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Appendectomy/Cholecystectomy Flashcards

1
Q

Two major types of gallstones

A

pigment & cholesterol stones

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2
Q

Pigment stones

A

bilirubin salt, calcium bilirubinate & associated with bacteria in the bile. Can only be removed surgically

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3
Q

Cholesterol Stones

A

more common. contain calcium salts & bile pigments

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4
Q

Cholecystitis

A

inflammation of the gallbladder. Can be acute or chronic

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5
Q

How does Acute Cholecystits develop?

A

Usually in association with cholelithiasis (gallstones) & high fat meal

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6
Q

Cholelithiasis

A

formation of gallstones

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7
Q

Symptoms of Acute cholecystitis

A

Severe pain radiating from RUQ abdomen to midline & posterior scapular region described as “colicky”, N/V, low grade fever, possible jaundice

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8
Q

What happens if a gallstone obstructs the cystic duct?

A

gallbladder becomes distended, inflamed & eventually infected (acute cholecystits)

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9
Q

Biliary colic

A

RUQ pain due to obstruction of a bile duct by a gallstone

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10
Q

Key sign for Cholecystitis

A

Patient is restless for 30min-6hrs after eating a meal

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11
Q

Cholecystitis makes stool what color & why?

A

white because gallbladder cant secrete any bile. Bile makes stool brown

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12
Q

What will urine look like with cholecystitis and why?

A

Urine may be dark & foamy b/c bilirubin increases which causes kidneys to try & filture out the bilirubin

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13
Q

A patient with cholecystitis will have an __________ WBC count

A

Incresed

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14
Q

Cholecystiits medical objectives

A

supportive and dietary management to reduce the incidence of acute episodes of gallbladder pain & to remove the cause of cholecystitis by pharmacologic therapy, endoscopic procedures or surgical interventions

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15
Q

Ursodiol (URSO)

A

a bile acid that dissolves gallstones and decreases biliary cholesterol formation. Used to treat asymptomatic cholecystitis

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16
Q

Who is at risk for cholecystitis?

A

3 F’s: Female, FAT, Forties. Chances increases with age, increased with pregnancy

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17
Q

Why does cholecystitis increase with pregnancy?

A

because baby can smush gallbladder (that’s what Marty said) online says its because when youre pregnant you produce lots of estrogen which produces cholesterol (hence cholesterol stones)

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18
Q

Symptoms of chronic cholecystitis

A

not as severe as acute, more vague. Long-term intolerance of fatty foods, vague gastric symptoms, increased flatulence

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19
Q

Cholecystitis diagnostics

A

Cholangiogram (Radiography of the bile ducts), endoscopic, IV, transhepatic, operative, oral cholecystograpy, CT scan

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20
Q

Cholecystitis surgical management

A

Laparoscopy cholecystectomy

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21
Q

Cholecystectomy

A

removal of gallbladder

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22
Q

Laparoscopic cholecystectomy

A

removal of the gallbladder through a small incision thru the umbilicus

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23
Q

advantages of laparoscopic cholecystectomy

A 
Decreased:
 surgical risks,
 length of hospital stays, 
recovery periods & 
postoperative pain
Patient does not experience paralytic ileus that occurs with open abdominal surgery
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24
Q

How many incisions for a Laparoscopic cholecystectomy ?

A

4

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25
Q

How many incisions for a Laparoscopic Appendectomy?

A

3

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26
Q

Preferred treatment for acute cholecystitis?

A

Early Laparoscopic cholecystectomy (within 24-48 hrs of symptoms)

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27
Q

paralytic ileus

A

paralyzed intestines. Not able to pass stool or gas. happens often with abdominal surgery

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28
Q

If a patient has paralytic ileus why don’t you want to give them a laxative?

A

Because stool will just build up and could bust appendix

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29
Q

Steps in Laparoscopic cholecystectomy

A
  1. ) Anesthesia is administered
  2. ) A small incision is made thru the abdominal wall at the umbilicus.
  3. )Abdominal wall is filled with carbon dioxide
  4. )The fiberoptic scope is inserted thru umbilicus
  5. ) other instruments make small incisions
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30
Q

Why is abdominal wall filled with carbon dioxide during a laparoscopic cholecystectomy?

A

to assist in inserting the laparoscope & to aid in visualizing the abdominal structures

31
Q

Discharge instructions for a patient that had a laparoscopic cholecystectomy

A

written and verbal instructions about managing postoperative pain & reporting s/s of intra-abdominal complications

32
Q

Common s/s AFTER a laparoscopic cholecystectomy

A

pain or discomfort in right shoulder due to gas used to inflate abdominal area, may be drowsy afterward

33
Q

Abnormal s/s a patient that has had a laparoscopic cholecystectomy should report when home

A

redness, tenderness, swelling, heat, or drainage around incision site. Loss of appetite, vomiting, pain, distention of abdomen and temp elevation

34
Q

When should a patient who has had a laparoscopic cholecystectomy shower or take a bath?

