Gall/biliary

Question 1

Cholecystitis
Def
2 types
3 s/s

Answer 1

Acute infection Gb filled with fluid

Calculous and acalculous

Cause pain(fetal position) rigid RUQ n/v

Question 2

Calculous cholest
Def
4 pc

Answer 2

GB stone obstructs outflow, bile remain in gb creates chem rxn that allow autolysis and edema for blood supply to be compromised

Gangrene, perf GB, e.coli. Bile peritonitis- incr wbc, fever, board like rigid

Question 3

Peritonitis aka

Answer 3

Board like rigid

Question 4

Acalculous cystitis
Def
Causes 5
How patient feels

Answer 4

GB inflammation without stones
Bile is sludgy- bile stasis incr viscosity

Occurs after major surg, trauma, burn, alt in fluid and lytes in visceral circulation

Ice pick pain

Question 5

Cholelithiasis
Def
2 types

Answer 5

Calculi or gall stones- form in GB from solid constituents of bile

Pigmented and cholesterol

Question 6

Cholelithiasis (maybe both cholelithiasis and cholecystitis)
s/s 5

(How they feel, labs, diet)

Answer 6

1 No pain to severe and steady awaken pains . RUQ that radiate to R shoulder

2. Mild GI sx , feel full
3. Fever/ high wbc
4. Low BG
5. Nausea and pain worsen p high fat meal

Question 7

Pigmented stone
Def
3 Complication

Answer 7

Formed in unconjugated pigment

Incr in cirrhosis, hemodialysis, infected biliary tree

Question 8

Cholesterol
5 risk factors
Increase comp

Answer 8

4 F- fat, 40, fertile, fair

Question 9

Gallbladder disease
a. biliary colic
S/s- 6
2 PC

Answer 9

Pain/biliary colic
Go distention
Infected
Murphy sign-Pain on palpating RUQ
Anorexia n/v 
Pain p high fat meal 
Unable to fully inspire 

Pneumonia atelectasis

Question 10

Gallbladder disease
treatment Med to use
Contraindicated

Answer 10

Meperidine

Can used hydromorphone (dilaudid) but not choice

Cannot use morphine sulfate -sphincter

Question 11

Gallbladder disease S/s 4

Answer 11

Pain/ biliary colic
Jaundice
Change in urine still color
Vitamin def- kade

Question 12

What procedure do you give telepaque PO?

Answer 12

Cholecystography/ GI series

Question 13

X-ray do?

Answer 13

Note gallstones picks up calcification

Only 15-20 % are calcified

Question 14

Ultrasound do/ 2 important things

Answer 14

Npo after midnight and fast

Visualize stones

Question 15

Radionuclide/ cholescintography
What it do?
Process
3 problems

Answer 15

Scan GB and biliary tree

Radioactive IV then scan- should force fluid

Longer and expensive, can’t visualize stone, radiate pt

Question 16

Cholecystography/ GB series
Does
Process
Important things

Answer 16

Visualize stones xray RUQ

Check iodine shellfish allergy, telepaque tabs PO, contrast given 12 hours before

Question 17

Endoscopic retrograde cholangiopancreatography (ercp)
Process
What is does

Answer 17

Npo c sedation, md numbs throat ,scope inserted into esophagus down into duodenum, fluoroscopy and xray to detect stones then remove stones, npo until gag reflex returns

Look at stones can widen the biliary duct so stones past or blast to break up

Question 18

What procedure can blast and break up stones?

Answer 18

ERCP

Question 19

What two procedure is npo c sedation? What does that mean

Answer 19

Ercp and percutaneous transhepatic cholangiography

Question 20

Percutaneous trans. Choleangiography

Process
PC 3

Answer 20

Npo c sedation, inject dye into biliary tree, needle to GB withdraw bile, injection due, X-ray , then aspirate dye

Bleeding, bile peritonitis, septic

Question 21

Cholelithiasis and cholecystitis medical management
5 implementations
Dietary can have can’t have

Answer 21

80 remission c rest 
IVF, Angesics
NPO and NG for gut rest 
NG suction 
Delay surg until acut s/s over- can't for lap chole 

Diet - low fat liquid, high protein powder supp, hi carb in skim milk
Add cool fruits, lean meat, mash pot, non gassy veg, bread , coffee and tea- too much stimulant

No- egg cream pro fried cheese, rich dressing alcohol

Question 22

Cholecystitis and lithis
Pharmacological therapy
 what med 
What does 
How long 
Indicated

Answer 22

UDCA/CDCA- dissolve small stone decrease size
Not for pigmented stones or freq episodes
6-12 mo
Indicated pt refuse surgery - compliance

Question 23

Non surgical removal

4 and what they do

Answer 23

Mtbe- solvent to dissolve stone, not widely use

ERCP- enlarge ducts for pass to duodenum for excretion or grab basket to extract- removal

Extracorpeal shock wave lithotripsy ESWL- shock waves to dissolve via water bath or fluid bag

Intracorpeal lithrotrupsy- laser through endoscope directly to stone remove e irrigation or aspiration. Drain in place after

Question 24

Surgical management
When indicated
6 types why they do

Answer 24

Delayed until acute episodes subside

Laparoscopy cholecystectomy- lap chole CO2 in abd, umbilical decision general anesthesia , scope visualize structures, GB remove by other inst

Cholecystectomy- abd incision , co2 in abd, GB removed, drain in place pentode davol for blood and bike, replace by lap chol

Mini- cholecystectomy- smaller inc

Choledichostomy- inc bike duct insert drain , gb removed
Surgical cholestomy
percutaneous cholecystostomy

Question 25

Surgical cholecystectomy

Indication
What they do

Answer 25

Fragile pt

GB open, stone removes drain in place, GB removed once acute s/s resolve

Question 26

Percutaneous cholecystistosomy
Indication
4 risk pts
What do

Answer 26

For poor surg or anesthesia risk

Pt- heart, renal/Kidney, pulmonary and liver problem

Local anesthetic, needle inserted with ultrasound or CT, bile aspirated, catheter inserted, provides immediate relief (not asleep)

Question 27

Patient to report p surgical management 5

Nursing implementation -5

Answer 27

Abdominal (GI) comps -abdomen dist
Loss of appetite/ vomit
Pain unrelieved by mes
Increase temp

Drowsy for 24-48 hrs, someone drive home, assist , pain in R shoulder from co2 ok, , heat pad increase HOB