Latarsha

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latarsha
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25438
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Latarsha
Updated:
2010-07-02 07:16:32
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Gallbladder Exocrine Pancreatic Problems
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Summer semester 3rd exam Pavel
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  1. Cholelithiasis
    stone in the common bile duct
  2. Cholecystitis
    Inflammation of the Gall Bladder
  3. Choledocholithiasis
    stones in the Gallbladder
  4. In the Us where are GB stones common
    caucasians Native Americans and Hispanics
  5. who are GB stones more common in
    2-3 times more common in women
  6. the incidence of GB stones increases how
    with age
  7. what else should people know that is a factor in GB stones
    Obesity
  8. someone with rapid weight loss may have what
    CHOLEDOCHOLITHIASIS (stones in the GB)
  9. pregnancy, multiparity, use of contraceptives
    risk for GB stones
  10. people with Hypercholesterolemia is what
    more prone to form stones
  11. If someon have a sedentary lifestyle what can happen
    can get GB stones
  12. someone with diabetes is more prone to get
    GB stones
  13. where is there a familial relationship with GB stones
    Jewish, Italian, Chinese
  14. what is the saying about GB stones
    female Fat, Forty, and Fertile
  15. 3 types of GB stones
    • 1. Cholesterol stones (90%)
    • 2.Black pigmented stones
    • 3.Mixed
  16. very fine like mud in the GB
    Sludge
  17. Signs and symptoms of Choledocholithiasis
    • Sudden RUQ pain (Biliary Colic)
    • 1 severe and steady in quality
    • 2 frequently radiates to the right scapula or shoulder
    • 3 persists 1-3 hours
    • 4 May awaken patient at night
    • 5 May be associated with large fatty meal
  18. If clot gets clogged in GB what can happen
    Jaundice
  19. when a Xray of the biliary tree is perfomed what is used to see the stones
    nuclear medicine is injected in
  20. more signs and symptoms of GB stones
    • 1. Anorexia, nausea and possibly vomiting
    • 2. Mild to moderate fever
    • 3. Decreased or Absent bowel Sounds
    • 4. Acute abdominal tenderness and a positive Murphy's sign or Blumberg's sign (blue)
    • 5. Jaundice, Clay colored stools, dark urine, Steatorrhea (if bile is not getting to intestines)
    • 6. Elevated WBC count, slightly elevated Serum Bilirubin and Alkaline Phosphatase levels
  21. What diagnostic test are done to detect GB stones
    • 1. Ultrasound of GB NPO, NPO, NPO
    • 2. Oral Cholecystogram (pills night before Iodine)
    • 3. HIDA scan
    • 4. ERCP
    • 5. IV Cholangiogram
    • 6. Bloodwork (amylase, lipase the next day LFT liver function study, CBC)
  22. what is the treatment for GB stones
    • 1. NPO
    • 2. IV's
    • 3. Possible NG
    • 4. Antimetics
    • 5. Pain control
  23. what are some more treatments for GB stones
    • 1. Extracorporeal shock wave lithotripsy (to break up the stones)
    • 2. Percutaneous Transhepatic biliary catheter insertion
    • 3. Endoscopic bile duct stone removal
    • 4. Surgery (remove GB) T tube inserted in common bile duct
  24. if stone gets stuck in the pancreas what can happen
    can get pancreatitis
  25. when will the T Tube come out
    when inflammation goes away
  26. how many incisions will someone have with a open cholecystectomy
    4, 1 for the scope 1for the camera and 2 for the surgery
  27. six weeks off of work with what surgery
    open cholecystectomy
  28. possible 2 days off of work with what GB surgery
    laparoscopic Cholecystectomy
  29. what should be known about Cancer of the GB
    • 1. diagnosis is difficult
    • 2. prognosis is poor
  30. what are some risk factors for Acute Pancreatitis (Major)
    • 1. Biliary stones
    • 2. Alcohol use/Abuse
  31. what are some Minor risk for Acute Pancreatitis
    • 1. Trauma
    • 2. Infectious disease
    • 3. cancer
    • 4. Chronic diseases
    • 5. Drug toxicities
    • 6. operative manipulation (ERCP)
  32. Acute Pancreatitis what happens
    mild (80%) or necrotizing hemorrhagic
  33. In Acute Pancratitis 4 Major processes occur
    • 1. Lypolysis
    • 2. Proteolysis
    • 3. Necrosis of blood vessels
    • 4. Inflammation (can start eating the pancreas)
  34. Fatty acids are released and combine with Ionized calcium and Hypocalcemia occurs
    Lipolysis (Acute Pancratitis)
  35. Autodigestion of the pancreatic
    Proteolysis (Acute Pancreatitis)
  36. Parenchyma by the enzymes leading to thrombosis and gangrene of the pancrea
    Proteolysis (Acute Pancreatitis)
  37. May lead to hemorrhage
    Necrosis of the blood vessels (Acute Pancratitis)
  38. Client is critically ill with pancreatic destruction, irreversible shock, and death
    Necrosis of blood vessels (Acute pancreatitis)
  39. Leukocytes cluster, Abscess formation may occur, Infection occurs
    Inflammation (Acute Pancreatitis)
  40. Exocrine production of digestion enzymes from Acinar Cells
    • -Trypsin breaks down protein
    • -Amylase breaks down Carbohydrates
    • -Lipase breaks down fats
  41. what leads to autodigestion of the pancreas
    trpsin, amylase and lipase accumulating in the pancreas and becoming activated
