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Chapter 32: Disorders of Gallbladder, Pancreas, Bile Duct
Terms in this set (20)
What clinical finding indicates cholecystitis? Select all that apply.
b. Right upper quadrant pain
c. Nausea following a high fat meal
d. Cullen sign
e. Grey-Turner's sign
Right upper quadrant pain
Which of the following is suspected in a patient who has an obstruction in the common bile duct?
a. Chronic pancreatitis
d. Pancreatic cancer
Which of the following may indicate damage to the pancreas? Select all that apply.
a. Prolonged clotting time
b. Decreased AST
c. Elevated serum amylase
d. Decreased ALT
e. Elevated serum lipase
Elevated serum amylase
Elevated serum lipase
Which disorder is treated with Whipple procedure?
b. Calculous cholecystitis
d. Acute pancreatitis
e. Pancreatic cancer
Which is an early sign of pancreatic cancer? Select all that apply.
a. Grey Turner sign
b. Epigastric pain
d. Cullen sign
Grey Turner sign
Laura is a 48-year-old woman who recently appeared at the clinic complaining of RUQ pain that worsens after eating. From her records, you see that Laura has been in poor health for some time. She is obese and leads a sedentary lifestyle. Past medical history shows prolonged alcohol abuse, although Laura reports she has been attending Alcoholics Anonymous meetings "on and off" for the past 2 years. She states that when she stops attending AA meetings, she has "at most" two to three alcoholic drinks, two to three times per week.
You want to evaluate Laura's report of pain further. Upon palpation of the right abdomen, Laura cringes as you press down while asking Laura to take a deep inhalation. You consider this to be positive for _______________.
a. Cullen sign
b. Grey Turner sign
c. Murphy's sign
d. Chvostek's sign
e. Trousseau sign
Murphy's sign is is considered positive if pain is elicited on the right side, but not the left side. A positive test may indicate cholecystitis. Cullen and Grey Turner signs may be present in pancreatitis, whereas Chvostek's and Trousseau signs appear with abnormal calcium levels.
Laura finds it strange when you ask if she feels any pain in her _________________. You tell her you are asking this question because you suspect she may have inflammation of her gallbladder and the pain from this condition often radiates.
a. Right hip
Pain from the gallbladder often refers to the shoulder area, commonly the right shoulder.
Inflammation of the gallbladder is known as ________________. It most commonly is caused by gallstones, known as _________________________.
a. biliary stasis, cholecystitis
b. biliary colic, cholangitis
c. cholecystitis, cholangitis
d. cholelithiasis, cholecystitis
e. cholecystitis, cholelithiasis
Cholecystitis refers to inflammation if the gallbladder, whereas cholelithiasis is the presence of gallstones. Gallstones are the most common cause of inflammation in the gallbladder.
When you speak with Laura to review her symptoms further, you ask what type of food she eats that tends to result in pain. You know that ________________ foods tend to worsen gallbladder pain.
a. high glycemic
b. high protein
c. simple carbohydrate
d. high fat
e. high fiber
Eating foods high in fat can increase the sensation of pain in patients with gallbladder issues. Bile is stored in the gallbladder and is released into the small intestine to aid in fat digestion. When foods high in fat are eaten, the gallbladder is signaled to contract and release bile. In those individuals with an inflamed gallbladder, pain may occur.
CT scans later reveal the presence of gallstones in Laura's gallbladder. Most gallstones are comprised of _____________________.
b. uric acid
c. oxalic acid
e. free fatty acids
Cholesterol is the most common component of gallstones, as cholesterol is a primary substance in bile.
Given Laura's history of alcohol abuse and the current condition of cholelithiasis, you are worried about the ________________ being affected.
e. esophageal veins
Both the gallbladder and pancreas have ducts that enter the duodenum near the opening from the stomach. Because of the close proximity of these structures, problems in either the gallbladder or pancreas may affect the other organ.
Acute pancreatitis may cause autodigestion of the pancreas and result in elevation in the serum of pancreatic ______________ and _________________.
a. AST, ALT
b. bilirubin, bile salts
c. amylase, lipase
d. Hct, Hb
e. None of the above are correct.
In addition to producing the hormones glucagon and insulin, the pancreas creates and secretes several digestive enzymes. Normally, these enzymes are released into the small intestine, where they are activated. In the case of pancreatitis, cell damage may result in the release of these enzymes into the bloodstream. Thus, a key sign for pancreatitis is the elevation in the serum of pancreatic amylase and lipase.
Bleeding in the peritoneal and retroperitoneal areas may present as ________________ and ______________ signs in patients with acute pancreatitis.
a. Chvostek, Trousseau
b. Cullen, Grey Turner
c. Murphy, McBurney
d. Psoas, Obturator
e. Ranson, Cullen
Cullen, Grey Turner
Cullen and Grey Turner signs occur when internal hemorrhage is present in the abdominal area. These signs may appear in acute pancreatitis. Cullen sign appears around the umbilicus area, whereas Grey Turner sign appears on the flanks.
___________ criteria are used to evaluate severity of acute pancreatitis, by examining 5 characteristics at admission and 6 additional characteristics within 48 hours.
b. Grey Turner
Ranson criteria are used to assess prognosis of acute pancreatitis. Criteria such as age, blood glucose levels, and white blood cell count are evaluated at admission. Additional criteria are assessed 48 hours after admission.
If pancreatitis is chronic, _______________ is the primary sign.
c. elevated uric acid
d. pancreatic calcification
e. elevated lipase
Pancreatitis can occur in acute and chronic forms. The hallmark for chronic pancreatitis is the appearance of calcium deposits in the pancreas. The calcification is due to scar tissue forming during inflammation of the pancreas, which is then calcified.
A nurse finds that the diagnostic report of a patient shows gallstones in the cystic duct. Which substance is most commonly found in gallstones?
c. oxalic acid
d. uric acid
A patient complains of nausea and vomiting after eating, along with right upper quadrant pain that radiates to the right shoulder. What condition do you suspect?
a. Pancreatic cancer
b. Peptic ulcer disease
c. Liver cancer
e. Acute pancreatitis
A biliary duct obstruction may cause _______________.
a. liver cancer
b. increased blood clotting time
c. increased serum bilirubin levels
d. decreased bile production
e. elevated serum amylase
increased serum bilirubin levels
Laboratory values for a patient reveal elevated serum amylase and lipase. What condition do you suspect?
c. Grey Turner disease
Ranson criteria are used to evaluate _______________.
a. severity of gallstones
b. severity of acute pancreatitis
c. severity of pancreatic cancer
d. severity of liver cancer
e. severity of cholecystitis
severity of acute pancreatitis
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