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71 Cards in this Set
- Front
- Back
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The most common disorder of the biliary system
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Cholelithiasis
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Cholelithiasis
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Stones in the gallbladder
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Cholecystitis
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Inflammation of the gallbladder
*Usually associated with cholelithiasis |
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Incidence of Cholelithiasis
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-Higher in women
-Multiparous women -Persons over 40 |
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What increases the risk of Cholelithiasis
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-Estrogen therapy
-Sedentary lifestyle -Family tendency -Obesity |
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Cholecystitis is most commonly associated with
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obstruction
*gallstones or biliary sludge |
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In an absence of an obstruction, cholecystitis may occur in
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-older adults
-those who have trauma -extensive burns -recent surgery (from handling the abdominal viscera) |
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Inflammation with cholecystitis
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-major pathophysiologic condition
-confined to the mucous lining or entire wall -Gallbladder is edematous and hyeremic -May be distended with bile or pus -Cystic duct may become occluded |
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Etiology of Cholelithiasis
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-Develops when balance that keeps COH, bile salts, Ca+ in solution is altered
*The actual cause is unknown |
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Cholelithiasis caused
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infection and disturbances in metabolism of cholerterol
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With cholelithiasis, the bile in the gallbladder
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becomes supersaturated with cholesterol
*precipitation of cholesterol results |
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Components of bile that precipitate to stones
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-Bile salts
-Bilirubin -Ca+ -PRO |
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Which stones are most common?
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Stones that are primarily cholesterol
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What are causes of decreased bile flow?
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-Immobility
-Pregnancy -Inflammatory or obstructive lesions of the biliary system |
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Stones may remain in the GB or travel where?
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-cystic or common bile duct
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Pain associated with stones is caused by
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obstructions that are formed while the stone is passing through the ducts
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What occurs if blockage occurs in the cystic duct
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-bile can continue to flow into the duodenum directly from the liver
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What can happen when bile in the GB cannot escape stasis of bile
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leads to cholecystitis
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Manifestations of GB disease
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-Indigestion
-Moderate to severe pain -Fever -Jaundice |
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Initial s/s of acute cholecystitis
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-Indigestion
-Pain -Tenderness in RUQ |
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Clinical manifestations of acute cholecystitis
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-Pain may be acute
-Inflammation manifestations -RUQ tenderness -Abdominal rigidity |
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Pain associated with acute cholecystitis is often accompanied by
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-n/v
-restlessness -diaphoresis |
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Inflammation associated with acute cholecystitis often results in
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-leukocytosis
-Fever |
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Pt with Chronic Cholecystitis may have a hx of
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-fat intolerance
-dyspepsia -heartburn -flatulence |
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"silent cholelithiasis"
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called this because it may produce no symptoms at all
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Severity of Cholelithiasis depends on
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-presence of obstruction
-whether stones move or not |
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Stones lodged in ducts or moving may cause spasm leading to
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severe pain
*termed biliary colic |
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Pain associated with moving stones may be accompanied by
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-tachycardia
-diaphoresis -prostration |
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Pain from moving stones may last
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for an hour
*tenderness in the RUQ will result when the pain resides |
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Attacks of pain associated with stones may occur ____ to _____ hours after a heavy meal
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3 to 6 hours
*high fat meals can trigger a reaction |
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Clinical manifestations of cholelithiasis (total obstruction)
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-janudice
-dark amber urine -clay-colored stools -pruritis (from bile salts) -intolerance to fatty foods -bleeding tendencies -steatorrhea -no urobilinogen in urine |
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Complications of Cholecystitis
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-Gangrenous cholecystitis
-subphrenic abscess -pancreatitis -cholangitis -biliary cirrhosis -fistulas -GB rupture -Bile peritonitis |
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Complications of Cholelithiasis
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-Cholangitis
-Biliary cirrhosis -Carcinoma -Peritonitis -Choledocholithiasis |
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Diagnostic studies for GB disease
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-Ultrasound
-Assessment for what triggers pain -Percutaneous transhepatic cholangiography |
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Lab results for GB disease
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-Liver function studies
-WBC -Serum bilirubin -Serum amylase -ERCP -Ultrasound -X-ray |
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WBC count with GB disease
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elevation in WBC due to infection and inflammation