  42. what are some complications of Acute Pancreatitis
    • Pancreatic Infection (most common cause of death)
    • Hypooooovolemia
    • hemorrhage
    • acute renal failure
    • paralytic ileus
    • hypooooovolemic shock
  43. more compications of Acute pancreatitis
    • Pleural effusion, Atelectasis, Pneumonia
    • ARDS
    • DIC
    • multiorgan system failure
    • diabetes millitus (beta cells destroyed, these pt. will be in intensive care, beta cells make insuline)
  44. where is pancreas pain
    LUQ, under the stomach
  45. what kind of pain with pancreas
    acute pain in the epigastric region (lot of pain)
  46. will you see nausea and vomiting with acute pancreatitis
    yes
  47. how would the abdomen be on assessment
    ab. tenderness, rigidity, distention
  48. how would bowel sounds be with acute pancreatitis
    decreased bowel activity
  49. would someone with acute pancreatitis have a fever
    yes
  50. if acute pancreatitis is sever what will i see
    Shock, Ascites, Jaundice, Acute tubular necrosis, and respiratory failure
  51. what is Turner's Sign in Acute Pancreatitis
    grey blue discoloration along the flanks (severe)
  52. with Acute pancreatitis may show Cullen's sign how does this look
    grey blue discoloration around the umbilicus (severe)
  53. what type of diagnostic test for Acute Pancreatitis
    • Acute Abdominal pain
    • elevated amylase
    • elevated lipase (considered more specific)
    • elevated trypsin
    • Thrombocytopenia
    • hyperglycemia, hypogycemia
  54. more diagnstic tests for acute pancreatitis
    • hypomagnesemia
    • elevated LFT (ALT, ALK. PHOS, Bili)
    • Ab. Xrays, CXR
    • ultrasound
    • CT scans
    • need to make sure it's pancreatitis
  55. what is the treatment for Acute Pancreatitis
    • Supporive Care: pain management, NPO, NPO, NPO IV's NGT, NGT, NGT
    • RESt the bowel, keep pt. comfortable
  56. fibrosis and scar tissue replace normal pancreatic tissue
    Chronic Pancreatitis
  57. what are some causes of Chronic Pancreatitis
    • 1 Chronic alcohol consumption, (called chronic calicifying pancreatitis)
    • 2 Obstruction
    • 3 Metabolic disturbances
    • 4 Malutrition
  58. Signs and symptoms of Chronic Pancreatitis
    • 1. Nausea, Vomiting
    • 2. Abdominal pain
    • 3. Ascites
    • 4. Streatorrhea, clay colored stools
    • 5. weight loss
    • 6. Diarrhea and streatorrhea
    • 7. Diabetes, Jaundice
  59. what would a simple treatment plan for chronic pancreatitis be
    • 1. Pain Control
    • 2. bowel rest
    • 3. NO ALCOHOL
    • 4. High protein, High carbohydrate, low fat diet
  60. what are some more treatments for Chronic Pancreatitis
    • 1. Enzyme replacement
    • 2. supplemental pancreatic enzymes
    • 3. Fat soluable vitamin replacement
    • 4. management of diabetes
  61. usually adenocarcinomas
    Cancer of the pancreas
  62. where is cancer of the pancreas found
    in the head of the pancreas
  63. this cancer is found more in men and can be due to cigarette smoke
    cancer of the pancreas
  64. this cancer has a hereditary component
    cancer of the pancreas
  65. NO LINK TO ALCOHOL
    cancer of the pancreas
  66. bad cancer poor prognosis
    cancer of the pancreas
  67. what are some signs and symptoms of cancer of the pancreas
    • 1. Pain
    • 2. Jaundice
    • 3. light colored stools
    • 4. dark urine
    • 5. Steatorrhea
    • 6. Diarrhea
    • 7. weight loss
  68. what is a treatment for cancer of the pancreas
    • Surgery is the only hope for cure if found early
    • whipple procedure or total pancreatectomy
  69. what is the prognosis of pancreatic cancer
    usually fatal in 18-20 months (less than 5% survive for 5 years)
  70. by the time pancreatic cancer is usually diagnosed what has happened
    metastasis has usually occurred
  71. how would the use of chemo and radiation be for pancreatic cancer
    chemo and radiation has limited success
  72. if someone has pancreatic cancer how would they eat
    tube feeding and TPN
  73. what is the whipple procedure
    • 1. Partial gastrectomy
    • 2. cholecystectomy
    • 3. removal of the common bile duct
    • 4. removal of the head of the pancreas
    • 5. removal of the duodenum, proximal jejunum and regional lymph nodes
    • 6. splenectomy
  74. what is often a common problem with the whipple procedure
    obstruction is a common problem and surgical bypass is often necessary
  75. after the whipple procedure what is an ongoing chanlleng
    pain management
  76. what should be tried 1st before having surgery for obesity
    • 1. Diets
    • 2. drug therapy
    • 3. exercise
    • 4. bebavioral treatment
  77. after trying the normal treatment of losing weight what else could be done
    • surgical management
    • 1. liposuction (more cosmetic)
    • 2. bariatric surgery
    • need to be 20% over body weight to have the surgery
  78. what are the different bariatric surgeries someone can have
    • 1. vertical banded gastroplasty
    • 2. circumgastric banding
    • 3. gastric bypass or Roux-en Y gastric bypass
  79. what shouldn't be done with bariatric patients
    • DO NOT INSERT NGT
    • NEVER REPOSITION THE TUBE, because it is movement can disrupt the suture line

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