GALL BLADDER

Question 1

CHOLELITHIASIS

Answer 1

• STONES (CALCULI) WITHIN THE GALLBLADDER OR BILIARY DUCT SYSTEM
• BILIARY DUCT SYSTEM INCLUDES THE COMMON BILE DUCT OR CYSTIC DUCT
• STONES ARE USUALLY MADE UP OF BILE PIGMENTS OR CHOLESTEROL
• ACCUMULATION OF STONES MAY LEAD TO INFLAMMATION OF THE GALLBLADDER

Question 2

CHOLECYSTITIS

Answer 2

*INFLAMMATION OF THE GALLBLADDER
*ETIOLOGY
STONES
BACTERIAL INFECTION
OBESITY & RAPID WT. LOSS
HYPERLIPIDEMIA
FAMILY HISTORY
PREGNANCY (GALLBLADDER PUSHED UP
STONES BUILD UP-HAVE BABY AND
GALLBLADDER GOES DOWN-RUSH OF
STONES GET RELEASE) PAIN

Question 3

CLINICAL MANIFESTATIONS OF CHOLECYSTITIS

Answer 3

*RUQ PAIN RADIATES TO RIGHT SHOULDER & SCAPULA
*FEVER AND ELEVATED WBC COUNG
*INTOLERANCE FOR FATTY FOODS (3-4 HRS AFTER EATING-GALLBLADDER ATTACK)
*BILIARY COLIC (GAS, CRAMPING PAIN, SHARP
SQUEEZING KIND OF PAIN

Question 4

COMPLICATIONS OF CHOLECYSTITIS

Answer 4

• SUBPHRENIC ABSCESS
• PANCREATITIS
• BILIARY CIRRHOSIS (GALLBLADDER NOT GETTING RID OF STONES OR BILIARY BLOCKED-ENLARGED LIVER (CIRRHOSIS)
• PERITONITIS FROM RUPTURE OF GALLBLADDER
• BILE DUCT OBSTRUCTION

Question 5

CLINICAL MANIFESTATIONS OF BILE DUCT OBSTRUCTION

Answer 5

• OBSTRUCTIVE JAUNTICE
• INTOLERANCE TO FATTY FOODS
• DARK AMBER URINE
• CLAY COLORED STOOLS & STEATORRHEA
• PRUITIS
• BLEEDING TENDENCIES

Question 6

DIAGNOSTIC STUDIES FOR DISORDER OF THE GALLBLADDER

Answer 6

• ULTRASOUND (BEST NON INVASIVE STUDY
• ABDOMINAL XRAY - LIMITED VALUE
• ORAL CHOLECYSTOGRAM - DETECTS RADIOPAQUE STONES (DYE)
• IV CHOLANGIOGRAMS - DETECTS STONES BILIARY DUCT SYSTEM
• HIDA SCAN - NUCLEAR STUDY (DYE) 3-4 HRS TO TAKE TEST

Question 7

LABORATORY TESTS FOR DISORDERS OF THE GALLBLADDER

Answer 7

• COMPLETE BLOOD COUNT - ELEVATED WBC
• SERUM AMALYSE & LIPASE TO MEASURE PRESENCE OF PANCREATITIS
• SERUM BILIRUBIN LEVELS - DIRECT OR INDIRECT
• SERUM ELECTROLYTES - CHEMSCREEN
• LFT’S
• CARDIAC ENZYMES (GALLBLADDER SYMPTOMS MIMIC CARDIAC SYMPTOMS)

Question 8

PHARMACOLOGICAL MANAGMENT FOR ACUTE CHOLELLITHIASIS/CHOLYCYSTITIS

Answer 8

• ANALGESICS TO CONTROL PAIN-DEMEROL DRUG OF CHOICE
• ANTICHOLINERGICS/ANTISPASMODICS - BENTYL
• ANTI EMETICS - COMPAZINE
• CHOLESTEROL SOLVENTS TO DISSOLVE STONES (BILE SALTS WILL EMULCIFY FAT)
• FAT-SOLUBLE VITAMINS, A, D, E, K
• QUESTRAN FOR RELIEF OF PURITIS
• ANTIBIOTICS (FOR SECONDARY INFECTION)

