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Cholelithiasis
stone in the common bile duct
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Cholecystitis
Inflammation of the Gall Bladder
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Choledocholithiasis
stones in the Gallbladder
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In the Us where are GB stones common
caucasians Native Americans and Hispanics
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who are GB stones more common in
2-3 times more common in women
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the incidence of GB stones increases how
with age
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what else should people know that is a factor in GB stones
Obesity
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someone with rapid weight loss may have what
CHOLEDOCHOLITHIASIS (stones in the GB)
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pregnancy, multiparity, use of contraceptives
risk for GB stones
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people with Hypercholesterolemia is what
more prone to form stones
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If someon have a sedentary lifestyle what can happen
can get GB stones
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someone with diabetes is more prone to get
GB stones
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where is there a familial relationship with GB stones
Jewish, Italian, Chinese
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what is the saying about GB stones
female Fat, Forty, and Fertile
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3 types of GB stones
- 1. Cholesterol stones (90%)
- 2.Black pigmented stones
- 3.Mixed
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very fine like mud in the GB
Sludge
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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
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If clot gets clogged in GB what can happen
Jaundice
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when a Xray of the biliary tree is perfomed what is used to see the stones
nuclear medicine is injected in
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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
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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)
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what is the treatment for GB stones
- 1. NPO
- 2. IV's
- 3. Possible NG
- 4. Antimetics
- 5. Pain control
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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
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if stone gets stuck in the pancreas what can happen
can get pancreatitis
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when will the T Tube come out
when inflammation goes away
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how many incisions will someone have with a open cholecystectomy
4, 1 for the scope 1for the camera and 2 for the surgery
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six weeks off of work with what surgery
open cholecystectomy
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possible 2 days off of work with what GB surgery
laparoscopic Cholecystectomy
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what should be known about Cancer of the GB
- 1. diagnosis is difficult
- 2. prognosis is poor
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what are some risk factors for Acute Pancreatitis (Major)
- 1. Biliary stones
- 2. Alcohol use/Abuse
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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)
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Acute Pancreatitis what happens
mild (80%) or necrotizing hemorrhagic
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In Acute Pancratitis 4 Major processes occur
- 1. Lypolysis
- 2. Proteolysis
- 3. Necrosis of blood vessels
- 4. Inflammation (can start eating the pancreas)
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Fatty acids are released and combine with Ionized calcium and Hypocalcemia occurs
Lipolysis (Acute Pancratitis)
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Autodigestion of the pancreatic
Proteolysis (Acute Pancreatitis)
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Parenchyma by the enzymes leading to thrombosis and gangrene of the pancrea
Proteolysis (Acute Pancreatitis)
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May lead to hemorrhage
Necrosis of the blood vessels (Acute Pancratitis)
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Client is critically ill with pancreatic destruction, irreversible shock, and death
Necrosis of blood vessels (Acute pancreatitis)
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Leukocytes cluster, Abscess formation may occur, Infection occurs
Inflammation (Acute Pancreatitis)
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Exocrine production of digestion enzymes from Acinar Cells
- -Trypsin breaks down protein
- -Amylase breaks down Carbohydrates
- -Lipase breaks down fats
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what leads to autodigestion of the pancreas
trpsin, amylase and lipase accumulating in the pancreas and becoming activated
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what are some complications of Acute Pancreatitis
- Pancreatic Infection (most common cause of death)
- Hypooooovolemia
- hemorrhage
- acute renal failure
- paralytic ileus
- hypooooovolemic shock
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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)
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where is pancreas pain
LUQ, under the stomach
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what kind of pain with pancreas
acute pain in the epigastric region (lot of pain)
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will you see nausea and vomiting with acute pancreatitis
yes
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how would the abdomen be on assessment
ab. tenderness, rigidity, distention
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how would bowel sounds be with acute pancreatitis
decreased bowel activity
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would someone with acute pancreatitis have a fever
yes
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if acute pancreatitis is sever what will i see
Shock, Ascites, Jaundice, Acute tubular necrosis, and respiratory failure
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what is Turner's Sign in Acute Pancreatitis
grey blue discoloration along the flanks (severe)
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with Acute pancreatitis may show Cullen's sign how does this look
grey blue discoloration around the umbilicus (severe)
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what type of diagnostic test for Acute Pancreatitis
- Acute Abdominal pain
- elevated amylase
- elevated lipase (considered more specific)
- elevated trypsin
- Thrombocytopenia
- hyperglycemia, hypogycemia
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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
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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
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fibrosis and scar tissue replace normal pancreatic tissue
Chronic Pancreatitis
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what are some causes of Chronic Pancreatitis
- 1 Chronic alcohol consumption, (called chronic calicifying pancreatitis)
- 2 Obstruction
- 3 Metabolic disturbances
- 4 Malutrition
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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
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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
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what are some more treatments for Chronic Pancreatitis
- 1. Enzyme replacement
- 2. supplemental pancreatic enzymes
- 3. Fat soluable vitamin replacement
- 4. management of diabetes
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usually adenocarcinomas
Cancer of the pancreas
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where is cancer of the pancreas found
in the head of the pancreas
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this cancer is found more in men and can be due to cigarette smoke
cancer of the pancreas
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this cancer has a hereditary component
cancer of the pancreas
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NO LINK TO ALCOHOL
cancer of the pancreas
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bad cancer poor prognosis
cancer of the pancreas
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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
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what is a treatment for cancer of the pancreas
- Surgery is the only hope for cure if found early
- whipple procedure or total pancreatectomy
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what is the prognosis of pancreatic cancer
usually fatal in 18-20 months (less than 5% survive for 5 years)
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by the time pancreatic cancer is usually diagnosed what has happened
metastasis has usually occurred
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how would the use of chemo and radiation be for pancreatic cancer
chemo and radiation has limited success
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if someone has pancreatic cancer how would they eat
tube feeding and TPN
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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
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what is often a common problem with the whipple procedure
obstruction is a common problem and surgical bypass is often necessary
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after the whipple procedure what is an ongoing chanlleng
pain management
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what should be tried 1st before having surgery for obesity
- 1. Diets
- 2. drug therapy
- 3. exercise
- 4. bebavioral treatment
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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
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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
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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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