Gall/biliary Flashcards
Cholecystitis
Def
2 types
3 s/s
Acute infection Gb filled with fluid
Calculous and acalculous
Cause pain(fetal position) rigid RUQ n/v
Calculous cholest
Def
4 pc
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
Peritonitis aka
Board like rigid
Acalculous cystitis
Def
Causes 5
How patient feels
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
Cholelithiasis
Def
2 types
Calculi or gall stones- form in GB from solid constituents of bile
Pigmented and cholesterol
Cholelithiasis (maybe both cholelithiasis and cholecystitis)
s/s 5
(How they feel, labs, diet)
1 No pain to severe and steady awaken pains . RUQ that radiate to R shoulder
- Mild GI sx , feel full
- Fever/ high wbc
- Low BG
- Nausea and pain worsen p high fat meal
Pigmented stone
Def
3 Complication
Formed in unconjugated pigment
Incr in cirrhosis, hemodialysis, infected biliary tree
Cholesterol
5 risk factors
Increase comp
4 F- fat, 40, fertile, fair
Gallbladder disease
a. biliary colic
S/s- 6
2 PC
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
Gallbladder disease
treatment Med to use
Contraindicated
Meperidine
Can used hydromorphone (dilaudid) but not choice
Cannot use morphine sulfate -sphincter
Gallbladder disease S/s 4
Pain/ biliary colic
Jaundice
Change in urine still color
Vitamin def- kade
What procedure do you give telepaque PO?
Cholecystography/ GI series
X-ray do?
Note gallstones picks up calcification
Only 15-20 % are calcified
Ultrasound do/ 2 important things
Npo after midnight and fast
Visualize stones
Radionuclide/ cholescintography
What it do?
Process
3 problems
Scan GB and biliary tree
Radioactive IV then scan- should force fluid
Longer and expensive, can’t visualize stone, radiate pt
Cholecystography/ GB series
Does
Process
Important things
Visualize stones xray RUQ
Check iodine shellfish allergy, telepaque tabs PO, contrast given 12 hours before
Endoscopic retrograde cholangiopancreatography (ercp)
Process
What is does
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
What procedure can blast and break up stones?
ERCP
What two procedure is npo c sedation? What does that mean
Ercp and percutaneous transhepatic cholangiography
Percutaneous trans. Choleangiography
Process
PC 3
Npo c sedation, inject dye into biliary tree, needle to GB withdraw bile, injection due, X-ray , then aspirate dye
Bleeding, bile peritonitis, septic
Cholelithiasis and cholecystitis medical management
5 implementations
Dietary can have can’t have
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
Cholecystitis and lithis Pharmacological therapy what med What does How long Indicated
UDCA/CDCA- dissolve small stone decrease size
Not for pigmented stones or freq episodes
6-12 mo
Indicated pt refuse surgery - compliance
Non surgical removal
4 and what they do
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
Surgical management
When indicated
6 types why they do
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
