Pancreas Functions and Aging

Gallbladder contraction, blocked bile flow due to a gallstone.

Right upper quadrant, between the 9th and 10th ribs.

Severe pain needing pain medications.

Morphine avoided due to sphincter of Oddi spasm risk, meperidine used instead (controversial).

Blocked bile duct prevents bile from entering the intestines.

Dark urine due to bile pigment excretion by the kidneys.

Grayish/clay-colored stool due to lack of bile pigment.

Obstructed bile flow hinders absorption of vitamins A, D, E, and K.

Ultrasonography is the preferred diagnostic method; it's fast, accurate, and safe for patients with liver issues and jaundice, using sound waves to create images.

Ultrasound can detect gallstones or a dilated bile duct with about 90% certainty.

An abdominal X-ray can be used to rule out other causes of symptoms if gallbladder problems are suspected.

Only a small percentage (10-15%) of gallstones are visible on abdominal X-rays due to calcification.

A diagnostic test using a radioactive agent to visualize the gallbladder and bile ducts to detect acute cholecystitis or bile duct blockage.

This test uses a contrast agent to visualize the gallbladder's function if ultrasound isn't available or isn't conclusive.

A patient drinks a contrast agent (avoiding iodine/seafood allergies) several hours before an X-ray to check gallbladder function and detect stones visually.

Expensive, radiation exposure, and longer procedure, usually following inconclusive diagnosis.

The primary goal is to reduce inflammation and achieve remission of symptoms. This often involves rest, IV fluids, pain relief, and antibiotics.

Surgery (laparoscopic cholecystectomy) is usually delayed until acute symptoms subside, typically within a few days.

A low-fat liquid diet is recommended initially, gradually progressing to include cooked fruits, lean meats, and other low-fat foods.

Foods high in fat, such as eggs, cream, fried foods, cheese, and alcohol, should be avoided as they may trigger another episode.

Ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) are used to dissolve cholesterol gallstones.

UDCA inhibits cholesterol synthesis and secretion, reducing the size of existing stones, dissolving small ones, and preventing new ones.

It can take 6 to 12 months of UDCA therapy to dissolve stones, and monitoring for recurrence or side effects is required.

This treatment is generally indicated for patients who refuse surgery or for whom surgery is not possible.

A surgical procedure where the gallbladder is opened to remove stones and drain bile, often used when a patient is too ill for a full cholecystectomy.

Performed when a patient is too ill for a full cholecystectomy or when the gallbladder inflammation is severe.

A tube is inserted into the gallbladder to drain bile and prevent leaks into the abdominal cavity.

A minimally invasive procedure where a needle is inserted into the gallbladder through the skin using ultrasound or CT guidance.

Used for patients who are too high-risk for surgery or general anesthesia.

Surgical cholecystostomy has a high mortality rate (10-30%) due to underlying infections.

Biliary tract disease is common in older adults due to increased cholesterol in bile.

Older adults have higher cholesterol in bile because their liver makes more cholesterol and less bile acid.

Older adults may not experience typical gallstone symptoms like fever, pain, chills, and jaundice. Instead, they may present with septic shock features like oliguria, hypotension, altered mental state, rapid heart rate, and rapid breathing.

Surgery for gallbladder disease in older adults carries risks due to pre-existing conditions. However, ignoring severe complications can be fatal, making surgery sometimes necessary despite risks.

For well-managed older adults, elective gallbladder surgery is usually safe and leads to good recovery with appropriate care before, during, and after surgery.

Reduced reimbursement for elective procedures leads to less frequent elective gallbladder surgeries, causing patients to be diagnosed in later stages of disease.

Older patients (over 60) undergoing surgery for gallbladder disease are more likely to have complicated acute cholecystitis, making thorough pre-surgical assessment essential.

Older patients and families require specific information about signs of complications and preventative measures to ensure early detection and optimal recovery.

Pre-admission tests and patient education are vital to minimize complications, including stopping smoking, avoiding aspirin and other medications that affect clotting.

Prior to surgery, focus on the patient's respiratory status to identify potential complications and tailor care accordingly.

Common nursing diagnoses after gallbladder surgery include acute pain, impaired gas exchange, impaired skin integrity, imbalanced nutrition, and deficient knowledge.

This diagnosis is relevant if a traditional surgical approach was used, as the incision can limit lung expansion.

This diagnosis is relevant if a drainage device (e.g., T-tube) is used, as it can affect the skin around the surgical site.

A common problem after gallbladder surgery due to limited bile secretion, which helps with digestion.

Patients may need education about incision care, diet, medications, and warning signs after surgery.

Potential complications after gallbladder surgery include bleeding and GI symptoms.

After gallbladder surgery, patients are placed in the low Fowler position, meaning they are slightly elevated.

IV fluids are given after surgery, and a nasogastric tube may be used for non-laparoscopic procedures to reduce bloating.