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XIO > biliary > Flashcards

biliary Flashcards

1
Q

coalathiatis - and symptoms or no?

A

stones in gallbladder. usually asymptomatic.

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2
Q

how to detect coalathiatis (koalas need ultrasound)

A

ultrasound, and need to fast for about 6 hours.

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3
Q

The primary function of the gallbladder is

A

to store and concentrate bile.

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4
Q

Bile is comprised of

A

bile salts, bilirubin, phospholipids, cholesterol, bicarbonate and water.

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5
Q

Bile salts mix with ingested fats to

A

promote absorption of fats from the gastrointestinal tract.

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6
Q

Bicarbonate and water are needed in the gastrointestinal tract to (bi is the great neutralizer)

A

help neutralize stomach acid, as digestion and absorption require an alkaline environment.

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7
Q

After it’s formation in the liver, bile flows into

A

After it’s formation in the liver, bile flows into the hepatic duct.

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8
Q

The sphincter of Oddi surrounds the ampulla of Vater. (oddi and vader)

A

needs to relax to let bile out.

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9
Q

Cholelithiasis formation

A

Stones d/t precipitation➔ bile ➔ obstruction ➔Sx

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10
Q

Cholecystitis (think itis)

A

Inflammation of the gall bladder ➔obstruction ➔Sx.

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11
Q

Cholangitis (chang in the ducts is an emergency)

A

Inflammation of the bile ducts ➔obstruction ➔Sx. this is an emergency.

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12
Q

Cholecystectomy

A

Removal of gall bladder (open, laparoscopic, T-tube care)

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13
Q

Cholecystitis - s/sx - hurts before or after eating?

A

Food stimulation moves stone to block duct
Pain after meals (high fat)
Nausea, belching, flatulence, indigestion

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14
Q

Cholecystitis - s/sx - pain, bowel sounds (itis in my right-is)

A

Epigastric pain, decreased or absent bowel sounds. right upper quadrant and chest pain.

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15
Q

cholecystitis - skin

A

Bile flow blocked leads to bile salts on skin, pruritus
Mild jaundice (bile is obstructed form liver)
Clay colored stools, dark foamy urine, steatorrhea (fatty stools)
Strictures

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16
Q

Cholecystitis-Kehr’s sign (Chole says Kerry on, right?)

A

Pain radiates to right shoulder with breathing

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17
Q

Cholecystitis- Murphy’s sign (murphy inspired the upper right)

A

Pain on deep inspiration with RUQ palpation

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18
Q

Cholecystitis - diagnostics and what blood tests? (Chole is a cutie)

A

Amylase, lipase, CBC (WBC), LFT’s
Abdominal ultrasound, CT

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19
Q

Cholecystitis - treatment

A

NPO, IV hydration
NGT suction with N/V
T-Tube insertion if no resolution or worsening Sx
Cholecystectomy if tolerated
low fat diet

20
Q

Cholecystitis - meds (Cole and the 4 As)

A

Antibiotics
Analgesics (opiate –demerol versus morphine)
Anticholinergic (decrease motility and acid)
Antispasmotics (decrease GI spasms and therefore pain)

21
Q

Cholecystitis - complications

A

Gall bladder perforation
Peritonitis (secondary)
Pericholecystic abscess (15% mortality)
Empyema
Suppurative cholecystitis ➔sepsis/shock

22
Q

gallstones

A

Super saturated bile stasis, precipitates
Cholesterol orcalcium bilirubinate (pigment) gallstones

23
Q

gallstones - who gets them

A

More prevalent in women than men, obesity, rapid weight loss post pregnancy/multiple pregnancy, use of estrogens, rich/fatty foods, Mexican American or American Indian

24
Q

gallstones - causes (hard livin gal)

A

High fat/low fiber diet, heavy drinking, infection, CAD, intestinal disorders, smoking

25
Q

smoking and coffee - (friends with gale)

A

decrease risk of gallstones

26
Q

gallstones - s/sx - and if symptoms, when do they start?

