Cholecystitis & Pancreatitis
Gallbladder disease
Cholelithiasis: stones in gallbladder
Cholecystitis: inflammation of gallbladder
Risk Factors
• Common in females (Female, Forty, Fat)
• High fat diet
• Older adults
• Estrogen therapy
• Sedentary lifestyle
• Obesity
• Diabetes
Etiology
• Cholecystitis: obstruction from stones or sludge
• Cholelithiasis: develops when balance that keeps cholesterol, bile salts & calcium in
solution is altered, leading to stones. Stones may remain in gallbladder or may migrate
to cysts or common bile duct
Clinical Manifestations
• Nausea & vomiting after high fat food
• Sharp RUQ, epigastric or shoulder pain
o More severe when stones moving or obstructing
o Sharp, excruciating
o May be referred to shoulder/scapula
o Residual tenderness in RUQ
o Occur 3-6 hr after high fat meal or when pt lies down
• Positive Murphy’s sign (pain when palpating gallbladder)
• When total obstruction occurs
o Dark amber urine
o Clay-colored stools
o Pruritis (itchy skin)
o Intolerance to fatty foods
o Jaundice
o Heartburn
Diagnostic Studies
• Ultrasound
• ERCP (endoscopic retrograde cholangiopancreatography)
• Lab tests
o ↑ WBC count
o ↑ serum bilirubin level, ↑ urinary bilirubin level
,Nursing Care
• Admin meds
• Maintain low fat diet
• Therapeutic measures
o ERCP w/ sphincterotomy
o Shock wave lithotripsy
• Surgery
o Cholecystectomy
Medication
• Analgesic (morphine)
• Antiemetics
• Anticholinergics (atropine)
o Decrease DI secretions
o Counteract smooth muscle spasms
• Antibiotics
Therapeutic Therapy: ERCP with sphincterotomy
• Visualization
• Dilation
• Placement of stents
• Open sphincter of Oddi, if needed
• Endoscope passed to duodenum
• Stones removed w/ basket or allowed to pass in stool
Post-ERCP Care
• Assess for complications
o Perforation
o Hemorrhage
o Infection
• Bed rest
• NPO until return of gag reflex
Therapeutic Therapy: Lithotripsy
Shock wave therapy used to break up small cholesterol stones
Surgical Therapy: Cholecystectomy
Laparoscopic cholecystectomy
• Treatment of choice
• Removal of gallbladder through 1-4 puncture holes
• Minimal postop pain, discharged day of surgery
• Resume normal activities w/in 1 week
• Few complications
,Open (incisional) cholecystectomy
• Removal of gallbladder through right subcostal incision
• T-tube inserted in common bile duct
o Ensures patency of duct
o Allows excess bile to drain
o Report drainage >1000 mL/day
o Keep below level of gallbladder
Postop Care
• Prevent respiratory complications
• Maintain drainage tubes (T-tube, Penrose, or Jackson-
Pratt)
• Replace fluids & electrolytes
• No heavy lifting for 4-6 weeks
• Usual activities when ready
• Low fat diet
Pancreatitis
Acute or chronic
Acute
• Acute inflammatory process of pancreas
• Spillage of pancreatic enzymes into surrounding pancreatic tissue causing autodigestion
by exocrine enzymes
• Life-threatening
Chronic
• Progressive disease characterized by remission & exacerbations diminishing function
Etiology
• Gallbladder disease
• Chronic alcohol intake
• Illegal drug use
• Infection
• Blunt abdominal trauma
Clinical Manifestations
• Abdominal pain predominant
o LUQ or mid-epigastrium
o Radiates to back, Sudden onset
o Deep, piercing, continuous, or steady
o Intensifies after meals, Starts when lying down
o Not relieved with vomiting
, • Nausea/vomiting
• Abdominal skin discoloration
o Grey Turner’s sign (bruising of flank)
o Cullen’s sign (bruising around umbilicus)
• Weight loss
• Abdominal tenderness/ascites
• Steatorrhea
• Decreased or absent bowel sounds
Diagnostic
• Contrast enhanced CT scan
• Labs
o ↑ serum amylase level
o ↑ serum lipase level
Nursing Care
• Nutritional Therapy
o NPO status initially
o NG suctioning for severe vomiting
o Enteral vs. parenteral nutrition
o Small, frequent feedings when able
§ High carb (high calorie)
§ High protein
§ Low fat
o No alcohol
o Supplemental fat-soluble vitamins
• Follow up lab work
Medications
• Pain management
o Opioid analgesics
o IV morphine
o NO Demerol/meperidine - contraindicated
• Antispasmodics
• Anticholinergics
• Pancreatic enzyme (take before meals & snacks)
