biliary tract disorder

Question 1

what should every disease process start with

Answer 1

health promotion

Question 2

what is the health promotion of biliary tract disease

Answer 2

early identification considering risk factors
low-fat diet
exercise

Question 3

what do we have to have to have stone formation

Answer 3

inflammation

Question 4

what is cholelithiasis

Answer 4

stones in the gallbladdr

Question 5

what is the most common disorder of the biliary system

Answer 5

cholelithiasis

Question 6

what does cholelithiasis frequently occur with

Answer 6

cholecystitis (inflammation of the gallbladder)

Question 7

is cholelithiasis more likely in men or women

Answer 7

2/3X more likely in women

Question 8

what are the risk factors with cholelithiasis

Answer 8

obesity
multiparity
sedentary lifestely
women taking bc which increases risk because of change in file

Question 9

what race is cholelithiasis high in

Answer 9

native americans, more common in asian and african americans than whites

Question 10

when does the incidence increase for cholelithiasis

Answer 10

increase with age over 40, gender differences decreases after age 50

Question 11

when does cholelithiasis develop

Answer 11

when balance that keeps cholesterol, bile salts and calcium in solution is altered so that precipitation occurs

supersaturation with cholesterol
stasis of bile

Question 12

which stones are most

Answer 12

cholesterol

Question 13

where do the stones go

Answer 13

may remain in the gallbladder or move into the cystic or common bile ducts

Question 14

what does movement mean

Answer 14

PAIN

and opportunity for obstruction

Question 15

what is pain called

Answer 15

colic

Question 16

who are absence of obstruction (acalculous= no stones) seen in

Answer 16

older adults
trauma, burns, recent surgery
immobility, fasting, TPN, DM

Question 17

what is cholecystitis

Answer 17

gallbalddr is inflamed and hyperemic (increase in blood flow) may be distended with bile or pus

Question 18

what is chelecystitis commonly associated with

Answer 18

obstruction

Question 19

severity of cholelithiaiss relates to

Answer 19

stone movement and position

Question 20

what can biliary colic cause (pain)

Answer 20

tachycardia, diaphoresis and prostration

Question 21

when does an attack occur

Answer 21

3-6 hours post high fat meal or patient lies down

Question 22

what are the classic signs of cholecystitis

Answer 22

indigestion
pain
tenderness in RUQ
referred to right shoulder and scapula

Question 23

what are some other signs of cholecystitis

Answer 23

leukocytosis 
fever
nausea
vomiting
restlessness
diaphoresis

Question 24

what are some signs of chronic cholecystitis

Answer 24

history of fat intolerance, dyspepsia heartburn and flatulence

Question 25

what could be some complications with cholecystitis

Answer 25

subphrenic abscess
fistulas
pancreatitis
chonlangitisis
biliary cirrhosis
rupture of gallbladder
bile peritonitis

Question 26

which lab tests will have an increase so we know its cholecytisis

Answer 26

WBC
bilirubin (direct, indirect and urinary)
serum enzymes (alkaline phosphatase, ALT,AST)
serum amylase if pancreas is involved

Question 27

what are diagnostic studies for cholecytisis

Answer 27

ultrasound
lab tests
ERCP (endoscoptic retrograde cholangiopancreatography)
precutaneous transhepatic cholangiography
hepatobiliary scintigrapy (HIDA scan)

Question 28

which diagnostic study is most common

Answer 28

hepatobiliary scintigraphy (HIDA scan)

Question 29

what is some conservative therapy we would do with acute cholecysistis

Answer 29

pain control
antibiotics
fluid and electrolyte balance
possible gastic decompression by NG tube
anticholinergics (antispasmotics) = atropin

Question 30

what is nonsurgical approaches for conservative management for cholelithiasis

Answer 30

ERCP

cholesterol solvents

Question 31

what are the cholesterol solvents

Answer 31

ursodiol
chnodiol

these are rarely used
oral drugs that dissolve the stone

Question 32

what are the two ways to do cholecystectomy

Answer 32

laparascopic

open

Question 33

what is a laparoscopic colescystectomy

Answer 33

90% used
1-4 punctures
CO2
LOS 1-2 days 
OR DC the day of surgery
risk of common bile duct injury 

RECOVERY IS FASTEST AND MORE FREEDOM

Question 34

what is an open cholescystectomy

Answer 34

through a right subcostal incision
T tube inserted into common bile duct when common bile duct exploration is done - lie a JP tube

manitains duct patency
allows excess bile to drain during adjustment

Question 35

what is post op care for a laparoscopic

Answer 35

pain due to CO2
early ambulation
deep breathing to get rid of CO2

Question 36

what is post op care for an open

Answer 36

adequate ventilation
T tube care
avoid heavy lifting 4-6 weeks

Question 37

before giving anything in their mouth what must we asscess

Answer 37

bowel sounds

Question 38

what are some drug therapys

Answer 38

analgesis- keep comfortable
anticholinergic (antispasmotics) - relaxes smooth muscle

fat soluble vitamins
bile salts
cholestyramine

Question 39

what is cholestryamine

Answer 39

a powder mixed with milk or juice that binds bile salts to be exerted in the stool helps with pruritus

make sure they have regular bowel sounds first

Question 40

what is nutritional therapy

Answer 40

low fat diet

reduced calorie diet if obese

Question 41

for a post lap chole: what is the nutritional therapy

Answer 41

liquids for day, light meals several days

Question 42

for a post open lap what is the nutritional therapy

Answer 42

restrict fats for 4 - 6 weeks

Question 43

what is the goals of cholecytisis

Answer 43

relief of pain and discomfort
no post op complications
no recurrent attacks of cholecystitis or cholelithiasis

Question 44

what are some nursing interventions

Answer 44

• pain management
• nausea and vomiting management
• measures to reliever itching if pruritus from jaundice- cholestryramine
• watch for bleeding and maintain bleeding precautions if symptoms of obstruction are present
• assess to detect complications