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Mabini Colleges

Daet, Camarines Norte


College of Nursing and Midwifery

Gallbladder and Pancreatic Disorders


OBJECTIVES: At the end of the discussion the students will be able to:
Define different terms
Review the anatomic and physiologic overview of gallbladder and
pancreas
Assess client with Biliary disorders or Pancreatic disorder
Identify different Gallbladder and Pancreatic Disorders
Describe clinical manifestations
Identify different nursing interventions

Gallbladder

BILE

It stores and concentrates the bile produced by the liver.


The liver produces 600-1,200 mls. of bile at a time.
90%-95% of this volume is water, which is absorbed by the mucous
membrane lining the gallbladder.
Stores 50-70 ml. of concentrated bile.

-greenish liquid composed of water, cholesterol, bile salts, electrolytes


and phospholipids.
-important in fat emulsification and intestinal absorption of fatty acids,
cholesterol and other lipids.
-aids in excretion of conjugated bilirubin from the liver and prevents
jaundice.
Presence of fat in the acidic chyme transported into the duodenum
causes secretion of cholecystokinin (CCK).
CCK causes gallbladder contraction and relaxation of sphincter of Oddi,
releasing bile into the common bile duct for delivery to the duodenum.
Pancreas
A heterocrine gland
Performs both exocrine and endocrine functions.
PANCREATIC EXOCRINE FUNCTION
EXOCRINE:
secretes pancreatic amylase, lipase
and trypsin
AMYLASE
-completes digestion of carbohydrates

LIPASE
-completes digestion of fats
TRYPSIN
-completes digestion of proteins
CONTROL IN THE RATE AND THE AMOUNT OF PANCREATIC SECRETION
Vagal stimulation
Secretin
CCK

PANCREATIC ENDOCRINE FUNCTION


ENDOCRINE:
-involves Islet of Langerhans
-2 TYPES OF CELL
*Alpha Cells
*Beta Cells
ALPHA CELLS
-secrete glucagon, STIMULATES
glycogenolysis
BETA CELLS
-secrete insulin, PROMOTE
carbohydrate metabolism
DISORDERS
*GALLBLADDER DISORDERS
CHOLELITHIASIS
-presence of gallstones(CALCULI)
ACUTE CHOLECYSTITIS
-inflammation of the gallbladder
4 THEORIES THAT ATTEMPT TO EXPLAIN GALLSTONE FORMATION
Bile may undergo a change in composition.
Gallbladder stasis may lead to a bile stasis.
Infection may predispose a person to stone formation
Genetics and demography.
3 TYPES OF GALLSTONE
Cholesterol stones
Pigment stones
Mixed stones

PREDISPOSING FACTOR
5 Fs
Female
Fat
Fair (Caucasian)
Forty
Fertile (multigravida and those who use contraceptive pills)
FACTORS IN THE CREATION OF CALCULI
Genetic
Body weight
Decreased motility(movement) of the bladder
Diet
BILE STASIS LEADS TO THE FOLLOWING:
Decreased fat emulsification
Inflammation of bladder
Biliary obstruction
Infection
ASSESSMENT
CLINICAL MANIFESTATION
Pain and Biliary Colic(RUQ)
Jaundice
Changes in urine and stool color
Vitamin Deficiency

MANAGEMENT
GALLBLADDER DISORDER
COLLABORATIVE MANAGEMENT
Relief pain
Diet
Administer anti-emetics
Administer medications for cholelithiasis
Extracorporeal shockwave lithotripsy
Surgical Interventions:
CHOLECYSTECTOMY
- removal of the gallbladder
CHOLEDOCHOTOMY
-removal of common bile duct
LAPAROSCOPIC CHOLECYSTECTOMY
-lift abdominal wall
OPEN CHOLECYSTECTOMY
-Right subcostal incision

NURSING IMPLICATIONS
Before procedure, the patient is given an explanation of the procedure
and his role on it
The patient is NPO for several hours before the procedure
May be necessary to administer meds,such as glucagon/ticholinergics
The nurse observes closely for signs of respiratory and central nervous
system, depression, hypotension, oversedation and vomiting
Monitor VS
Monitor Side effects of medication
MAJOR OBJECTIVE
-reduce the incidence of gallbladder pain and cholecystitis
NUTRITIONAL SUPPORT
-DIET: Low fat liquids, avoid eggs, cream, pork, fried foods
CHOLECYSTITIS
CHOLECYSTITIS
CALCULOUS CHOLECYSTITIS
-gallbladder stone obstructs the bile outflow
ACALCULOUS CHOLECYSTITIS
-inflammation in the absence of obstruction of bile flow
PANCREATIC DISORDER
PANCREATIC DISORDER
PANCREATIC DISORDER
PANCREATIC DISORDER
PREDISPOSING FACTOR
5 Ms
Male
Middle Age
Medicine-substance
Meat/meal intake
Midnight attack
ASSESSMENT
PANCREATIC DISORDER
CLINICAL MANIFESTATION
Pain (LUQ)
N&V
Abdominal tenderness and distention
Anorexia and vomiting
Severe dehydration
Steatorrhea
PANCREATIC DISORDER
CLINICAL MANIFESTATION
Hypocalcemia
Laboratory Findings
-elevated urine,serum amylase,serum lipase,wbc,bilirubin,
Hyperglycemia
Jaundice
Hemorrhagic
o Turners sign (left flank),
o Cullens sign (periumbilical area)

PANCREATIC DISORDER
PANCREATITIS
-an acute or chronic inflammation
escape of pancreatic enzyme into
PANCREATIC DISORDER
PATHOPHYSIOLOGY

of the pancreas with the associated


surrounding tissue

PANCREATIC DISORDER
ACUTE PANCREATITIS
-suddenly as one attack or can be recurrent with resolution
CHRONIC PANCREATITIS
-continual inflammation and destruction of the pancreas and
pancreatic duct.
MANAGEMENT
MANAGEMENT
PANCREATIC DISORDER
COLLABORATIVE MANAGEMENT
Relief pain
Diet
IV Therapy
Nasogastric tube insertion
Digestive enzyme as prescribed
Administer fat-soluble vitamins
Administer antacids to neutralize gastric secretions
Administer histamine H2receptor
Antibiotics
Administer Calcium and Vit. D

Reference:
Textbook of Medical-Surgical Nursing, Brunner & Suddarth 12th
Edition Volume 1, Wolters Kluwer Lippincott Williams &
Wilkins,2010

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MARY BENJIE R. BANDELARIA


BSN III