cholelithiasis + cholecystitis Flashcards
what is cholelithiasis
the presence of 1 or more gall stones in the gall bladder.
what is cholecystitis?
gall bladder inflammation and can be a complication of gall stones, sludge ( when bile stays in the gall bladder for too long) , or structural/ functional disorders.
what is chole?
bile or gall
what organ makes cholesterol/bile?
liver
what is cholecystectomy?
to remove the gall bladder
which is the function of gall bladder?
to store bile
early symptoms of cholecystitis
indigestion cause the bile stone stuck at the bile duct.
pain
tenderness in the upper right quadrant ( pain may refer to right shoulder and scapula)
nausea vomiting
restlessness
diaphoresis (sweating)
symptoms of progression to acute cholecystitis
severe pain,
fever
chills
jaundice
inflammation.
what to assess for cholecystitis ( physical examination)
pain - COLDSPA
leukocytosis ( elevated WBC) - infection
tachycardia
restlessness
fever
jaundice - affect the liver
changes in urine or stool appearance
abdominal rigidity.
symptom of chronic cholecystitis :
what happens if it keeps recurring?
if acute inflammation resolves but continues to recur, the gallbladder becomes fibrotic and contracted, does not concentrate bile or empty normally.
patients will report a history of fat intolerance, dyspepsia( indigestion) heartburn and flatulence.
possible diagnostic tests for cholecystitis
blood tests
gallbladder ultrasound
abdominal CT scan
Gallbladder
radionucleotide scan (HDA SCAN)
endoscopic retrograde cholangiopancreatography ( ERCP)
what types of blood test will be ordered for cholecystits
CBC
Liver function test
bilirubin
amylase end lipase
what enzymes are found in liver ?
AST- Aspartate Transaminase 0-35
GGT - Gamma-glutamyl transpeptidase 9-48
*ALT - Alanine Transaminase 0-35
ALP- Alkaline phosphotase 20-140
*ALT is more specific to the liver, it is found in the liver cells, it can be released into the blood stream when damaged - serum ALT is high.
where is GGT found?
concentrated in the liver, found in gall bladder, spleen, pancreas, kidneys
where are ALP made in a pregnant woman
liver and placenta
what are the functions of liver enzymes? ( AST ALT GGT ALP)
enzymes helps break down protein and have an important role in liver function and bone development.
what does it indicate if the liver fxn test is high
underlying medical condition involving the liver, bones, gall bladder.
what is a common cause of ALT elevation?
Nonalcoholic fatty liver disease (NAFLD) or alcoholic liver disease
a possible cause of ALP elevation other than gall bladder related.
bone cancer metastasis
what are the 2 main groups of serum protein?
what’ s the third one?
albumin and globulin ( 6-8.3)
fibrinogen
what does albumin attract?
what does it do?
sodium
it helps to keep out adequate volume out of the intravascular space to maintain an adequate blood pressure.
what is bilirubin
a waste product when old red blood cells are worn out and removed and recycled by the liver.
what causes high bilirubin levels?
bilirubin cant make it to the intestine to be broken down and excreted, back up in the liver, causes circulating blood levels of bilirubin to rise.
cholecystitis complications
gangrenous gall bladder, suphrenic abscess, pancreatitis, cholangitis, biliary cirrhosis, fistulas, and rupture of the gall bladder.
what are the drugs for cholecystitis?
ceftriaxone and metronidazole
what is ceftriaxone?
a beta lactam antibiotic, 3rd gen cephalosporin.
it inhibits bacterial cell wall synthesis- bactericidal and is broad spectrum.
Need to monitor for rash and diarrhea.
what is metronidazole?>
it is a DNA synthesis inhibitor, in disrupts the DNA synthesis via oxidative stress.
fight against protozoans and anaerobes. monitor for headache, dizziness, stomach pain, nausea, metallic taste
Abnormal lab values for cholecystitis
Leukocytosis
Elevated bilirubin and or without alkaline phosphate
Complications of cholecystitis
Gangrenous gall bladder to sepsis
Rupture of gallbladder - peritonitis
Suphrenic abscess
Pancreatitis
Cholangitis
Billiary cirrhosis
Fistulas
