cholecystitis/cholelithiasis

Question 1

cholycystitis

Answer 1

inflammation of gallbladder

Question 2

cholilithiasis

Answer 2

stones in the gallbladder

Question 3

Risk factors

Answer 3

fat, female, fair skin, forties

• female, multiparous, over 40 years old
• sedentary lifestlye,familial tendency, obesity, caucasian. Obesity causes increased secrection of cholesterol in bile

Question 4

patho

Answer 4

• gallstones made of motly cholesterol
• cause unknown
• changes in bile comp lead to formation of gallstones. immobility,pregnancy, inflammatory, obstructive lesions of the biliary system decrease bile flow. hormonal factors during pregnancy may cause delayed emptying of the gallbladdr, resulting in stasis of bile the gallstones

Question 5

S/S

Answer 5

• indigestion
• steatorrhea
• pain RUQ which can radiate to the right shoulder/scapula usually occurs 3-6 hrs after a meal or when pt lies down
• nausea/vomiting
• biliary colic
• leukocytosis/fever=fever /infection
• jaundice=lver involvement

Question 6

complications

Answer 6

gangrenous cholecystitis, subphrenic absess, pancreatitis, biliary cirrhosis, fistulas, rupture of gallbladder=peritonitis

Question 7

Diagnosis

Answer 7

• Ultrasound 90-95 %
• ECRP endoscopic identifies stone tumors narrowing bile ducts
• labs WBC infection
• bilirubin-liver (urinary bilirubin willl be increased if there is obstruction)
• AST/ALT/Alkaline phospatase elevated if liver involved
• lipase amylase elevated if liver involved

Question 8

Treatment

Answer 8

• gastric decompression/NG tube for suction
• bile salts to facilitate digestion/vitamin absorption
• Cholesttyramine (Questran) for pruritis
• diet low fat/ low cal if obese
• also fat soluble vit A D E K

Question 9

pain control treatment

Answer 9

-analgesics(morphine)
-NSAIDS
-anticholinergics antispasmotics/ decrease secretions and relax smooth muscle spasms
-

Question 10

non surgical interventions

Answer 10

dissolve stone w/ursodeoxycholic acid, ursodiol/actigall, chenodeoxycholic acid

• MTBE/methyl tertiary terbutyl ether infusion via tube directly into the gallbladder
• stone removal by lithotripsy or

Question 11

surgical intervention

Answer 11

-laparoscopic cholecystectomy :shoulder
pain can occur bcuz CO2 gas is used causes pain
-open cholecystectomy:drains t-tubes/ make sure suction is on,measure amt, maintain patency of common bil duct
-TCDB, ambulate, incentive spirometer, pain control
-post op lay them in SIMS position to divert gas pocket if any trouble breathing or phrenic nerve stimulation

Question 12

post op teaching

Answer 12

avoid heavy lifting for 4-6 weeks

• sex can be resumed as soon as pt feels ready unless given other instructions
• diet low fat 4-6weeks then a reg diet avoid excess fats