursing considerations when administering pancrelipase?                          

                        Give with every meal and snack, swallow whole or sprinkle on soft acidic food (not hot), and avoid crushing or chewing capsules.                          

                        How is the effectiveness of pancrelipase evaluated?                          

                        By the absence of steatorrhea and improved nutritional status or weight gain.                          

                        What are possible side effects of pancrelipase?                          

                        GI upset, abdominal pain, diarrhea, or irritation of oral mucosa if chewed.                          

                        What teaching should the nurse provide for a patient on pancrelipase?                          

                        Take with food, maintain a low-fat diet, avoid alcohol, and report persistent diarrhea or abdominal pain to the provider.