13 Gall Bladder Disorders

Question 1

Cholelithiasis

Answer 1

Presence of gall stones within gall bladder or biliary duct system

Question 2

Cholecystitis

Answer 2

Inflammation of gall bladder, usually by obstruction of cystic duct by gall stone

Question 3

Type of gall stone

Answer 3

Cholesterol stone
Pigment stone

Question 4

Pathophysiology of cholithiasis

Answer 4

1. Abnormal bile composition
   - excessive cholesterol in bile due to obesity, high calories and cholesterol diet
   - bile supersaturated with Cholesterol, precipitate to form stones
2. Biliary stasis
   Slow emptying, contribute to stone formation
3. Inflammation of gall bladder
   Excessive water and ball salt reabsorption, increase risk of stone formation

Migrate into duct, cholangitis

Question 5

Cholangitis膽管炎

Question 6

What happen if obstruction in common bile duct

Answer 6

bile reflux to liver
Liver damage, jaundice, pain

Question 7

Why rapid weight loss cause cholelithiasis

Answer 7

Increase cholesterol concentration in bile and decrease gallbladder contraction

Question 8

Which kind of drug increase risk of cholelithiasis

Answer 8

Oral contraceptive
Increase cholesterol levels

Question 9

Biliary colic location

Answer 9

RUQ

Question 10

Cholelithiasis: why epigestric fullness, distress and pain after heavy meal

Answer 10

Bile secretion and contraction increase
Move stone

Question 11

How cholecystitis cause peritonitis

Answer 11

Obstruction of cystic duct by stone
Increase pressure within gallbladder
Ischemia of gallbladder wall & mucosa
Necrosis and perforation

Question 12

Empyema

Answer 12

Collection of infected fluid
積膿

Question 13

Manifestation of cholecystitis

Answer 13

Acute pain (RUQ, radiate to back shoulder and right scapula, aggregate by movement)
RUQ tenderness to palpation
Restlessness, diaphoresis, n/
Chills

Question 14

Diaphoresis

Answer 14

Excessive sweating

Question 15

Why diagnosis
Serum bilirubin
amylase and lipase
CBC

Answer 15

Serum bilirubin: any obstruction of duct
amylase and lipase: pancreatitis
CBC: inflammation (WBC)

Question 16

What if patient allergy to contrast

Answer 16

Give hydrocortisone

Question 17

ERCP

Answer 17

Endoscopic retrograde cholangiopancreatography

To visualise biliary structure and pancreas by endoscopy
Evaluate presence and location of ductal stones

Question 18

Pre procedural ERCP

Answer 18

Hx, allergy, vital signs
Explain the procedure, informed consent
NPO
Prophylactic antibiotic
Establish IV Line

Question 19

Extracorporeal shock wave of choleslithiasis

Answer 19

震出去
non-surgucal management

Question 20

Ecchymosis

Answer 20

瘀血

Question 21

Observe for post-op complication

Answer 21

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)

Question 22

Complication of cholecystectomy

Answer 22

Wound infection
Biliary peritonitis

Question 23

Function of t-tube

Answer 23

-Ensure patency of common bile duct (CBD) until edema produced by surgery subsided
-allow excess bile to drain

Question 24

Criteria of extracorporeal shock wave lithotripsy

Answer 24

Few stones and small enough

Question 25

Advantage of laparoscopic cholecystectomy

Answer 25

Quick recovery and less complications

Question 26

(+/-) procedure for open cholecystectomy

Answer 26

Exploration of common bile duct
(Find ductle stone in cbd)

Question 27

Nursing care do T-tube

Answer 27

• 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)