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Adult Health I Test IV > Cholelithiasis and Cholecystitis > Flashcards

Cholelithiasis and Cholecystitis Flashcards

1
Q

cholecystitis

A
  • inflammation of the gallbladder wall
  • Most often caused by gallstones (cholelithiasis) obstructing the cystic and/or common bile ducts (bile flows from the gallbladder to the duodenum) causing bile to back up and the gallbladder to become inflamed
  • Can be acute or chronic
  • Can obstruct the pancreatic duct–>pancreatitis
  • Can cause the gallbladder to rupture–>secondary peritonitis
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2
Q

cholelithiasis

A
  • presence of stones in the gallbladder related to the precipitation of either bile or cholesterol into stones
  • Bile is used for digestion of fats
    • It is produced in the liver and stored in the gallbladder
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3
Q

cholelithiasis/cystitis: health promotion & dz prevention

A
  • Consume low fat diet rich in HDL (seafood, nuts, olive oil)
  • Participate in regular exercise program
  • Do not smoke
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4
Q

cholelithasia/cystitis: risk factors

A
  • Females: hormone therapy and use of some oral contraceptives
  • High fat diet
  • Obesity: impaired metabolism, high cholesterol
  • Genetic predisposition
  • Older adults: dec contractility
  • Type 2 DM (high triglycerides) or Crohn’s
  • Low calorie, liquid protein diets
  • Rapid weight loss: inc cholesterol
  • Native Americans or Mexican ethnicity
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5
Q

cholelithaisis/cystitis: expected findings

A
  • Sharp pain in the RUQ, often radiating to right shoulder
  • Pain w/ deep inspiration during right subcostal palpation: Murphy’s Sign
  • Intense pain: inc HR, pallor, diaphoresis–w/ n/v after ingestion of high fat food caused by biliary colic
  • Rebound tenderness: Blumberg’s sign performed by provider
  • Dyspepsia, eructation (belching), flatulence
  • Fever
  • Jaundice, clay colored stools, steatorrhea (fatty stools), dark urine, pruritis in clients with chronic cholecystitis
  • Older adults: if they have DM, can have atypical presentation–>absence of pain/fever
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6
Q

cholelithiasis/cystitis: lab tests

A
  • Inc WBC–>inflammation
  • Direct, indirect, and total serum bilirubin increased if bile duct obstructed
  • Amylase and lipase inc w/ pancreatic involvement
  • AST, LDG, and ALP–>inc w/ liver dysfunction and can indicate common bile duct is obstructed
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7
Q

cholelithaisis/cystitis: diagnostic procedures

A
  • U/S: visualize gallstones and a dilated common bile duct
  • Abdominal x-ray or CT scan: visualize calcified gallstones and an enlarged gallbladder
  • Hepatobiliary scan (HIDA): assesses patency of biliary duct system after an IV injection of contrast
  • Endoscopic retrograde cholangiopancreatography: allows for direct visualization using an endoscope that is inserted thru the esophagus to common bile duct via duodenum
    • A sphincterotomy w/ gallstone removal can be done during this procedure
  • Magnetic resonance cholangiopancreatography: combines use of oral/IV contrast with an MRI
    • Assess in determining cause
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8
Q

cholelithiasis/cystitis: meds

A
  • analgesics
  • bile acids
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9
Q

cholelithiasis/cystitis: analgesics

A
  • Opioid analgesics (morphine sulfate or hydromorphone)
    • Preferred for acute biliary pain
  • NSAIDs (ketorolac)
    • For mild to moderate pain
    • Monitor for GI bleeding
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10
Q

cholelithiasis/cystitis: bile acids

A
  • chenodiol, ursodiol
  • Gradually dissolves cholesterol based gallstones
  • Nursing Considerations:
    • Use caution if client has liver condition or disorders w/ varices
  • Client Edu:
    • Teach clients to report abdominal pain, diarrhea, or vomiting
    • Limited to 2 yrs administration and requires a gallbladder U/S every 6 mos during 1st year to determine effectiveness
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11
Q

cholelithiasis/cystitis: list the therapeutic procedures

A
  • extracorporeal shock wave lithotripsy
  • cholecystectomy
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12
Q

cholelithiasis/cystitis: extracorporeal shock wave lithotripsy

A
  • type of therapeutic procedure
  • Shock waves are used to break up stones
    • Can be used on nonsurgical candidates of normal weight who have small, cholesterol based stones
  • Nursing Actions:
    • Instruct and assist client to lay on fluid filled pad for delivery of shock waves
    • Administer analgesia
  • Client Edu:
    • Inform client that several procedures can be required to break up all stones
    • Client may have pain intraprocedure due to gallbladder spasm of removal of stones
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13
Q

cholecystectomy: what is it?

