concept map
Table
CAUSES/ RISK FACTORS:
ACALCULOUS CHOLECYSTITIS= A = WITHOUT
STONESICK GALLBLADDER NOT CAUSED BY STONE=
Inflammation OF THE GALLBLADER WITHOUT STONE
COMMON IN OLDER PATIENTS, SECONDARY TO BILARY
STASIS (when bile flow is statis = does not move) =
EMERGENCY CONDITION, 5% OF POPULATION
NOT GOOD (POOR) OUTCOME BECAUSE IT IS NOT
CAUSED BY A STONE
OTHER CAUSES OF ACALCULUS (BILE STASIS):
Blockage of the bile duct due to:
1) INFECTION (AIDS, SALMONELA INFECT,
CYTOMEGALOVIRUS)
2) TUMOR
3) TPN/PPN
4) FASTING/
5) HX/ Dx ABD SURGERY (scar tissue press on
ducts),
6) PROLONG IVTPN/ PPN = GREATER THAN 1
MONTH
7) DIABETESE,
8) PROLONG IMMOBILITY,
9) ENDOTOXINS=CHEMICAL IRRITANT IN THE
BILE
10) OLDER ADULT WHO HAVE BURN, EXTENSIVE
SURGERY, TRAUMA
11) SEVERE TRAUMA
Cholelithiasis = Lith = stone; Stone in the gallbladder,
its neck, its duct most common disorder of the biliary
system = CALCULEOUS CHOLECYTHITIS
Cholecystitis: A) inflammation of gallbladder 2nd to
blockage / obstruction of the bile flow to/ from the gall
ducks /tube, or stone lodge in the gallbladder neck or
cystic duck; b) can be acute or chronic, c) the organ can
become necrotic and cause gangrene (
COMPLICATIONS)
SYMPTOMS CHOLECYTITIS /MANAGEMENT RISK
FACTORS
ACUTE SIGNS
1) RUQ Pain (MURPHY SIGN)= stone blockage in the
duct or common bile duct = CHOLECLETHIATIS
2) Jaundiced (SKIN AND EYES)
3) Nausea/Vomiting
4) Diaphoresis
5) Restlessness
6) Biliary Colic
OTHER SIGNS
7) Fever
8) Intolerance of fatty foods
9) Weight loss:
10) Pruritus
11) Dark, amber urine
12) Steatorrhea
13) Clay colored stools
14) Bleeding tendencies
15) Actual number of people in the USA is not know
because some people are asymptomatic
Risk Factors for Gallbladder Disease:
Five Fs:
16) >40 (age) = chances increase with age
17) Female (gender)
18) Fair (CAUCASIAN)= (race)
19) Fat (OBESITY =BMI>25), eating large
quantity of saturate fat), FASTING and
RAPID WEIGHT LOSS (>3.3LB / WEEK) OR
WEIGHT LOSS 2nd to SURGERY (cause bile
statis or liver to produce more cholesterol =
which worsens saturation of bile)
20) Fertile = Increase in progesterone during
pregnancy
Others risk factors:
21) Cholesterol lowering medication (Statins)
COMPLICATIONS:
ARE EMERGENCY CONDITIONS:
1) GANGREEN
2) CHOLANGISTIS
3) PERFORATION:
4) PERITONITIS:
5) PANCREATITIS:
6) ABSCESS:
7) RUPTURED GB:
8) FISTULA:
9) ABCESS or SEPSIS (S/S FEVER)
Post-op cholecystectomy syndrome:
1) Due to removal of chole
2) Monitor for 2 YEARS
1) CAN BE TRANSCIENT OR FOR LIFE
2) Symptoms:
a) Dyspepsia
b)
DIAGNOSTIC:
TREATMENT:
NURSES EDUCATION:
Diagnostic IS DONE BASED ON THE COMBIBATION OF 2
OUT OF 3 THINSGS:
1) RUQ PAIN
2) FEVER OVER 99.5F OR WBC > 10,000
3) Evidence of ULTRASOUND showing
thickening or edematous gallbladder
Care: Acute Cholecystitis
1) NPO
1) Gastric Decompression
2) Pain Control
3) Antiemetics
4) Anticholinergics
5) Antibiotics
6) Low Fat Diet
7) Fluid & Electrolyte Balance
8) Pre-op Teaching
Post-op Care: LAPAROscopic Cholecystectomy:
1) Monitor for bleeding = at puncture site
2) Pain control
3) Shoulder discomfort due to CO2
4) Wound care/monitor for infection
5) Advance diet
6) Resume activity:
1) Promote deep breathing while splinting the
incision
2) Use Incentive spirometry
3) Ambulate to increase CO2 to leave the body
4) Raise the head of the bed for better breathting
1) ULTRASOUND:
2) HIDA SCAN:
3) ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY
(ERCP):
4) CHOLANGIOGRAM:
SURGERY: Indicated for who? D(is)Advantages:
1) Cholecystectomy
2) Laparoscopic Cholecystectomy
3) Lap Chole vs. Open Chole
4) Transhepatic Biliary Catheter
(T tube)
Contraindications to Laparoscopic Cholecystectomy
1) Peritonitis
2) Cholangitis
3) Gangrene of the Gallbladder
4) Perforation of the gallbladder
5) Portal Hypertension
6) Serious bleeding disorders
7) Previous abdominal surgery with left over scares
8) Morbid obesity
Post-op Care: OPEN Cholecystectomy:
1) VS
2) Pain
3) Abdomen assessment
4) Diet
5) Respiratory support
6) Ambulation
Discharge Teaching:
1) Incision care
2) S/Sx infection
3) S/Sx jaundice
4) Pain control
5) Constipation
6) Activity
7) Shower
concept map
n
Gallbladder (Cholecystitis) Disease: (Hoffman) Ch. 60, pp. 1393-1397 AND ATI RN Medical Surgical
Nursing Ch. 53, pp. 355-358
TRUE OR FALSE Epidemiology OF GALL BLADDER DISEASE
1) Cholecystitis : INFLMMATIONOF THE GALLBLADDER CAUSED BY STONE
2) Calculous = with gallstones
3) Acalculous Cholecystitis = a = without stone, sick gallbladder not caused by stone, inflammation of the gallblader
without stone common in older patients secondary to biliary stasis (when bile flow is statis = does not move) =
emergency condition, 5% of population, not good (poor) outcome because it is not caused by a stone
4) Two Most commonly caused by obstruction: Stone or bile circulation obstruction by other things
5) Cholecystectomy = Removal of the gallbladder = Most COMMON PROCEDURE performed in the USA
6) Biliary Colic: STONE IS LARGE AND IT CAUSE THE GALLBLADDER TO SPASM CAUSING SEVER PAIN
(that last for hours after eating fatty food, because eating stimulate stimulation of gallbladder) that extend to the lower
part of the RIGHT SHOULDER BLADE to the BACK, and the PAIN IS STEADY, EXCRUTIATING AND makes
the patient diaphoresis, tachycardic, restless
7) 8-10% of American adults have gallstone. Actual number is not known because some people are asymptomatic
8) Diagnostic IS DONE BASED ON THE COMBIBATION OF 2 OUT OF 3 THINSGS: RUQ PAIN, FEVER OVER
99.5F OR WBC > 10,000 Evidence of ULTRASOUND showing thickening or edematous gallbladder
9) Acute Clinical Symptoms of Cholecystitis: MAIN SYMPTOMS= Murphy’s sign: RUQ pain with inspiration
10) Cholecystectomy: Removal of the gallbladder, Is indicated for pt. with cystic duct leading to sever abdominal pain =
biliary colic, Infection, Inflammation of the gallbladder, Blockage of the bile ducts leading to the duodenal
11) Murphy’s sign
12) Trousseau’s sign
13) Cullen’s sign
14) Grey Turner’s sign
a.