A

after 1 or 2 days

35
Q

When should a patient who has had a laparoscopic cholecystectomy drive a car?

A

after 3 or 4 days

36
Q

How should a patient who has had a laparoscopic cholecystectomy care for wound?

A

check puncture site daily, wash with mild soap and water, allow special adhesive strips on site to fall of. DO NOT peel them off.

37
Q

Lithotripsy

A

sound waves that break up gallstones

38
Q

Appendicitis is most common in what age groups

39
Q

Where is the appendix located?

A

RLQ (usually) attached to the cecum just below the ileocecal valve

40
Q

Function of appendix

A

regularly fills with food & empties into cecum.

41
Q

Average length of appendix

A

3-6 inches

42
Q

peritonitis

A

inflamation of the serous membrane that lines the abdominal cavity

43
Q

what causes peritonitis

A

Rupture/perforation of appendix

44
Q

Appendicitis is most common in countries with…

A

diet low in fiber & high in refined carbs

45
Q

Key sign of appendicitis

A

Pain that moves from umbilicus to RLQ

46
Q

McBurney’s point

A

rebound pain. (when you push down on abdomin and pain starts when you lift off)

47
Q

where could the appendix be located if not in the RLQ?

A

lumbar region, pelvis, by kidney,

48
Q

Rovsing’s sign?

A

pain is felt when reverse side is palpated

49
Q

Fecalith

A

harden mass of stool

50
Q

pathophysiology of appendicitis

A

inflamation occurs –> decrease in blood supply
–>infection –>fluid secretion –> increase in pressure & once it exceeds venous pressure then blood flow is restricted –> further infection with more swelling –>gangrene from hypoxia or reputure can occur in 24-36 hrs

51
Q

obstruction of appendix can be caused by..

A

kinking, occlusion, adhesions, fecalith, tumor, intestinal worms, foreign material, viral infections causing enlarged lymphoid follicles

52
Q

What happens to abdomen once appendix is ruptured/perforated?

A

abdominal distention, abdomen may become ridgid, pain may become more diffused or it may subside b/c of a decrease in pressure

53
Q

MANTRELS score

A

Migration of pain, Anorexia, N/V,Tenderness, Rebound pain, Elevated temp, Leukocytosis, Shift to the left

54
Q

what MANTRELS signs are worth 2 points?

A

Tenderness * Leukocytosis. All others are 1 point

55
Q

simple appendicitis

A

appendix is inflamed & intact

56
Q

Gangrenous appendicitis

A

appendix has area of tissue necrosis & microscopic perforations present

57
Q

Perforated appendix

A

evidence of gross perforation & contamination of the peritoneal cavity

58
Q

what kind of anesthesia is used for a appendectomy?

A

general or spinal

59
Q

What sugical prodecures are prefored in the treatment of appendicitis with perforation

A

Laparotomy or laparoscopy. Lapaproscopy has a quicker recovery period

60
Q

Why cant you give a laxative or emea to a patient with appendicitis?

A

Because they have pain which doesnt allow them to poop. Giving a laxitive will just make it worse. They will have an increase in pressure and it may cause the appendix to burst

61
Q

When can you give a laxative to a patient with appendicitis?

A

AFTER surgery. It helps the patient decrease staining

62
Q

What may form due to perforation of the appendix

63
Q

What will the surgen do to help with an abscess

A

before surgery they will be put on antibiotics & during surgery, a drain will be placed in the abscess

64
Q

Heel-jar test

A

stand on tiptoe & suddenly drop both heels to the floor =RLQ pain=+ sign

65
Q

Hop Test

A

hop on one foot = RLQ pain = + sign

66
Q

what other tests can you do for appendicitis?

A

Cough test * if patient is too ill to stand, tap heel while pt is supine & fully extended=RLQ pain =+ sign

67
Q

lliopsoas muscle test

A

lie on left sign while right hip & legs are passively extended - a retroperitoneal appendix will have contact with muscle & elicit RLQ pain

68
Q

Obturator muscle test

A

lie supine with right hip flexed & passively rotated inward =+ sign

69
Q

Cutaneus hyperesthesia test

A

gently lifts fold of skin between thumb & index fingers without pinching at a series of points on abdomen, moving from UQ to LQ esp over McBurney’s point= + sign

70
Q

5-6 points on MANTRELS score

A

possible appendicitis

71
Q

7-8 points on MANTRELS score

A

probable appendicitis

72
Q

9-10 points on MANTRELS score

A

very probable

73
Q

If ithere is a possibility of peritonitis after surgery, what will the surgeon do?

A

A drain will be left in place at the area of the incision.

Nursing II (16 decks)

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