Cholecystitis and Pancreatitis Quiz

Nursing Management of Adults with Liver and Biliary Tract Disorders

• This course focuses on the nursing management of adults with disorders of the liver and biliary tract.
• Specific conditions like Cholelithiasis, Cholecystitis, Pancreatitis, Hepatitis, and Cirrhosis are used as examples.
• The objectives for the course include interpreting assessment data and diagnostic testing for liver and biliary tract conditions, developing comprehensive nursing care plans that include discharge plans, analyzing the impact of these disorders on physiological, psychological, and social domains, summarizing common drugs used for these conditions and their side effects, analyzing nursing research and ethical/legal considerations, and determining economic factors.

Anatomy Review

• Diagram of the liver, gallbladder, pancreas, cystic duct, common bile duct, pancreatic duct, and duodenum is provided in the anatomy review section.
• Illustrations help visualize the key locations and relationships of these organs.

The Gallbladder

• The gallbladder is a sac-like organ that stores and concentrates bile.
• Hormones from digestion stimulate the gallbladder to release bile.
• Gallstones are made of cholesterol, bilirubin, and calcium salts.

Cholecystitis

• Cholecystitis: Inflammation of the gallbladder
• Cholelithiasis: Gallstones in the gallbladder
• Choledocholithiasis: Gallstones in the common bile duct
• Cholangitis: Inflammation of the common bile duct

Acute Cholecystitis Pathophysiology

• Diffuse inflammation of the gallbladder.
• Usually due to obstruction of the cystic duct by gallstones.
• Inflammation develops behind the obstruction.
• Treatment involves removing the obstruction.
• May resolve spontaneously but can recur.

Chronic Cholecystitis Pathophysiology

• Repeated episodes of acute cholecystitis.
• Varying symptoms.
• Treatment typically involves cholecystectomy (gallbladder removal).

Cholecystitis Risk Factors & Assessment

• Women more frequently affected than men.
• Age as a risk factor.
• Pregnancy as a risk factor.
• Obesity.
• Stones vs No stones as underlying causes

Cholecystitis Diagnostic Tests

• X-rays can be used to rule out other causes but gallstones are rarely visible
• Ultrasound helps determine the size and presence of masses in abdominal organs.
• Magnetic Resonance Cholangiopancreatography (MRCP) visualises biliary tree and detects obstructions.
• Endoscopic Retrograde Cholangiopancreatography (ERCP) visualises biliary & pancreatic structures via endoscopy.
• Cholecystogram and cholangiogram help visualize gallbladder and bile duct.
• Laparoscopy allows for visualization of liver, gallbladder, and surrounding structures.

Cholecystitis Medical Management

• Surgical procedures such as cholecystectomy are outlined as the standard of treatment.
• Collaboration is crucial with supportive measures such as rest, intravenous fluids, and nutritional support.
• Medications such as analgesics, antibiotics, and ursodeoxycholic acid may also be employed in treatment.
• Extracorporeal shock wave lithotripsy is also an option.

The Pancreas

• The pancreas has exocrine and endocrine functions.
• Exocrine functions involve producing digestive enzymes that are secreted into the small intestine (enzymes such as amylase, protease and Lipase).
• Endocrine functions involve releasing hormones into the bloodstream (such as insulin, glucagon, somatostatin, and pancreatic polypeptide).

Acute Pancreatitis Pathophysiology

• Pancreatic enzymes are activated within the pancreas itself causing autodigestion and inflammation.
• This can lead to damage and scarring in the pancreas
• Obstruction is a common cause, for example, by gallstones.