MANAGEMENT/ MEDICAL MANAGEMENT
EXPLAIN TESTING AND COMPLICATIONS
1)
2)
3)
4)
HIDA:
ERCP:
CHOLANGIOGRAM OTHER DIAGNOSTIC STUDIES:
CHOLANGIOGRAM:
LABS TEST FOR CHOLECYSTHITIS
1) WBC: ELEVATED
a. >10,000
2) Liver Function Tests = ELEVATED = B/C BILE BACK UP IN THE BLOOD STREAM
concept map
a.
b.
c.
d.
AST:
ALT:
LDH:
ALP
TREATMENT: MEDICATIONS
1. NPO:
2. Gastric Decompression:
3. Pain Control:
4. Antiemetics:
5. Anticholinergics:
6. Antibiotics:
7. Low Fat Diet:
8. Fluid & Electrolyte Balance:
9. Pre-op Teaching:
10. Diet:
CONTRAINDICATIONS TO LAPAROSCOPIC CHOLECYSTECTOMY
1) Peritonitis
2)
Cholangitis
3)
Gangrene of the Gallbladder
4)
Perforation of the gallbladder
5)
Portal Hypertension
6)
Serious bleeding disorders
HOFFMAN / DAVIS ADVANTAGE / GASTRITIS
https://quizlet.com/344796430/exam-3-biliary-and-pancreatic-disorders-flash-cards/
https://quizlet.com/575434599/medsurg2-pancreatitis-chapter-60-flash-cards/
https://quizlet.com/512640569/davis-ch-60-pancreatitis-flash-cards/
Question 1 of 10 A patient is diagnosed with severe peptic ulcers in the gastrointestinal tract. Which surgical
procedure is the patient most likely to have?
1) Vagotomy: removes the nerve that stimulate the acide production, decreasing the risk of peptic ulcer disease
2) Gastrojejunostomy
3) Hepaticojejunostomy
4) Distal pancreatectomy
Question 2 of 10 the primary healthcare provider prescribed four different medications for four different
patients with acute pancreatitis. Which patient is most likely to have decreased gastric acid secretions?
concept map
1)
Patient A
2)
Patient B
3)
Patient C: decrease gastric secretion in the stomach
4)
Patient D
Question 3 of 10 The patient is concerned about his abdominal pain and symptoms, which mimic gallbladder disease.
He asks the nurse what tests he may need to undergo. Which test is commonly performed to determine dilation of
the gallbladder and identify cysts?
1)
2)
3)
4)
Ultrasound: detects gallstone and distension of the bile ducts
Computed tomography (CT) scan: reveal dilation of the bladder and cyst
Hepatobiliary iminodiacetic acid (HIDA) scan = ID gallstone presence
Endoscopic retrograde cholangiopancreatography (ERCP) = visualize bile tree and stone presence
Question 4 of 10 What does a Ranson score of 3 to 4 indicate in a patient with pancreatitis?
1. 2% mortality rate (score 1-2)
2. 15% mortality rate (score 3-4)
3. 40% mortality rate (5-6 score)
4. 100% mortality rate (7-8 score)
Question 5 of 10. A patient is diagnosed with gallstones in the bile duct and is scheduled for endoscopic
retrograde cholangiopancreatography. Which nursing action is most effective for this patient? Select all that
apply.
