Exam 3 - Cholelithiasis/Cholecystitis Flashcards
Manifestations of common bile duct obstruction
Jaundice
Severe itching
Dark urine
Gray feces
Manifestations of cholelithiasis
Asymptomatic to severe pain
Pain can be accompanied by tachycardia, diaphoresis, and prostration
Manifestations of cholecystitis
Vary from indigestion to severe pain (RUQ radiating to R shoulder and scapula) N/v Restlessness Diaphoresis Sx may follow a heavy meal
Complications of cholelithiasis and cholecystitis
Gangrenous cholecystitis Subphrenic abscess Pancreatitis Cholangitis Biliary cirrhosis Fistulas Rupture of gallbladder
Lab results associated with cholelithiasis/cholecystitis
WBC elevated - inflammation
Bilirubin elevation - bile duct obstruction
Amylase and lipase elevation - pancreatic involvement
AST, LDH, alkaline phosphatase elevation (liver dysfunction, may indicate common bile duct obstruction)
Cholesterol elevation above 200 mg/dL
Procedures to diagnose cholelithiasis/cholecystitis
Ultrasound
Endoscopic retrograde cholangiopancreatography
Radionuclide imaging
Cholescintigraphy
Percutaneous transhepatic cholangiography
Works to dissolve cholesterol stones. 6-12 months of medication. Less side effects. Can reduce size of existing stones, dissolve small stones, prevent new stone formation
UDCA (Actigall)
6-12 months of medication. Works to dissolve cholesterol stones
CDCA
Solvent infused through different routes. Not used often.
MTBE
Questran and antihistamines are used for
Itching
What are anticholinergics for?
Stop muscle spasms
Other medications given for cholelithiasis/cholecystitis
Antibiotics
Antiemetics
Bile salts
Gastric decompression for n/v
After surgery, what kind of diet
Low-fat liquid
What kind of foods should the pt avoid?
Eggs, cream, pork, fried foods, cheese rich dressings, gas-forming vegetables, ETOH
If pt just has sx r/t fatty foods, what will the therapy be?
Diet therapy
Open surgery requires
T tube placement
Used when endoscopic drainage fails, inoperable liver, pancreatic, or bile duct carcinoma
Transhepatic biliary catheter
Main surgical complication
Injury to common bile duct
Stone fragmented by laser pulse technology. Allows for improvement in pt condition until stones can be cleared endoscopically, percutaneously, surgically
Intracorporeal lithotripsy
How is a stone removed with cholelithiasis?
Endoscopic sphincterotomy
Lithotripsy (ESWL)
Cholesterl solvents such as MTBE
Repeated shock waves transmitted to body through fluid-filled bag or by immersing the pt in water bath
Extracorporeal shock wave lithotripsy
Chosen for surgery because of quicker recovery, less risk for complications. Small incision or puncture made through abd wall at umbilicus
Laparoscopic cholecystectomy
Post-surgery assessment
Guarding may lead to decreased breath sounds
Check 02 sat
Turn, cough, deep breathe, and do incentive spirometry
If abd wall is rigid - emergency
Semi-fowler’s position
Do not lift more than 5 lb
Monitor for obstruction
Assessment of T-tube
Inserted if common bile duct is inflamed for drainage.
Removed after successful sphincterotomy on ERCP
Monitor dressing around tube
Keep below level of insertion site
Avoid pulling, tension on tube