A

can be asymptomatic OR Abrupt, episodic pain epigastric/RUQ
Pain beginning in the abdomen and radiating to the chest, back and shoulders
N/V, tachycardia, diaphoresis
Attacks start after meals and usually at night

27
Q

gallstones - diagnostics (Erp is a good gal)

A

Ultrasound, oral cholecystogram, endoscopy, ERCP

28
Q

gallstones - treatment (gals like hot water)

A

Heat, sips of water, analgesics, non-surgical or surgery (ERCP, cholecystectomy)
Complications: empyema, peritonitis, duct or liver injury/damage

29
Q

gallstones - prevention

A

Exercise, diet, avoid modifiable risks

30
Q

ERCP

A

throat is numbed bc tube goes down throat. pt is under conscious sedation. bed rest for 4 hours after procedure. NPO until gag. 30-45 degrees.

31
Q

T-tube

A

T-tubes are colonized after 24 hrs so there is a high rate of infection.

32
Q

T-tube nursing - how often to change dressing?

A

Assess and measure drainage
Change dressing daily
Assess skin
Assess for peritonitis
Assess for leaks

33
Q

Cholangitis (chang is bacteria in my ducts)

A

very serious. Bacterial inflammation of bile ducts
Associated with stones
Predisposition with stagnant bile flow; pancreatic CA; procedures (ERCP, contrast injections), T tube infections (90% are colonized within one week)

34
Q

Cholangitis - s/sx (Chang loves charlotte P, the FJ)

A

Charcot’s triad (abdominal pain, fever, and jaundice)
Intermittent chills & fever
Abdominal pain
Jaundice (sudden onset)
RUQ tenderness
Elevated WBC, bilirubin, AST, ALT

35
Q

Cholangitis - treatment

A

IV antibiotics
EMERGENCY GB decompression
ERCP
PTC (percutaneous transhepatic cholangiography)
Surgery NOT done (20-60% mortality

36
Q

Cholangitis - complications (Chang has an abscess)

A

Hepatic abscess (15%) empyema

37
Q

Primary Sclerosing Cholangitis (think sclerosis)

A

Narrowing and hardening of the bile ducts which leads to a back up pressure and obstruction of the bile ducts.
Increased pressure leads to liver inflammation, fibrosis and cirrhosis of the liver

38
Q

Primary Sclerosing Cholangitis (inflammed bile duct) linked with (Chang is primarily friends with UC students)

A

ulcerative coalitis - 70%

39
Q

Primary Sclerosing (bile ducts inside and outside liver become scarred) - risk factors - gender and age only?

A

Risk factors: Ulcerative colitis (UC), male 30-40 years and family history, microbiome issues, genetics, environmental

40
Q

Primary Sclerosing - s/sx (same)

A

RUQ pain, jaundice, fatigue, pruritis, cirrhosis, LFT changes (alk phos elevates first, then bilirubin, and finally ALT, AST

41
Q

Cholecystectomy - Laparotomy

A

Hospitalized
Prevent/minimize pulmonary complications
ICS, TCDB, splinting, ambulate
Proactive pain management with PCA opioids, splinting
NPO, NGT, antiemetics
T tube or C tube, wound drain, incision care
Patient discharge education
Pain, wound, tubes, diet, activity restrictions

42
Q

Cholecystectomy - Laproscopic “lap choley” - when can I lift stuff and drink alcohol?

A

Ambulatory surgery
Multiple stab wounds, insuffation with CO2, cameras, laser, “bagged” and removed
Fever pulmonary complications
Pain management
Less trauma, less pain
Free air in abdomen, absorbs, ambulate
Patient discharge education
Pain management, wounds, tubes, diet (low fat) , activity resumption
No lifting > 20 pounds for 10 days
No alcohol for 2 months
Report signs of obstruction or infection

43
Q

Foods to Avoid Cholecystitis or Cholelithiasis - high in cholesterol (and what else)

A

Dairy
Whole milk, ice cream, butter, cheese, cream
Fried, fatty foods
Rich pastries
Gravies
Nuts and chocolate
Egg yolks and avocado

44
Q

foods to avoid - gas forming veggies

A

Gas Forming Vegetables
Onions
Broccoli
Cauliflower
Sauerkraut
Radishes
Cucumbers
Beans

45
Q

cholysystitis - what type of pain? (Chole’s shoulder hurts)

A

pain radiates to shoulder. can have this without obstruction

46
Q

who usually gets cholycyitis? (Chole is really old)

A

usually really old or sick. immobile. it’s not very common. sludgy bile. could be cancer, opioids. can be from infection as well. worry is rupture and periotonitis.

XIO (372 decks)

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