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Chapter 62 Med-Surg
Terms in this set (44)
An inflammation of the gallbladder
Chemical irritation and inflammation result from gallstones that obstruct the cystic duct, gallbladder neck, or common bile duct.
inflammation occurring without gallstones
Key features of Cholecystitis
Vague UA pain
Pain triggered by high fat or high volume food
Feeling abdominal fullness
Rebound tenderness(Blomberg's sign)
5 F's for gallstones
Surgical removal of the gallbladder
Exocrine function of the pancreas
Responsible for secreting enzymes that assist in the breakdown of starches, proteins, and fats.(normally secreted in the inactive form and become activated once they enter the small intestine)
What results in the inflammatory response of pancreatitis?
Early activation(activation within the pancreas rather than the intestinal lumen)
Causes of pancreatitis
possible peptic ulcer, mumps or hypothermia
drugs such as: glucocorticoids, Retrovir, Videx, Diuril, and Imuran
Complications of acute pancreatitis
*Atelectasis and pneumonia; left lung pleural effusion
*ARDS (Acute Respiratory Distress Syndrome
*Multi system organ failure
*Acute Renal Failure
Why is hyperglycemia a complication of pancreatitis?
problems with exocrine function = problems with the endocrine functions
Why is Atelectasis and pneumonia; left lung pleural effusion: a complication of pancreatitis?
from backup of lymph that gets into the pleural space that prevents the lungs from fully expanding
Why is Multi system organ failure a complication of pancreatitis?
respiratory failure + kidney failure + liver failure +GI tract not working = slimmer survival chances
Why is ARDS (Acute Respiratory Distress Syndrome) a complication of pancreatitis?
• From lymph backing up and causing damage to alveoli
• Hallmark sign = inability to oxygenate a patient, even with giving 100% O2 on ventilator SpO2 = 80%
Clinical manifestations of Pancreatitis
-Severe abdominal pain in the mid-epigastric area or LUQ
- Typical pain from acute pancreatitis = a "boring" pain
When performing an abdominal assessment, inspect for(pancreatitis)
*Gray-blue discoloration of abdomen and peri-umbilical area
*Gray-blue discoloration of the flanks
*Reduced bowel sounds
Lab test to diagnose pancreatitits
Serum levels of
Critical care for pts with acute pancreatitis
monitor for significant changes in vital signs that may indicate life threatening complication of shock.
*excessive fluid volume shifting
*toxic effects of abdominal sepsis from enzyme damage
The priority problems for pts with acute pancreatitis are
*Acute pain related to pancreatic inflammation and leakage of enzyme
*Inadequate nutrition related to inability to properly digest food and absorb nutrients.
Managing Acute Pancreatitis: Non-surgical management
Hydration with Iv fluids, pain control, and drug therapy.
Common complication of acute pancreatitis is paralytic(adynamic) ileus, so what maybe necessary?
Prolonged nasogastric intubation.
*Assess frequently for the return of peristalsis.
what happens is a protein plug occludes the pancreatic duct that prevents the excretion of the enzymes = enzymes turn on the pancreas = inflammation of pancreas = necrosis of pancreas = (over time) fibrosis of the pancreas
Chronic obstructive pancreatitis
inflammation, spasm, and obstruction of the sphincter of Oddi, often from gallstones.
Loss of exocrine function in Chronic Pancreatitis
*Leads to decrease in fat absorption and decrease in protein absorption
*Decrease in fat = excreted by GI tract = steatorrhea (stool will have white streaks in it)
*Decrease in protein = protein can't be utilized by body = protein cannot hold the fluid in the serum in blood vessels = fluid leaks out into interstitial fluid = whole body edema (legs, abdomen, arms)
Loss of endocrine function of Chronic Pancreatitis
responsible for the development of diabetes mellitus
Diagnosis of chronic pancreatitis
• Intense abdominal pain (major clinical manifestation) that is continuous and burning or gnawing
• Abdominal tenderness
• Possible LUQ mass (if pseudocyst of abscess is present)
• Respiratory compromise manifested by adventitious or diminished breath sounds, dyspnea, or orthopnea
• Steatorrhea; clay colored stools
• Weight loss
• Dark urine
• Polyuria, polydipsia, polyphagia (diabetes mellitus)
Managament of patients with chronic pancreatitis
*assist in maintaining a sufficient nutritional intake
Major intervention of pt with chronic pancreatitis
Major intervention for pt with acute pancreatitis
Pancreatic enzyme replacement therapy (PERT)
Standard of care to prevent malnutrition, malabsorption, and excessive weight loss
Enzyme Replacement for the Patient with Chronic Pancreatitis
• Take with meals or snack and follow with glass of water
• Administer after antacid or H2 blockers (decreased pH inactivates drug)
• Do not chew to minimize oral irritation and to allow the drug to be released slowly
• If you can't swallow capsule, pierce the gelatin casting and place contents in applesauce
• Do not mix enzyme preparations with protein-containing foods
• Wipe lips after taking enzymes to avoid skin irritation
• Do not crush enteric coated tablet preparations
• Follow up on all schedule laboratory testing. (Pancrelipase can cause an increase in uric acid levels)
Diet of pts with chronic pancreatitis
high carb, high protein, low fat
4000-6000 calories a day
*False cyst (lack of epithelial lining), encapsulated, sac-like, form on or surround the pancreas
*May spontaneously resolve
If does not resolve in 6 weeks then surgical intervention is necessary
Primary symptom of pancreatic pseudocyst
Epicgastric pain that radiates to back and flank
*Pancreatic abscesses are the most serious complication of acute necrotizing pancreatitis
*Almost always fatal if untreated
How do pancreatic abscess occur
acute or chronic pancreatitis, or gallbladder surgery
Symptoms of pancreatic abscess
*High fever (as high as 104)
*Similar presentation as pseudocysts, but they're "a whole lot sicker"
*Pleural effusion commonly accompany abscess if they enter the pleural space
Diagnosis of pancreatic abscess
*Leading cause of cancer deaths because it is incredibly difficult to diagnose early - usually diagnosed in late stages
*Treatment has limited results and 5-year survival rates are low
Primary pancreatic tumors
*Usually come from epithelial cells of the pancreatic ducts
•Usually the tumor is discovered in late stages of development and may be a well-defined mass or diffusely spread throughout the pancreas
•Rapid growing and highly metastatic to anywhere else in body
•Head of pancreas most common site of primary pancreatic tumors
Secondary pancreatic tumors
•From cancer elsewhere in body
•Metastasis from lung, breast, thyroid, kidney, or skin cancers
•Primary tumors are generally adenocarcinomas
Risk factors of pancreatic cancer
*Age: 60-80 highest risk
*Diabetes - generally type 1
*High intake of red meat and processed meat
•Involves resection of the proximal pancreas, adjoining duodenum, distal portion of the stomach, and distal portion of the common bile duct.
•The pancreatic duct, common bile ducts, and stomach are anastomosed to the jejunum.
Pre op care for whipple procedure
oNG tube to decompress stomach
oJejunostomy tube for enteral feedings
oTPN typically begun in addition to tube feedings or as a single measure to provide nutrition
oIf laparoscopic surgery no bowel-prep is needed
oNPO at least 6-8 hours before surgery
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