1) Observing the patient for a systemic inflammatory response after the procedure
2) Observing the patient for changes in vital signs after the procedure
3) Instructing the patient to drink large amounts of water before the procedure = nothing to eat or drink before
midnight
4) Instructing the patient to avoid food in the morning before the procedure = avoid fluid from the night before
procedure
5) Instructing the patient to take his or her blood pressure medications in the morning before the procedure =
with small amount of water
Question 6 of 10: The nurse instructs the patient to breathe deeply while the nurse palpates the right upper
quadrant of the abdomen by placing the fingers and pressing down gently. When this occurs, the patient exhibits
pain. Which is observed from this assessment?
i. Cullen sign
ii. Murphy sign
iii. Chvostek sign
iv. Grey-Turner sign
Question 7 of 10 The laboratory report of a patient with gallstones reveals increased liver enzymes in the
blood. Which medication is most likely to be prescribed to this patient?
i. Demerol = narcotic meds for severe pain rx
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ii. Naproxen = help manage pain
iii. Chenodiol : accumulation of gallstone bile duct increases liver enzymes in the blood. This medication
breaks/ dissolves the cholesterol and stones
iv. Acetaminophen = help manage pt pain with ACUTE CHOLECYTITIS
Question 8 of 10 A patient is diagnosed with gallstone-induced pancreatitis. The primary healthcare provider
prescribes removal of the gallbladder. Which surgical method is most appropriate in this situation?
1) Cholecystectomy = removes gallbladder for gallbladder-induced pancreatitis
2) Distal pancreatectomy = resects the tail of the part of pancreas body
3) Pancreaticoduodenectomy = removes tumor located on the head, neck, or uncinate the process of
pancreatitis
4) Endoscopic sphincterotomy = done to dislodge gallstone
Question 9 of 10 Which medications are used to treat acute necrotizing pancreatitis?
1) Antibiotics
2) Spasmolytics
3) Opioid narcotics
4) Anticholinergics
Question 10 of 10 The nurse is assessing four different patients and documents clinical manifestations. Which
patient is most likely to have the illness in the image?
i. Right upper quadrant pain, abdominal tenderness, and fever
ii. Epigastric pain in the upper left quadrant, anorexia, and indigestion
iii. Abdominal pain worsening after drinking and eating, oily stools, and weight loss
iv. Abdominal pain on movement, pruritus on palms, and dark amber-colored urine
Question 1 of 5 A client with a history of chronic pancreatitis presents to the hospital for admission. The
nurse should expect to find which clinical manifestations on assessment? Select all that apply.
1) Decreased respiratory rate
2) Stable blood pressure
3) Clay-colored stools
4) Epigastric and left upper quadrant pain
5) Steatorrhea
Question 2 of 5 What clinical markers are used in the evaluation of Ranson’s Criteria when determining the
severity of acute pancreatitis? Select all that apply.
1) White blood cell count greater than 16,000/mL
2) Rise in hematocrit level greater than 10% = a decrease > 10%
3) Fluid sequestration greater than 3 L = greater than 6L
4) Glucose greater than 200 mg/dL
5) Age less than 20 years = greater than 55 years old
Question 3 of 5 What nutritional concern will the nurse expect to find in a client who has chronic
pancreatitis?
1)
2)
3)
4)
Weight gain
Denies nausea
Weight loss
Stabilized weight pattern with different food preferences
concept map
Question 4 of 5 The nurse is caring for a client with acute pancreatitis. What complications should the
nurse monitor for in the critical client? Select all that apply.
1) Hemorrhage
2) Gallstone development
3) Multiple organ failure
4) Pleural effusion
5) Osteoporosis
Question 5 of 5: The nurse is providing client teaching on pancreatic enzyme replacement therapy. What
should the nurse tell the client this therapy is used to treat?
1) Decreased insulin level
2) Inflammation and obstruction
3) Pseudocyst
4) Malnutrition and malabsorption
Question 1 of 6 Select the correct statements for each question when managing the client with chronic
pancreatitis. Select all that apply.
1) Oral pancreatic enzymes
a. a. Provided in extended-release capsules
b. b. Must be swallowed whole for therapeutic dose
c. c. Helps digest fats and proteins
d. d. Must be taken with to meals
e. e. Do not chew to prevent disruption of enteric coating
RATIONAL : Pancreatic enzymes, which help digest fats and proteins, are given with meals and
must be swallowed. Administering the medication swallowed whole allows for achievement of
the therapeutic dose and prevents disrupting the enteric coating and extended release.