Acute Pancreatitis Risk Factors

• Gallstones
• Alcohol abuse
• Biliary tract disease
• Bacterial or viral infection
• Trauma
• Drug toxicities
• Smoking

Acute Pancreatitis Clinical Manifestations

• Severe abdominal pain (often radiating to the back)
• Nausea and vomiting
• Fever
• Hypotension
• Tachycardia
• Jaundice
• Decreased or absent bowel sounds
• Cullen's sign (bluish discoloration around the umbilicus)
• Grey Turner's sign (bluish discoloration along the flanks)

Acute Pancreatitis Diagnostic Tests

• X-rays (abdominal and chest)
• CT scans
• ERCP
• Ultrasound
• Laboratory tests (Serum amylase, Serum lipase, Blood glucose, WBC, Serum bilirubin, and Serum calcium).

Acute Pancreatitis Medical Management

• Pain management
• Correcting fluid and electrolyte imbalances
• Preventing or reducing pancreatic secretions
• Removing the precipitating cause (e.g., gallstones)
• Providing adequate nutritional support either enterally or parenterally
• Supportive measures of pain control, position, IV fluids and electrolytes.

Chronic Pancreatitis Pathophysiology

• Ongoing inflammation and fibrosis.
• Destruction of pancreatic cells.
• Possible strictures and calcifications
• Impairment in digestive function and absorption.

Chronic Pancreatitis Medical Treatment

• Medication administration (non-opioid analgesics, insulin therapy)
• Pancreatic enzyme replacement therapy
• Balanced nutrition and lifestyle support (NPO, low-fat/ bland diet, etc.)
• Surgery (e.g., choledochojejunostomy, Roux-en-Y) when other interventions fail.

The Liver

• The liver is a vital organ, performing numerous functions.
• Functions include metabolism of drugs, production of bile, storing minerals & vitamins, carbohydrate & fat metabolism, filtering of the blood, and metabolism of steroid hormones.
• Detailed diagrams show the liver's anatomy.

Portal Circulation

• Blood from the gastrointestinal tract, pancreas, and spleen flows into the liver.
• Total blood flow through the liver is considerable.
• Blood flows into the hepatic portal vein.
• From the liver it exits through the hepatic vein to the vena cava

Fate of Bilirubin

• Breakdown of old red blood cells (RBCs) produces bilirubin
• Bilirubin is transported by the liver, conjugated, and excreted into the bile (important for stool colour)

Jaundice

• High levels of unconjugated bilirubin in the blood leads to jaundice.
• Jaundice causes a yellowing of skin and eyes

Hepatitis

• Inflammation of the liver.
• Caused by toxins, bacteria, or viruses including Hepatitis A, B, C, D, and E.
• Diagnostics may include but are not limited to serum amylase, alanine transaminase, direct bilirubin and urine bilirubin.

Hepatitis Medical Management

• Rest, adequate nutrition, limited medication and supportive care for liver metabolism.

Cirrhosis

• Extensive, irreversible scarring of the liver.
• Often due to chronic liver damage from conditions like alcoholism, Hepatitis B & C, or autoimmune diseases.

Portal Hypertension

• Increased pressure in the portal venous system.
• Liver damage leads to poor circulation and can cause fluid to build up in the abdomen which is known as ascites.
• Portal hypertension can cause varices (enlarged veins) in the esophagus and other areas.
• Diagnosed through a variety of tests, such as imaging (e.g., ultrasound) and blood tests

Cirrhosis Clinical Manifestations

• Portal Hypertension, Ascites, Hepatic Encephalopathy, Esophageal Varices, and other symptoms

Liver Failure

• Complete liver failure results in an array of symptoms related to liver function impairment.

Liver Transplant

• Surgical procedures involve replacing the diseased liver with a healthy one.
• Potential donors can be either deceased or living.
• Immunosuppressive therapy is essential to prevent rejection.

Issues Related to Liver Transplantation

• Rigorous selection processes for suitable donors and recipients.
• Ethical considerations regarding organ allocation.
• Complications, such as bleeding, infection, and rejection, are potential risks.

Nursing Process, Interventions, and Education

• Nursing diagnoses, overall goals, and nursing interventions related to liver diseases are addressed.
• Patient education regarding different aspects of liver diseases and treatment are discussed