biliary tract disorder Flashcards
what should every disease process start with
health promotion
what is the health promotion of biliary tract disease
early identification considering risk factors
low-fat diet
exercise
what do we have to have to have stone formation
inflammation
what is cholelithiasis
stones in the gallbladdr
what is the most common disorder of the biliary system
cholelithiasis
what does cholelithiasis frequently occur with
cholecystitis (inflammation of the gallbladder)
is cholelithiasis more likely in men or women
2/3X more likely in women
what are the risk factors with cholelithiasis
obesity
multiparity
sedentary lifestely
women taking bc which increases risk because of change in file
what race is cholelithiasis high in
native americans, more common in asian and african americans than whites
when does the incidence increase for cholelithiasis
increase with age over 40, gender differences decreases after age 50
when does cholelithiasis develop
when balance that keeps cholesterol, bile salts and calcium in solution is altered so that precipitation occurs
supersaturation with cholesterol
stasis of bile
which stones are most
cholesterol
where do the stones go
may remain in the gallbladder or move into the cystic or common bile ducts
what does movement mean
PAIN
and opportunity for obstruction
what is pain called
colic
who are absence of obstruction (acalculous= no stones) seen in
older adults
trauma, burns, recent surgery
immobility, fasting, TPN, DM
what is cholecystitis
gallbalddr is inflamed and hyperemic (increase in blood flow) may be distended with bile or pus
what is chelecystitis commonly associated with
obstruction
severity of cholelithiaiss relates to
stone movement and position
what can biliary colic cause (pain)
tachycardia, diaphoresis and prostration
when does an attack occur
3-6 hours post high fat meal or patient lies down
what are the classic signs of cholecystitis
indigestion
pain
tenderness in RUQ
referred to right shoulder and scapula
what are some other signs of cholecystitis
leukocytosis fever nausea vomiting restlessness diaphoresis
what are some signs of chronic cholecystitis
history of fat intolerance, dyspepsia heartburn and flatulence
what could be some complications with cholecystitis
subphrenic abscess fistulas pancreatitis chonlangitisis biliary cirrhosis rupture of gallbladder bile peritonitis
which lab tests will have an increase so we know its cholecytisis
WBC
bilirubin (direct, indirect and urinary)
serum enzymes (alkaline phosphatase, ALT,AST)
serum amylase if pancreas is involved
what are diagnostic studies for cholecytisis
ultrasound
lab tests
ERCP (endoscoptic retrograde cholangiopancreatography)
precutaneous transhepatic cholangiography
hepatobiliary scintigrapy (HIDA scan)
which diagnostic study is most common
hepatobiliary scintigraphy (HIDA scan)
what is some conservative therapy we would do with acute cholecysistis
pain control antibiotics fluid and electrolyte balance possible gastic decompression by NG tube anticholinergics (antispasmotics) = atropin
what is nonsurgical approaches for conservative management for cholelithiasis
ERCP
cholesterol solvents
what are the cholesterol solvents
ursodiol
chnodiol
these are rarely used
oral drugs that dissolve the stone
what are the two ways to do cholecystectomy
laparascopic
open
what is a laparoscopic colescystectomy
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
what is an open cholescystectomy
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
what is post op care for a laparoscopic
pain due to CO2
early ambulation
deep breathing to get rid of CO2
what is post op care for an open
adequate ventilation
T tube care
avoid heavy lifting 4-6 weeks
before giving anything in their mouth what must we asscess
bowel sounds
what are some drug therapys
analgesis- keep comfortable
anticholinergic (antispasmotics) - relaxes smooth muscle
fat soluble vitamins
bile salts
cholestyramine
what is cholestryamine
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
what is nutritional therapy
low fat diet
reduced calorie diet if obese
for a post lap chole: what is the nutritional therapy
liquids for day, light meals several days
for a post open lap what is the nutritional therapy
restrict fats for 4 - 6 weeks
what is the goals of cholecytisis
relief of pain and discomfort
no post op complications
no recurrent attacks of cholecystitis or cholelithiasis
what are some nursing interventions
- 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
