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53 Cards in this Set
- Front
- Back
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What is the TERM that means "stones in the gallbladder"?
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cholelithiasis
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What do the two parts of the word chole-lithiasis mean?
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chole - gall bladder
lithiasis - stone |
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In what organ is bile produced?
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liver
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Gallstones develop when there is an imbalance of cholesterol, bile salts & calcium so that these substances "settle out" of the bile. What causes this imbalance?
patho |
bacteria and/or disturbance in cholesterol that the bile becomes SUPERSATURATED with CHOLESTEROL
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If a stone stays in the gallbladder and just settles down to the bottom of the gallbladder, what does the patient experience?
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nothing. the stone has to move to the cystic duct in order to cause pain. Pain is caused by inflammation.
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What are two PC's that result from a gallstone moving to the common bile duct and occluding that duct?
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1. PC: pancreatitis
2. PC: hepatitis |
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What are the risk factors for cholelithiasis?
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age
female family hx obesity hyperlipidemia imbalance of estrogen biliary stasis: pregnancy, fasting, prolonged TPN oral contraceptives (b/c they increase cholesterol saturation) |
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How does obesity cause cholelithiasis?
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obesity increases the secretion of cholesterol in the bile
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How does fasting cause cholelithiasis?
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fasting can lead to biliary stasis (no food coming in, no release of bile....bile just sits there with no purpose=stasis)
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What are gallstones primarily made of?
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cholesterol
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Name the term for an inflammed gallbladder.
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cholecystitis
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What causes cholecystitis?
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primarily it is associated with obstruction caused by gallstones or biliary sludge
if it happens without stones (acalculous cholecystitis) then it is from trauma, burns or recent surgery. |
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Where is the pain with cholelithiasis?
duration? location? frequency? aggravating factors? severity? |
RUQ - severe abdominal
referred to shoulder and scapula 30 min-5 hours duration happens 3-5 hours post high fat meal often caused biliary colic |
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Although we just discussed the severity of pain with cholelithiasis, what is important to remember about clinical manifestations of this condition?
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may not have pain at all. may be completely silent
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If a stone causes a blocked duct, pain is the #1 manifestation. List additional manifestations.
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1. pain
2. n/v 3. clay colored stools |
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What is the patho of the clay colored stools described as a manifestation of cholelithiasis?
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if a stone blocks the common bile duct, bile can not get into the duodenum. bilirubin is bound to and excreted in bile in the intestines. if you don't have bile, it won't excrete the bilirubin...which makes your poop brown.
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What is stentorrhea?
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high fatty stools (they float!!! haha)
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What bacteria is a causative agent of cholecystitis?
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e. coli
(this is an inflammed gallbaldder WITHOUT stones....look at the terms!!) |
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What are the manifestations of cholecystitis?
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pain - RUQ
Anorexia N/V RUQ tenderness and guarding chills & fever |
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How does the pain in cholecystitis differ from the pain in cholelithiasis?
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location & timing & severity
(stones - pain is intermittent, aggrevated, coliccy, shoulder/scapula and severe) (no stones -generalized, aggravated by movement/breathing, lasts LONGER...radiates sholder/scapula and BACK) |
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Which condition lists chills/fever as a manifestation?
cholelithiasis cholecystitis |
cholecystitis
(think about it...you have an inflammed gallbladder, most likely caused from bacteria or trauma. Both of those causes would bring in an immune response. CYTOKINES!) |
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What are the risk factors of cholecystitis?
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cholelithiasis
surgery trauma chemical irritant exposure |
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List the diagnostic tests that might be done for a suspected gallbladder problems. (stones/no stones, pain in the GB area)
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1. Abdominal Flat Plate
2. Oral Cholecystogram 3. Abdominal Ultrasound 4. Endoscope Retrograde Cholangiopancreatography (ERCP) |
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Which of the four diagnostic tests require a patient to be NPO for greater than 8 hours?
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All except abdominal flat plate
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When they perform an oral cholecystogram, what can they view? how?
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they can see the gallbladder AND the stones...and their ability to concentrate and excrete bile
they use a dye (ORAL) |
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How is the radiopaque dye used in a oral cholecystogram administered?
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oral. tablets (telepaque)
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Other than keeping patient NPO for 12 hours prior to the test and administering the radiopaque tablets (with sips of water), what are the other nursing interventions in regards to this diagnostic study?
Oral cholecystogram |
1. Advise patient to eat a fat free diet 24 hours prior to test
2. Assess for allergies to iodine, seafood, x-ray dye (this is an outpatient procedure most of the time) |
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What is the most popular diagnostic study to diagnose gallstones?