• H2 blockers or PPI
Gallbladder disease
Cholelithiasis: stones in gallbladder
Cholecystitis: inflammation of gallbladder
Risk Factors
• Common in females (Female, Forty, Fat)
• High fat diet
• Older adults
• Estrogen therapy
• Sedentary lifestyle
• Obesity
• Diabetes
Etiology
• Cholecystitis: obstruction from stones or sludge
• Cholelithiasis: develops when balance that keeps cholesterol, bile salts & calcium in
solution is altered, leading to stones. Stones may remain in gallbladder or may migrate
to cysts or common bile duct
Clinical Manifestations
• Nausea & vomiting after high fat food
• Sharp RUQ, epigastric or shoulder pain
o More severe when stones moving or obstructing
o Sharp, excruciating
o May be referred to shoulder/scapula
o Residual tenderness in RUQ
o Occur 3-6 hr after high fat meal or when pt lies down
• Positive Murphy’s sign (pain when palpating gallbladder)
• When total obstruction occurs
o Dark amber urine
o Clay-colored stools
o Pruritis (itchy skin)
o Intolerance to fatty foods
o Jaundice
o Heartburn
Diagnostic Studies
• Ultrasound
• ERCP (endoscopic retrograde cholangiopancreatography)
• Lab tests
o ↑ WBC count
o ↑ serum bilirubin level, ↑ urinary bilirubin level
,Nursing Care
• Admin meds
• Maintain low fat diet
• Therapeutic measures
o ERCP w/ sphincterotomy
o Shock wave lithotripsy
• Surgery
o Cholecystectomy
Medication
• Analgesic (morphine)
• Antiemetics
• Anticholinergics (atropine)
o Decrease DI secretions
o Counteract smooth muscle spasms
• Antibiotics
Therapeutic Therapy: ERCP with sphincterotomy
• Visualization
• Dilation
• Placement of stents
• Open sphincter of Oddi, if needed
• Endoscope passed to duodenum
• Stones removed w/ basket or allowed to pass in stool
Post-ERCP Care
• Assess for complications
o Perforation
o Hemorrhage
o Infection
• Bed rest
• NPO until return of gag reflex
Therapeutic Therapy: Lithotripsy
Shock wave therapy used to break up small cholesterol stones
Surgical Therapy: Cholecystectomy
Laparoscopic cholecystectomy
• Treatment of choice
• Removal of gallbladder through 1-4 puncture holes
• Minimal postop pain, discharged day of surgery
• Resume normal activities w/in 1 week
• Few complications
,Open (incisional) cholecystectomy
• Removal of gallbladder through right subcostal incision
• T-tube inserted in common bile duct
o Ensures patency of duct
o Allows excess bile to drain
o Report drainage >1000 mL/day
o Keep below level of gallbladder
Postop Care
• Prevent respiratory complications
• Maintain drainage tubes (T-tube, Penrose, or Jackson-
Pratt)
• Replace fluids & electrolytes
• No heavy lifting for 4-6 weeks
• Usual activities when ready
• Low fat diet
Pancreatitis
Acute or chronic
Acute
• Acute inflammatory process of pancreas
• Spillage of pancreatic enzymes into surrounding pancreatic tissue causing autodigestion
by exocrine enzymes
• Life-threatening
Chronic
• Progressive disease characterized by remission & exacerbations diminishing function
Etiology
• Gallbladder disease
• Chronic alcohol intake
• Illegal drug use
• Infection
• Blunt abdominal trauma
Clinical Manifestations
• Abdominal pain predominant
o LUQ or mid-epigastrium
o Radiates to back, Sudden onset
o Deep, piercing, continuous, or steady
o Intensifies after meals, Starts when lying down
o Not relieved with vomiting
, • Nausea/vomiting
• Abdominal skin discoloration
o Grey Turner’s sign (bruising of flank)
o Cullen’s sign (bruising around umbilicus)
• Weight loss
• Abdominal tenderness/ascites
• Steatorrhea
• Decreased or absent bowel sounds
Diagnostic
• Contrast enhanced CT scan
• Labs
o ↑ serum amylase level
o ↑ serum lipase level
Nursing Care
• Nutritional Therapy
o NPO status initially
o NG suctioning for severe vomiting
o Enteral vs. parenteral nutrition
o Small, frequent feedings when able
§ High carb (high calorie)
§ High protein
§ Low fat
o No alcohol
o Supplemental fat-soluble vitamins
• Follow up lab work
Medications
• Pain management
o Opioid analgesics
o IV morphine
o NO Demerol/meperidine - contraindicated
• Antispasmodics
• Anticholinergics
• Pancreatic enzyme (take before meals & snacks)
• H2 blockers or PPI