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Serum bilirubin count with GB diesase
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conjugated bilirubin is elevated with bile duct obstruction
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Serum amylase count with GB disease
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WILL INCREASE IF OBSTRUCTION OF COMMON BILE DUCT HAS CAUSED PANCREATITIS
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True/False
ERCP can cause pancreatitis |
True
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The most common diagnostic test for GB disease
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Ultrasound
*90-95% accurate -useful in patients with jaundice |
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Serum Bilirubin lab values with GB disease
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-Increased direct
-Increased indirect -Increased urinary bilirubin if obstruction is present |
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Serum amylase will be increased with GB disease if
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there is pancreatic involvement
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Conservative Therapy for Cholelithiasis
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-Mechanical lithotripsy
-Cholesterol solvents -Oral Drugs -Endoscopic sphincterotomy -Etracorporeal shock-wave lipotripsy -Surgery |
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Mechanical lithotripsy is indicated if
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-stone is too large to pass
*endoscopist will crush the stone |
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Oral drug for Cholelithiasis
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Actical
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Treatment of choice for cholelithiasis
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Laparoscopic Cholecystectomy
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Laparoscopic Cholecystectomy
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-Removal of gall bladder through four puncture holes
-Minimal postoperative pain -Discharged that day or the next -Injury to the common bile duct is the most common complication |
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RN care for Laparoscopic Cholecystectomy
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Encourage pt to walk and change positions
*abdomen will be inflated with CO2 during the procedure, walking will help to remove it |
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Open Cholecystectomy
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-Removal of gall bladder through right subcostal incision
-T-tube inserted into common bile duct -Allows excess bile to drain |
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Open cholecystectomy many be contraindicated for
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Obese pt
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Transhepatic Biliary Catheter is used preoperatively for
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-Biliary obstruction
-Hepatic dysfunction |
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Transhepatic Biliary Catheter is used when
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-Inoperable liver, pancreatic bile duct or carcinoma obstructs bile flow
-Endoscopic drainage is unsuccessful Inserted percutaneously |
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Transhepatic biliary catheter allows for decompression of what?
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obstructed extrachepatic bile ducts
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After insertion of transhepaitc catheter it is connected to
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suction
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Drug Therapy for GB disease
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-Analgesics
-Anticholinergics -Fat-soluble vitamins -Bile salts |
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Medical dissolution therapy for GB disease is recommended for those with
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-small radiolucent stones
-mildly symptomatic -poor surgical risks -may take 6 months to 2 years for dissolution |
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Low dose medical dissolution therapy is recommended to
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prevent recurrence
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Medical dissolution therapy Rx
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-Ursodexycholine (UDCA)
-Ursodiol (Actigall) -Chenodeoxycholic acid (CDCA) |
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Diet for GB disease
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-Low-fat diet
-Reduced calorie if obese -Eat small frequent meals |
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Foods to avoid with GB disease
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-dairy
-fried -pastries -gravy -nuts -p butter -mayo -cheese |
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Nutritional therapy after laparoscopic cholecystectomy
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-Liquids for a day
-Light meals for several days |
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Nutritional therapy after incisional cholecystectomy
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-Liquids to bland diet after return of bowel sounds
-restrict fats for 4-6 weeks |
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Assessment for GB disease: Subjective data
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-Past med hx
-Medication -Surgical hx -Postitive family hx -Anorexia -Weight loss -Indigestion -n/v -fat intolerance -Clay-colored stools -Dark urine -Pain in RUQ -Pruritus |
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Important past medical hx info
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-obesity
-infection -cancer -pregnancy |
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Important medication hx
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-estrogen
-oral contraceptives |
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Assessment for GB disease: Objective data
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-Fever
-Restlessness -Jaundice -Tachypnea -Tachycardia -Abnormal liver enzymes -Abnormal gallbladder ultrasound |
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RN diagnosis r/t GB disease
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-acute pain
-Ineffective therapeutic regimen management |
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Overall Goals for GB disease
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-Relief of pain
-No complications post-operatively -No recurrent attacks of cholecystitis |
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Post Op care for Laparoscopic cholecystectomy
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Monitor for common complications:
-shoulder pain form irritation of phrenic nerve and diaphragm due to retained CO2 -Place pt in sim's position -pain medications |
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Post Op care for Incisional Cholecystectomy
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-Maintain adequate ventilation
-Prevent respiratory complications -Follow general postop nursing care |
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Post op care if T-Tube present with Cholecystectomy
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-Maintain bile drainage
-Observe function and drainage |
