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26 Cards in this Set
- Front
- Back
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What is cholelithiasis? |
Gallbladder stones; most common disorder of the biliary system |
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Where can the stones be lodged? |
In the neck of the gallbladder or the cystic duct |
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What is cholecystitis? |
Inflammation of the gallbladder; usually occurs with cholelithiasis; may be acute or chronic |
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What are risk factors for cholelithiasis? |
- Female, especially multiparous - Over 40 - Postmenopausal women on estrogen - Oral contraceptives - Sedentary lifestyle - Obesity - Family history - Asian/African/Native Americans |
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What causes gallstones? |
- Unknown cause - Bile is supersaturated with cholesterol |
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What causes cholecystitis? |
- Obstruction by stones or bilary sludge - Acalculous (no stones) -- More common in older adults and critically ill pts -- Prolonged immobility, parenteral nutrition, fasting or DM |
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What factors decrease bile flow? |
- Immobility - Pregnancy - Inflammatory/obstructive lesions in biliary system |
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What are S/S of cholelithiasis? |
- May be severe or asymptomatic/silent - Depends on whether stones are moving or stationary and whether obstruction is present - Spasms occur when stone moves or gets stuck -- Severe pain/biliary colic (steady pain) - Tachycardia - Diaphoresis - Prostration |
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How is gallstone pain described? |
- Excrutiating - May last up to an hour - When pain subsides, residual tenderness in right upper quadrant - Pain occurs 3-6 hours after high fat meal or when pt lies down |
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What are S/S of obstructed bile flow? (** Emphasized in class **) |
- Jaundice - Dark, amber urine; foams when shaken - No urobilinogen in urine - Clay-colored stools - Pruritus - Intolerance of fatty foods -- N/V, anorexia, feeling of fullness - Bleeding tendencies - Steatorrhea - Fever - Increased WBC count - Observe for bleeding in mucous membranes of mouth, nose, gingivae, injection sites) -- Check pt's prothrombin time |
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What are S/S of cholecystitis? |
- Indigestion - Moderate-severe pain - Fever - Jaundice - Tenderness/rigidity in right upper quadrant -- May refer to right shoulder/scapula - N/V - Restlessness - Diaphoresis - Fever, leukocytosis - Dyspepsia, flatulence, heartburn |
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What are complications of cholecystitis and cholelithiasis? |
- Gangrenous cholecysitis - Subprhenic abscess - Pancreatitis - Cholangitis (biliary duct inflammation) - Biliary cirrhosis - Fistulas - Gallbladder rupture/bile peritonitis |
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What are diagnostic studies for gallbladder issues? |
- US for gallstones - ERCP - Percutaneous transhepatic cholangiography -- Needle into gallbladder duct/injection of contrast - WBC labs - Bilirubin levels - Liver enzymes, amylase |
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What are conservative treatments for gallstones? |
- Bile acids to dissolve stones - Not usually treated with meds - ERCP for stone removal - Extracorporeal shock-wave lithotripsy (ESWL) -- Disintegrates stones in 1-2 hours - Surgery needed if gallstones become symptomatic |
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What are conservative treatments for cholecystitis? |
- Pain control - Infection control/antibiotics - Fluid/electrolyte balance - NG tube/gastric decompression for severe N/V - NSAIDs, anticholinergics, antiemetics - Cholecystostomy to drain purulent material |
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What is the surgical therapy for symptomatic gallstones? |
Laparoscopic cholecystectomy; safe procedure with minimal morbidity; only complication is possible injury to the common bile duct |
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When is open gallbladder surgery required? |
- If the gallbladder is ruptured or gangreous - T-tube inserted into the common bile duct to ensure patency and provide drainage - Risk of respiratory complications |
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What meds are used to treat gallbladder disease? |
- Analgesics - Anticholinergics/antispasmotics - Fat-soluble vitamins - Bile salts - Cholestyramine (relief from pruritis) |
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What are nutritional needs for pts with gallbladder disease? |
- Small, frequent meals - Some fat at each meal to promote gallbladder emptying - Reduced-calorie diet if pt is obese - Reduce saturated fats (butter, lard) - High fiber and calcium - Avoid rapid weight loss (risk of stones) |
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What are post op diet recommendations for gallbladder surgery? |
- Liquids for the rest of the day after surgery - Light meals for the first few days - Low fat or fat restriction for a few weeks, esp if pt is obese or has reduced bile flow - Normal diet but avoid excessive fat - For open surgery, liquids to regular diet after return of bowel sounds |
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What are nursing interventions after an ERCP with papillotomy? |
- Assess for complications -- Pancreatitis, perforation, infection, bleeding - Monitor VS - Ab pain/fever may indicate pancreatitis - Pt on bed rest for several hours - Pt NPO until gag reflex returns - Teach pt importance of follow-up for stent |
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What is a common gallbladder surgery post op problem? |
Referred pain to shoulder/jaw R/T gas used to inflate stomach during surgery - May cause difficulty breathing - Place pt in Sims position - Deep breathing, coughing, ambulation - Give NSAIDS or codeine - Usually resolves in a few days |
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What are nursing interventions to relieve pruritis? |
- Baking soda/Alpha Keri baths - Lotion - Soft linen - Temp control - Short, clean nails - Scratch with knuckles, not nails |
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What are discharge teaching pts for gallbladder pts (no surgery)? |
- Low-fat diet - Take fat-soluble vitamins - Watch for S/S of obstruction (stool/urine changes, jaundice, pruritis) - Follow-up care |
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What are discharge teaching pts for gallbladder pts (lap surgery)? |
- Discharged same/next day - Remove bandages the day after surgery; ok to shower when removed - Call surgeon if redness, swelling, bile-colored drainage from incisions; N/V, fever, chills, severe ab pain - Gradually resume normal activities - Return to work in one week - Usual diet, but low-fat foods better tolerated |
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What are discharge teaching pts for gallbladder pts (open surgery)? |
- Pt discharged in 2-3 days - No heavy lifting for 4-6 weeks - Resume usual activities/sex when pt feels ready - Possible low-fat diet for 4-6 weeks |
