13 Gall Bladder Disorders Flashcards
Cholelithiasis
Presence of gall stones within gall bladder or biliary duct system
Cholecystitis
Inflammation of gall bladder, usually by obstruction of cystic duct by gall stone
Type of gall stone
Cholesterol stone
Pigment stone
Pathophysiology of cholithiasis
- Abnormal bile composition
- excessive cholesterol in bile due to obesity, high calories and cholesterol diet
- bile supersaturated with Cholesterol, precipitate to form stones - Biliary stasis
Slow emptying, contribute to stone formation - Inflammation of gall bladder
Excessive water and ball salt reabsorption, increase risk of stone formation
Migrate into duct, cholangitis
Cholangitis膽管炎
What happen if obstruction in common bile duct
bile reflux to liver
Liver damage, jaundice, pain
Why rapid weight loss cause cholelithiasis
Increase cholesterol concentration in bile and decrease gallbladder contraction
Which kind of drug increase risk of cholelithiasis
Oral contraceptive
Increase cholesterol levels
Biliary colic location
RUQ
Cholelithiasis: why epigestric fullness, distress and pain after heavy meal
Bile secretion and contraction increase
Move stone
How cholecystitis cause peritonitis
Obstruction of cystic duct by stone
Increase pressure within gallbladder
Ischemia of gallbladder wall & mucosa
Necrosis and perforation
Empyema
Collection of infected fluid
積膿
Manifestation of cholecystitis
Acute pain (RUQ, radiate to back shoulder and right scapula, aggregate by movement)
RUQ tenderness to palpation
Restlessness, diaphoresis, n/
Chills
Diaphoresis
Excessive sweating
Why diagnosis
Serum bilirubin
amylase and lipase
CBC
Serum bilirubin: any obstruction of duct
amylase and lipase: pancreatitis
CBC: inflammation (WBC)
What if patient allergy to contrast
Give hydrocortisone
ERCP
Endoscopic retrograde cholangiopancreatography
To visualise biliary structure and pancreas by endoscopy
Evaluate presence and location of ductal stones
Pre procedural ERCP
Hx, allergy, vital signs
Explain the procedure, informed consent
NPO
Prophylactic antibiotic
Establish IV Line
Extracorporeal shock wave of choleslithiasis
震出去
non-surgucal management
Ecchymosis
瘀血
Observe for post-op complication
Bile duct injury
Bile leak (peritonitis, abdominal pain and distension)
Increase temperature (sign of wound infection or peritonitis)
Injury or perforation
Pain on right shoulder or scapular (use heating pad for 15-20/hours)
Complication of cholecystectomy
Wound infection
Biliary peritonitis
Function of t-tube
-Ensure patency of common bile duct (CBD) until edema produced by surgery subsided
-allow excess bile to drain
Criteria of extracorporeal shock wave lithotripsy
Few stones and small enough
Advantage of laparoscopic cholecystectomy
Quick recovery and less complications
(+/-) procedure for open cholecystectomy
Exploration of common bile duct
(Find ductle stone in cbd)
Nursing care do T-tube
- maintain aseptic technique: connect to sterile container
- maintain patency: keep drainage bag below level of wound , fowler’s position
- monitor color(green-brown), amount(500-1000mL/d), consistency(viscous)
