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15 Cards in this Set

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two major disorders of the biliary tract
Cholelithasis-stones in gall bladder
Cholecystitis- inflammation of the gallbladder
one of the most common surgical procedures for disorders of the biliary tract
Cholecystectomy
Highest incidence of cholelithasis
(fair, fat, 40), women myltipara, over 40, obesity, white
etiology of cholelithasis
unknown
alteration in cholesterol, bile salts, calcium
stasis of bile
pathophysiology of cholecystitis
inflammation, during acute attack gallbladder is edematous and hyperemic, may be distended with bile or puss
cholecystitis clinical manifestations
indegestion to severe pain with fever and jaundice
pain (RUQ) may refer to shoulder and scapula, n/v, diaphoresis, leukocytosis, abdominal rigidity, very guarding, can palpate gallbladder, steatorrhea, ot able to tolerate fat
cholelithasis diagnostic studies
US- best diagnostic
ERCP-visualize remove
increased liver enzymes-amylase,AST, ALT
Increased WBC
Direct and indirect bilirubin elevated because of obstruction
urinary bilirubinlevated with obstruction
___ will be elevated if pancreas is involved in choleithasis.
Serum amylase
treatment for cholecystitis
pain management
antibiotics
maintain fluid and electrolytes
anticholinergics
nonsurgical treatment of cholelithasis
ERCP- placement of stents, removal of stones, sphinterotomy
Mechanical lithotripsy (crushes stones but can create pancreatitis)
medications used for non surgical treatment of cholelithasis
cholesterol solvents-MTBE is instilled into gallbladder with catheter
dissolution medication-Actigall
Shock wave lithotripsy(ESWL)
surgical treatment for cholelithasis
laparoscopis cholecystectomy
Cholegastrostomyis duct between stomach and gall bladder, what is patient teaching
diet
post op lap chole
monitor for bleeding, VS, common post op pain-shoulder, place client on left side
liquids first day advance as tolerated
monitor for bowel sounds
low fat diet
monitor for DVT increase activity, deep breathe, may discharge same day if doing well
nursing interventions for surgical chole
turn cough deep breathe, make sure no draining puss, check bowel sounds to advane diet as ordered by physician, avoid heavy lifting