UNIT 8 – CH 37: Alt. in functions of the gallbladder and Exocrine Pancreas
Cholelithiasis – cholesterol Gallstone formation
What causes gallstones/ what is underlying cause?
1. MOST COMMON CAUSE à super saturation of bile w/ cholesterol causing cholesterol crystals
to form
2. Nucleation of crystals
3. Hypo motility (stasis of bile) allowing stone growth
Risk factors
o High cholesterol
o Female (2:1)
o Metabolic syndrome … DM à insulin resistance
o TPN… high fat content
o Rapid weight loss
o Pregnancy
o Spinal cord injuries, especially high spinal cord injuries à cause it can cause hypo mobility
o Obesity
S/S
o Persistent epigastric pain or RUQ pain à Pain radiates to back
o Precipitated by a meal
Cholecystitis – inflammation of the gallbladder wall CAUSED BY
90% CASES HAD STONES FIRST – Cholelithiasis (A. Cholecystitis)
Obstruction of cystic duct
Bacterial infection causing Cholecystitis instead of stones
Acute Cholecystitis – acute inflammation of the gallbladder wall and/or sphincter of Oddi
DON’T GIVE MORPHINE… GIVE DILAUDID
S/S
o HALLMARK à Fever (leukocytes) (Cholecystitis v. Cholelithiasis) and RUQ pain (severe à
radiates to back)
Chronic Cholecystitis –
Untreated CAN cause cancer … increased risk
Biliary Malignancy –
May by ASYMPTOMATIC until disease is advanced
CH 38: Liver diseases
Hepatocellular Failure –
S/S
o Jaundice
o Muscle wasting
o Ascites
o n/v
o anorexia
, Portal HTN –
Sluggish blood flow resulting in increased pressure in portal circulation
S/S: anorexia, Varices (esophageal, gastric, hemorrhoidal), ascites, Splenomegaly
Ascites –
Accumulation of sodium, water, and protein in peritoneal cavity
General S/S of Liver Disease
Jaundice – what is the underlying CAUSE?
o Impaired bilirubin metabolism (INCREASE)
Ascites – what is the underlying CAUSE?
o Portal HTN and hypoalbuminemia
Edema
AMS
Hepatitis A – also called “Enteric Hepatitis”
RNA Virus
S/S
o RUQ pain
o Malaise
o Nausea
o Anorexia
o Jaundice (2 weeks)
No TX ... preventative HBA vaccine’s
How is it transmitted? Poor sanitation
o Fecal – oral route
o Poor water source
What is incubation period?
o 2-7 weeks
What do we see?
o Pt may be asymptomatic
o LABS –
ACUTE – HAV IgM ELEVATED (recent ACUTE infection)
PREVIOUS INFECTION – HAV IgG (once elevated, it will ALWAYS be elevated), says they
have antibodies – tells if it’s CHRONIC
Hepatitis B –
DNA virus
Via Sex, blood, or parental
Prevention: HBV vaccine
Increase risk for cancer (cirrhosis scarring)
What is incubation period?
o 2-6 months or 4-26 weeks
Cholelithiasis – cholesterol Gallstone formation
What causes gallstones/ what is underlying cause?
1. MOST COMMON CAUSE à super saturation of bile w/ cholesterol causing cholesterol crystals
to form
2. Nucleation of crystals
3. Hypo motility (stasis of bile) allowing stone growth
Risk factors
o High cholesterol
o Female (2:1)
o Metabolic syndrome … DM à insulin resistance
o TPN… high fat content
o Rapid weight loss
o Pregnancy
o Spinal cord injuries, especially high spinal cord injuries à cause it can cause hypo mobility
o Obesity
S/S
o Persistent epigastric pain or RUQ pain à Pain radiates to back
o Precipitated by a meal
Cholecystitis – inflammation of the gallbladder wall CAUSED BY
90% CASES HAD STONES FIRST – Cholelithiasis (A. Cholecystitis)
Obstruction of cystic duct
Bacterial infection causing Cholecystitis instead of stones
Acute Cholecystitis – acute inflammation of the gallbladder wall and/or sphincter of Oddi
DON’T GIVE MORPHINE… GIVE DILAUDID
S/S
o HALLMARK à Fever (leukocytes) (Cholecystitis v. Cholelithiasis) and RUQ pain (severe à
radiates to back)
Chronic Cholecystitis –
Untreated CAN cause cancer … increased risk
Biliary Malignancy –
May by ASYMPTOMATIC until disease is advanced
CH 38: Liver diseases
Hepatocellular Failure –
S/S
o Jaundice
o Muscle wasting
o Ascites
o n/v
o anorexia
, Portal HTN –
Sluggish blood flow resulting in increased pressure in portal circulation
S/S: anorexia, Varices (esophageal, gastric, hemorrhoidal), ascites, Splenomegaly
Ascites –
Accumulation of sodium, water, and protein in peritoneal cavity
General S/S of Liver Disease
Jaundice – what is the underlying CAUSE?
o Impaired bilirubin metabolism (INCREASE)
Ascites – what is the underlying CAUSE?
o Portal HTN and hypoalbuminemia
Edema
AMS
Hepatitis A – also called “Enteric Hepatitis”
RNA Virus
S/S
o RUQ pain
o Malaise
o Nausea
o Anorexia
o Jaundice (2 weeks)
No TX ... preventative HBA vaccine’s
How is it transmitted? Poor sanitation
o Fecal – oral route
o Poor water source
What is incubation period?
o 2-7 weeks
What do we see?
o Pt may be asymptomatic
o LABS –
ACUTE – HAV IgM ELEVATED (recent ACUTE infection)
PREVIOUS INFECTION – HAV IgG (once elevated, it will ALWAYS be elevated), says they
have antibodies – tells if it’s CHRONIC
Hepatitis B –
DNA virus
Via Sex, blood, or parental
Prevention: HBV vaccine
Increase risk for cancer (cirrhosis scarring)
What is incubation period?
o 2-6 months or 4-26 weeks
