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Liver/Biliary/Pancreas - Coggle Diagram
Liver/Biliary/Pancreas
Cholelithiasis: The formation of gallstones, also called calculi, caused by precipitation of substances contained in bile, mainly cholesterol and bilirubin. Gallstones irritate the inner walls of the gallbladder, causing inflammation; this is referred to as cholecystitis.
Symptoms:
- The condition may be asymptomatic during the formation of the gallstones.
- Once formed, gallstones cause inflammation of the gallbladder, causing RUQ pain, indigestion, flatulence, eructations, nausea, and possibly vomiting.
- Pain builds up, then decreases, resulting in a biliary colic type of pain.
Assessment findings:
- Murphy’s sign: pain upon palpation of the RUQ of the abdomen.
Diagnostics:
- Ultrasonography, CT scans, MRI, and HIDA scans can show gallstones, inflamed gallbladder wall, bile stasis, or sludge.
- This can result in elevated WBC count, ESR, and CRP caused by inflammation.
Treatment
- Laparoscopic surgical removal of gallbladder or open cholecystectomy.
- Narcotic for pain.
Cholecystitis: Inflammation of the gallbladder; it is generally associated with cholelithiasis, biliary sludge, or bile stasis.
Assessment Findings:
- Murphy's sign
- Cullen's sign
Diagnostics
- Ultrasonography, CT scans, MRI, and HIDA scans can show gallstones, inflamed gallbladder wall, bile stasis, or sludge.
- This results in elevated WBC count, ESR, and CRP caused by inflammation.
Signs and Symptoms:
- The condition may be asymptomatic during the formation of the gallstones.
- Once formed, gallstones cause inflammation of the gallbladder, causing RUQ pain, indigestion, flatulence, eructations, nausea, and possibly vomiting.
- Pain builds up, then decreases, resulting in a biliary colic type of pain.
Treatment
- Laparoscopic surgical removal of gallbladder or open cholecystectomy.
- Narcotic for pain.
Pancreatitis, Chronic: Characterized by progressive destruction of the pancreas by enzymes. Gradual autodigestion of the pancreas. Gradually fibrotic tissue replaces pancreatic tissue.
Assessment Findings:
- Episodes of abdominal tenderness, vomiting, abdominal distention, lack of bowel sounds, and jaundice.
- Steatorrhea: clay-colored stool.
Diagnostics
- Elevated serum amylase and lipase occur with pancreatic inflammation.
- Elevated blood glucose, urea nitrogen, triglycerides, and calcium.
- Elevated bilirubin level.
- Elevated liver enzymes.
signs and symptoms:
- All symptoms associated with acute pancreatitis, although less severe.
- Episodic abdominal pain, nausea, and vomiting.
- Episodic epigastric and upper left quadrant pain, anorexia, nausea, vomiting, and flatulence.
- Steatorrhea: clay-colored stool.
Treatment
- Low-fat diet.
- Pancreatic enzymes may be needed.
- Insulin or antidiabetic medications are needed if the pancreas is not able to secrete insulin.
Pancreatitis, Acute: A severe, life-threatening disorder associated with activated pancreatic enzymes secreted into the pancreatic tissue and surrounding tissue, causing inflammation and autodigestion.
Assessment findings
- Abdominal distention, hypoactive bowel sounds, tachycardia, hypotension.
- Cool, clammy skin and fever.
- Jaundice.
- Cullen’s sign.
- Grey Turner sign.
Diagnostics
- Elevated serum amylase and lipase occurs with pancreatic inflammation.
- Elevated blood glucose, urea nitrogen, calcium, and triglycerides.
- Elevated liver enzymes.
- Elevated bilirubin level.
Signs and Symptoms:
- Acute abdominal pain, nausea, vomiting.
- Abrupt onset; may follow a heavy meal or an alcoholic binge.
- Severe epigastric and abdominal pain that radiates straight to the back, which is aggravated when the person is lying supine and is relieved when the person is sitting and leaning forward.
Treatment
- Antibiotic prophylaxis, DilaudidR as pain reliever, and rest of the gastrointestinal tract.
- Withholding of oral foods and fluid and institution of gastric suction to treat distention of the bowel and prevent further stimulation of the secretion of pancreatic enzymes.
Pancreatic Cancer: Neoplastic tumor that develops either in the head of the pancreas (most common) or the body or tail of the gland. Cancer of the head of the pancreas causes obstruction of the common bile duct, which causes backup of bile into the liver and backup of bilirubin into the bloodstream. This causes widespread destruction of the pancreas, with loss of pancreatic enzyme activity and metastasis to the liver.
Assessment Findings:
- Abdominal distention, hypoactive bowel sounds, and jaundice.
- Steatorrhea.
- Courvoisier’s sign.
Diagnostics:
- Elevated serum amylase and lipase occur with pancreatic inflammation. Bilirubin and liver enzyme level.
- Urine amylase: elevated levels with pancreatic inflammation.
Signs and Symptoms:
- When the tumor is in the head of the pancreas, there are early symptoms, whereas if it is in the body or tail, cancer remains silent until there is severe organ involvement.
- Cancer of the pancreatic head causes obstructive jaundice, steatorrhea, nausea, vomiting, and backup of bile salts, which causes pruritus.
- Weight loss may be caused by lack of pancreatic enzymes and malabsorption of all nutrients.
Treatment:
- Chemotherapy.
- Chemoradiotherapy.
- pain relief
- Whipple procedure: surgical excision of cancerous sections of the pancreas.