Cholelithiasis and Cholecystitis

Question 1

Stone formation in the gallbladder and accessory ducts

Answer 1

Cholelithiasis

Question 2

Stone formation at the common bile duct

Answer 2

Choledocholithiasis

Question 3

Inflammation of the gallbladder

Answer 3

Cholecystitis

Question 4

Risk Factors

Answer 4

Cystic fibrosis
Diabetes
Ileal resection
Rapid weight loss

4Fs
Female
Forty yrs old and above
Fat (obese)
Fertility (multiparous, using oral contraceptive pills)

Question 5

Signs and Symptoms

Answer 5

1. Decreased fat emulsification
2. Inflammation
3. Decreased bile flow to colon
4. Increased serum bilirubin

Question 6

Diagnostic Tests

Answer 6

1. Ultrasonography (procedure of choice)
2. Endoscopic Retrograde Cholangiopancreatography (ERCP)
3. IV Cholangiogram
4. Prolong Prothrombin time
5. CBC - Leukocytosis (WBC count)
6. Cholecystography

Question 7

Types of Cholecystography

Answer 7

1. Oral - done 10-12hrs after administration of contrast medium
2. IV - done 10 minutes after administration of contrast medium

Question 8

Nursing Interventions

Answer 8

1. Meperidine HCL (drug of choice; for pain)
2. AVOID MORPHINE
3. Use of baking soda or calamine containing lotions
4. Encourage low fat diet
5. Dissolution therapy: administration of bile salts

Question 9

Nonsurgical Interventions

Answer 9

1. Infusion of a solvent mono-octanoion or methyl tertiary butyl ether (MTBE)
2. Intracorporeal Lithotripsy - use of laser pulse technology creating a mechanical shock wave
3. Extracorporeal Shock Wave Lithotripsy - uses repeated shock directed at the gallstones at the gallbladder

Question 10

Surgical Management

Answer 10

1. Open Cholecystectomy
2. Laparoscopic Cholecystectomy

Question 11

Procedure: to drain bile

Answer 11

T-Tube