2) Dietary and alcohol intake with chronic pancreatitis
a. a. Avoid coffee and caffeine for prevention of gastric distress
b. b. Low-fat diet required for malabsorption of fats
c. c. Alcohol should be avoided to minimize pancreatic inflammation
d. e. Increased caloric intake too combat weight loss
e. f. Total parenteral nutrition for nutritional support
RATIONAL: Alcohol, fat, and caffeine in the diet can further exacerbate pancreatic inflammation.
A low-fat diet is implemented because pancreatitis leads to malabsorption of fats in the diet.
Weight loss is common in chronic pancreatitis, and nutritional support is needed with increased
caloric intake and/or TPN therapy.
3) Pain
a. a. Opioids provide best pain relief
b. c. Described as persistent and recurring
c. e. Focused over epigastric region
RATIONAL: Pancreatic pain is described as persistent and recurring in the epigastric or upper left
quadrant abdominal area. The pain is in response to inflammation and obstruction of the organ.
Opioids provide the best pain relief but non-opioids should be used when pain is less.
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4) Pancreatic Enzyme Replacement Therapy (PERT)
a. b. Provides amylase, lipase, and protease
b. d. Helps to aid in absorption of nutrients
c. f. Used to correct problems of malabsorption and malnutrition
RATIONAL: PERT therapy is used in the treatment of chronic pancreatitis. It is given to assist in
absorption of nutrients in foods and provides amylase, lipase, and protease. It does not cause
weight loss..
5) Gastrointestinal prophylaxis therapy for chronic pancreatitis.
a. b. Helps decrease gastric acid secretion
b. c. Relies on histamine blockers
c. d. Relies on proton pump inhibitors
RATIONAL: Gastrointestinal prophylaxis therapy consists of using either histamine blockers or
proton pump inhibitors in response to increased gastric acid secretion. It has no effect on bowel
function or activity in terms of frequency or bulk of stool formation.
6) Lab findings with chronic pancreatitis
a. a. Elevated amylase and lipase levels
b. d. Elevated glucose level
RATIONAL: Amylase and lipase levels are usually elevated, as are levels of serum alkaline
phosphatase and bilirubin. As the disease progresses and impairs endocrine functions of the
pancreas, serum glucose levels will increase due to the lack of insulin. Potassium and sodium are
not typically impacted from the pancreatitis itself.
7) Question 1 of 5A client with chronic pancreatitis may require which type of assistive therapy?
a. Pancreatic enzyme replacement therapy
b. Plasmapheresis
c. Mechanical ventilation
d. Hyperbaric oxygen therapy
8) Question 2 of 5 Which clinical presentation is seen in both acute and chronic pancreatitis?
a. Edema
b. Hyponatremia
c. Hypercalcemia
d. Pain.
9) Question 3 of 5 Which bed assignment would the admission nurse implement for a client being
admitted from the emergency department with acute pancreatitis?
a. Surgical floor in a private room
b. Medical floor in a semi-private room by the nurse’s station
c. Coronary cardiac care unit
d. Intensive care unit
10) Question 4 of 5 Which statement best reflects the difference between acute and chronic pancreatitis?
a. The pain from acute pancreatitis is less intense than from chronic pancreatitis.
b. Fluid replacement therapy is required only for treatment of acute pancreatitis.
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c. Once a client has been diagnosed with acute pancreatitis, it will progress rapidly to chronic
pancreatitis regardless of the response to treatment intervention.
d. Damage to the pancreas can be reversed in acute pancreatitis whereas with chronic pancreatitis
both exocrine and endocrine function are compromised.
11) Question 5 of 5 Which causes are associated with chronic pancreatitis? Select all that apply.
a. Hyperlipidemia
b. Cystic fibrosis
c. Spicy food indigestion
d. Hereditary disorders of the pancreas
e. Hypercalcemia