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ultrasonography
(Abdominal ultrasound) NPO 8-12 hours before test can be done to jaundiced patients as well as allergic to contrast dye patients |
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Why does someone with a gallbladder problem have a decreased tolerance for fatty diet?
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no bile in small intestine for fat absorption
(they may have tiny production of bile, but no BOLUS to cover a high fat meal) |
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Why does someone with a gallbladder problem have increased bleeding tendencies?
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lack of or decreased absorption of vitamin K, resulting in decreased production of prothrombin
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What is the procedure for an ERCP?
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fiberoptic endoscope inserted in oral cavity, progresses to descending duodenum, then common bile and pancreated ducts are cannulated. Injects contrast medium to view these areas. May go ahead and take out a stone while in there.
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What are the nursing responsbilities pre procedure for an ERCP?
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NPO for 8 hours
Consent signed Administer sedation Possible administration of abx |
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What are the nursing responsibilities POST procedure for an ERCP?
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check gag reflex!!!
vital signs (looking for perforation) observe for pancreatitis (most common complication) |
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What are the two most common PC of an endoscope retrograde cholangiopancreatography?
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PC: perforation
PC: pancreatitis (due to cannulation of duct/inflammation) |
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When is a T tube put in a person?
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when the gallstones are in the common bile duct. In order to remove the stones, the CBD may become inflammed, so this device is to divert bile until the edema decreases.
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Other than diverting bile, what is another purpose of a t-tube?
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stones can be removed through a T-tube
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Before removing a t-tube, what procedure is often performed?
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T-tube cholangiogram x-ray. They put dye through the tube to see if CBD is patent, then they will d/c it.
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What does a t-tube prevent?
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hepatitis
(by diverting the bile around the blockage in the CBD, the bile will not back up into the liver and cause hepatitis) |
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You have a patient with a t-tube. What do you need to assess with this patient?
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1. T-tube is connected to sterile container and kept below level of surgical wound
2. Monitor drainage (as output). Look at color and consistency and drain the drain every shift. chart. 3. Assess skin for bile leakage during dressing change |
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You have a patient with a t-tube and you are expecting to see a certain amount and type of drainage in the STERILE container. What should it look like and how much should be there?
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Might get up to 500ml in first 24 hours, then you'll get 200ml in days 2-3...until nothing.
COLOR - blood tinged initially then changing to GREEN-BROWN |
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The tech says that she sees the drainage container on your t-tube patient is almost full. You emptied the STERILE container this morning....how much drainage is considered EXCESSIVE? (this is post op day 3.
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Report excessive drainage (anything over 500mL after 48 hours)
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How should your t-tube patient be positioned in bed?
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Fowler's position to promote gravity drainage
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After rounds, the MD orders for the tube to be clamped (t-tube...patient had CBD occluded from a cholelithiasis). Why is he clamping the tube? What are your nursing responsibilities?
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Clamping the tube to check patency of the CBD. If bile can get around the clamped tube, then there is another way out.....the RIGHT WAY-CBD!!
You need to tell the patient to report any pain in that area. If pain, the CBD may still be blocked. If no pain, the T-tube will probably be d/c'd. |
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What is the diet for your gallbladder inflammed/gallstone problem patient?
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HIGH PRO (healing)
LOW FAT (rest gallbladder, ducts, bile areas, plus don't have bolus of bile....) LOW CARB (rest pancreas) |
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What type of diet would a gallbladder patient be put on upon admission?
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clear liquid
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What type of vitamins might be administered to a gallbladder patient?
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fat soluble vitamins
FAT KATIE!! K A D E |
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What is the surgical treatment of choice for cholelithiasis?
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laparascopic choleCYSTECTOMY
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Why might a cholecystectomy be done "open" instead of "laparascopically"?
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stones too big
doc wants to "explore" inside patient |
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What is a biliary lithotripsy?
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treats stones for a patient not a candidate for surgery...shockwaves break up the stones so they can pass
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What is a choleDOCHOlithotomy?
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incision into common bile duct for removal of stones
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What drug might be given to relieve the pruritus from cholelithiasis?
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Questran. It is a resin that binds to the bile salts in the intestine, increasing their excretion in the feces.
Administered in powder form, mix with milk or juice |
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List additional s/s that the bile ducts are blocked.
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jaundice
clay colored stools dark, foamy urine steatorrhea fever increased WBC count |
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Post op, when a patient has referred pain to the shoulder...caused by retained CO2, what position should you put them in?
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Sims position
left side with right knee flexed...helps move the gas pocked away from the diaphragm. TCDB. |
