NURS 621 (Advanced
Pathophysiology) LATEST UPDATED
(Liver, Gall bladder, Pancreas) EXAM
5 STUDY GUIDE
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Gallbladder
1. A&P of gallbladder and function
a. Pear shaped organ on the inferior side of the liver in the RUQ
b. Holds about 45mL of bile but secretes 600-800mL of bile per day
i. Bile is formed in the liver and excreted into hepatic ducts
which form the common duct, this joins the pancreatic
duct and empties into the duodenum
ii. Bile helps digest food, especially the emulsification and
digestion of fats and fat soluble vitamins (ADE and K)
c. Under sympathetic and parasympathetic nervous control so we
don’t have conscious control over it
d. The sphincter of Oddi regulates bile flow into the duodenum
e. The sphincter of Boyden regulates bile flow into the common duct
f. You can live without your gallbladder, it is not essential for life
2. Assessment data
a. Radiology Diagnostic Tests
i. Ultrasound (US) – looks for stones, sludge, or
malformations, test is painless and non- invasive
ii. Hida Scan – looks for gallbladder function of production
and flow of bile from liver to small intestine, ejection
fractions are formed when injected cholecystokinin is
given to mimic food causing the gallbladder to eject bile,
test lasts an hour and the amount of bile is measured to
show how well it functions
1. Pts must be NPO for 2 hours prior to scan
2. Pts who have not eaten for 24 hours can have false
positives
3. Educate to drink lots of water to flush radioactive
material out
iii. ERCP – visualizes gallbladder, cystic duct, common hepatic
duct, and common bile ducts through endoscopy
1. Pts must be NPO after midnight and have informed
consent
2. Treated with throat spray (local anesthesia) to numb gag
reflex
3. Complications include perforation, pancreatitis, and
aspiration
4. Lay patients on left side
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5. Post op- assess for gag reflex, remain NPO until it
returns
b. Gallbladder disease is common among “Fair, fat, Forty, and
Female” or those with sedentary lifestyles, fair skinned, over
40, and of European or American Indian descent
c. Increased risk for gallbladder disease is Obesity, Cancer,
Multiple parity (multiple births), pregnancy, and extensive
fasting
Cholecy Cholelith
stitis iasis
Acute or chronic inflammation of GB Gallstones in the GB or ducts
Caused by obstruction or Caused by formation of bile salts
acalculous and can have
infection present
US, HIDA, or ERCP to diagnose US, ERCP to diagnose
S/S RUQ pain with radiation, S/S RUQ pain with radiation, clay
leukocytosis, fat intolerance, colored stool, dark urine, jaundice,
fever, distention, fullness, elevated WBC, diaphoresis, N/V
Tx: NG tube, anticholinergics, ABX, Tx: ERCP, lithotripsy,
fluids, electrolytes, sphincterectomy, Actigall, MTBE,
morphine (1st line) or Demerol (2nd give low fat diet, replace fat soluble
line) vitamins, bile salts