A
  • Removal of gallbladder w/ laparoscopic, minimally invasive, or open approach
  • Client can be discharged in 24 hr if laparoscopic approach used
    • Open approach requires hospitalization for 1-2 days
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14
Q

laparoscopic approach to a cholecystectomy

A
  • nurse should provide immediate post op care
  • client edu:
    • ambulate frequently to minimize free air pain
    • Monitor incision for evidence of infection or wound dehiscence
    • Pain control
    • Report indications of bile leak: pain, vomiting, abdominal distention
    • Resume activity gradually
    • Resume pre op diet
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15
Q

minimially invasive approach to a cholecystectomy

A
  • natural orifice transluminal endoscopic approach
    • Explain to the client that this surgical procedure is performed thru entry of the mouth, vagina, or rectum
    • Eliminates visible incisions and dec risk of complications
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16
Q

open approach to a cholecystectomy

A
  • Jackson Pratt drain placed in gallbladder bed or a T tube in the common bile duct
    • Less common but clients can have T tube placed in common bile duct to drain bile if there were intraoperative complications involving the bile duct
  • client edu:
    • Resume activity gradually
      • Avoid lifting for 4-6 wks
    • Begin w/ clear liquids and advance to solid foods as peristalsis resumes
    • Report sudden inc in drainage, foul odor, pain, fever, or jaundice
    • Take showers instead of baths until drainage tube removed
    • Color of stools should return to brown in about a week
    • Diarrhea is common
17
Q

how to care for the drainage tube after a cholecystectomy

A
  • Clients w/ JP drain placed intraoperatively to prevent accumulation of fluid in gallbladder bed
  • Monitor and record drainage
    • Initially will be serosanguinous stained with green brown bile
  • Abx often prescribed to dec risk for infection
18
Q

how to care for a T tube after a cholecystectomy

A
  • Report absence of drainage w/ manifestations of nausea and pain (indicates obstruction)
  • Inspect skin for infection or bile leakage
  • If prescribed, elevate T tube above level of abdomen to prevent total loss of bile
  • Monitor and record color/amount of drainage
  • Clamp tube 1 hour before and after meals to provide bile necessary for food digestion
  • Assess stools for color
    • Will be clay colored until biliary flow is re-established
  • Monitor for bile peritonitis–>pain, fever, jaundice
  • Monitor response to food
  • Expect removal in 1-3 wks
19
Q

dietary counseling after a cholecystectomy

A
  • Encourage low fat diet: reduce dairy, avoid fried foods/chocolate/nuts/gravies
  • Inc tolerance if small frequent meals
    • Avoid gas forming foods: beans, cabbage, cauliflower, broccoli
  • Promote weight reduction
  • Take fat soluble vitamins or bile salts as prescribed to enhance absorption and aid w/ digestion
20
Q

cholelithiasis/cystitis: list the possible complications

A
  • obstruction of bile duct
  • bile peritonitis
  • postcholecystectomy syndrome
21
Q

cholelithiasis/cystits: complication of obstruction of the bile duct

A
  • Can cause ischemia, gangrene, and rupture of gallbladder wall
    • Rupture of gallbladder can cause a local abscess or peritonitis (rigid, board like abdomen, guarding) which requires a surgical intervention and administration of broad spectrum abx
22
Q

cholelithiasis/cystitis: complication of bile peritonitis

A
  • Can occur if adequate amounts of bile are not drained from surgical site
  • Rare but potentially fatal complication
  • Nursing Actions:
    • Monitor for pain, fever, jaundice
23
Q

cholelithiasis/cystitis: complication of postcholecystectomy syndrome

A
  • Manifestations of gallbladder dz can continue after surgery
  • Client will report findings similar to those experienced prior to surgery related to pain and nausea
  • Manifestations can recur immediately or months later
  • Nursing Actions:
    • Assess pain characteristics and other reported findings
    • Instruct client on the need for possible further diagnostic eval

Adult Health I Test IV (10 decks)

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