20. The exocrine function of the pancreas is the secretion of digestive enzymes for carbohydrates, fats and proteins Pancreatic amylase - carbohydrates Pancreatic lipase (steapsin) - fats Trypsin, Chymotrypsin and Peptidases - proteins Bicarbonate - to neutralize the acidic chyme.
22. Guaiac Test - detects the presence of fecal occult blood . Positive guaiac test shown on right, as would be seen for this patient. Negative result (on left) included for comparison.
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34. Customizable to meet specific surgical needs, endoscopes can be fitted with scissors, knives, lasers, or cameras. Here, the endoscope is fitted with a small grasping tool to remove a toy lodged in the esophagus of an infant
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37. 34 yr old female. She also had an endoscopy first. (bleeding and/or pain was the reason she came in.) That pinkish/white mass is cancer. It's right by/on the valve between the ileum (small intestine) and cecum (large intestine.)
120. Common locations of gallstones Abnormal metabolism of cholesterol & bile salts Gallstone fromation Gallstones may obstruct gall bladder Stasis of bile Autodigestion Migration of gallstones to ducts Inflammatory response Iiritation & impaired blood flow Ischemia of the gallbladder wall Necrosis & gangrene Perforation Abscess & peritonitis
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123. T-tube placement in the common bile duct. Bile fluid flows with gravity into a drainage collection device below the level of the common bile duct.
133. Inflammation caused premature acvtivation of enzymes Causes tissue damage Enzymes back up and spill out into pancreatic tissue Auto digestion Acute pancreatitis: Hemorrhagic necrotising pancreatitis Cell death & tissue damage Hemorrhage Multi organ failure Shock Chronic pancreatitis: Repeated attacks Cell replacement of fibrous tissue Inc.pressure & obstruction Inflammation & destruction Necrosis attack
155. Sites and position for paracentesis. A , Potential sites of needle or trocar insertion to avoid abdominal organ damage. B , The client sits comfortably; in this position, the intestines float back and away from the insertion site.
162. Inc. permeability Intestinal bacteria leak out into peritoneal cavity Bacterial peritonitis Constant severe pain Reflex contrxn of abdominal muscle Hypovolemicshock Dec. peristalsis adhesion
187. Gastrostomy . A , Gastrostomy tube placement. B , The tube is fixed against both the abdomen and stomach walls by cross bars.
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Editor's Notes
1. Eat smaller meals at more frequent intervals / adherence to six,small,dry, meals per day. 2. Avoid high-carbohydrate intake and concentrated sweets. 3. Consume liquids only between meals or refraining from taking fluids during meals but rather 2 hours after meals. 4. Lie down or rest after eating or on a recumbent position for ½ hour after meals. 1. Eat smaller meals at more frequent intervals / adherence to six,small,dry, meals per day. 2. Avoid high-carbohydrate intake and concentrated sweets. 3. Consume liquids only between meals or refraining from taking fluids during meals but rather 2 hours after meals. 4. Lie down or rest after eating or on a recumbent position for ½ hour after meals.
Abdominal cramps and spasms after meals Chronic diarrhea / steatorrhea Fever Flatulence Nausea Pain in the lower right quadrant Weight loss 3-4 semisoft stools / day with mucus and pus.
1. Subjective: indigestion after eating fatty or fried foods; pain, usually in the right upper quadrant of the abdomen, which may radiate to the back, nausea. 2. Objective: a. Vomiting; elevated temperature and WBC; jaundice may be present b. Diagnostic tests - Serum bilirubin is elevated - Ultrasonography determines the presence of gallstones; - Endoscopic retrograde cholangiopancreatography (ERCP) reveals presence of gallstones
1. Secure the drainage bag; avoid kinking of the tube 2. Measure drainage at least every shift; drainage during the first day may reach 500 to 1000 ml and then gradually decline 3. Apply ordered protective ointments around tube to prevent excoriation 4. When the tube is removed, usually in 7 days, observe stool for normal brown color, which indicates bile is again entering the duodenum T-tube tract removal – threaded catheter with basket ERCP removal – cut papilla of sphincter of Oddi enlarge opening, threaded cath with basket
Pain – meperidine, NG sxn, oral care, bedrest Nutrition – IVF, BT, wt, I/O, abd. Girth Respi – position, cough, deep breath Teaching – biliary dse, alcohol Goals: control pain, rest pancreas, support nutrition/hydration
Rest- wt, I/O, position, O2 Nutrition – early-CHON, B complex, Vit ACK, small freq, NGT/TPN, Aquasol ADE Late – adeq CHON – encephalopathy – (-) nitrogen balance mm wasting Skin care- SQ edema, immobility, jaundice, infxn, position, lotion Bleeding- pad rails, pressure injection site, melena, v/s, stool softeners Teaching- Alco Anon, low Na
varicesSengstaken - Blakemore tube for bleeding esophageal varices to apply direct pressure to the varices; vasopressin may be administered IV to control GI bleeding; plasminogen inhibitors to limit fibrinolysis
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