Question 9

THERAPUTIC/CONSERVATIVE MANAGEMENT FOR CHOLYCYSTITIS

Answer 9

*NPO W/NG TUBE
*IV FLUID THERAPY
*NUTRITIONAL MANAGEMENT (LINE OF FIRST DEFENSE)
LOW FAT DIET
WEIGHT REDUCTION FOR TH OBESE

Question 10

NON SURGICAL MANAGEMENT FOR CHOLELITHIASIS

Answer 10

• ERCP - REMOVAL OF STONES FROM BILIARY TREE WITH STENT PLACEMENT
• ESWL - HIGH ENERGY SHOCK WAVES TO DISINTERGRATE STONES

Question 11

SURGICAL MANAGEMENT FOR GALLBLADDER

Answer 11

• CHOLECYSTECTOMY - REMOVAL OF THE GALLBLADDER
• LAPAROSCOPIC CHOLECYSTECTOMY
• T-TUBE - TRANSHEPATIC BILIARY CATHETER (COLLECTS BILE FROM LIVER-ON OUTSIDE OF BODY-BEING USED LESS AND LESS)
• OBESE PATIENTS CANNOT GET ERCP, ESWL OR LAPAROSCOPIC- TOO MUCH ADIPOSE TISSUE

Question 12

POST OP NURSING CARE OF THE CLIENT WITH A T-TUBE

Answer 12

• INSERTED INTO THE CBD & CONNECTED TO CLOSED GRAVITY DRAINAGE
• DRAINAGE IS BLOOD TINGED INITIALLY THAN GREENISH-BROWN
• MAY DRAIN 500 ML IN FIRST 24 HOURS
• DRAINAGE DECREASES TO 200 IN 2-3 DAYS
• KEEP CLIENT FOWLER’S POSITION TO PROMOTE GRAVITY DRAINAGE
• WHEN DRAINAGE SUBSIDES & STOOLS RETURN TO NORMAL; CLAMP T-TUBE FOR 1-2 HOURS BEFORE AND AFTER MEALS (PATIENT DOESN’T NEED CLAMP

Question 13

POST OP NURSING INTERVENTIONS

Answer 13

• MONITOR VS INCLUDING THE TEMP & ABDOMINAL PAIN SCALE
• MONITOR FOR BLEEDING-DECREASED PROTHROMIBIN TIME
• GOOD SKIN CARE AROUND INCISION SITE/DRAINS
• LEFT SIMS POSITION, RIGHT LEG FLEXED TO REDUCE GAS POCKETS CAUSED BY CO2 IRRITATION OF PHRENIC NERVE (HICCUP)
• DEEP BREATHING & COUGHING
• NARCOTIC ANALGESICS FOR PAIN (PERCOCET)
• ASSESS FOR RETURN OF BOWEL SOUNDS (SHOULD RETURN NO LATER THAN 48 HRS, SHOULD HEAR WITHING 408 HOURS)
• CLEAR LIQUID- LOW FAT 6 WEEKS -REGULAR DIET
• AFTER REMOVAL OF GALLBLADDER AND 6 WEEK LOW FAT DIET, PATIENT CAN EAT NORMALLY
• ALL POST OP PATIENTS NEED TO BE ON THEIR LEFT SIMS POSITION, RIGHT LEG FLEXED

Question 14

POST OP COMPLICATIONS FOLLOWING A CHOLECYSTECTOMY WITH T-TUBE

Answer 14

• PULMONARY ATELECTASIS, PNEUMONIA
• PULMONARY EMBOLI; THROMBOPHLEBITIS
• WOUND DEHISCENCE; INFECTION
• PARALYTIC ILEUS: PERITONITIS
• PAIN

Question 15

HOME CARE MANAGEMENT AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Answer 15

• REMOVE BANDAGE DAY AFTER SURGERY
• CAN BATHE OR SHOWER NEXT DAY
• REPORT S&S OF BILE COLORED DRAINAGE, REDNESS, SWELLING OR PUS
• REPORT SEVERE ABDOMINAL PAIN, FEVER, N/V
• AVOID HEAVY LIFTING 4-6 WEEKS
• MAY RETURN TO WORK IN 1 WEEK

Question 16

HOME CARE MANAGEMENT W/A T-TUBE PLACEMENT

Answer 16

• WEAR LOOSE FITTING CLOTHES
• REMOVE DRESSING AROUND T-TUBE; CLEANSE SKIN AROUND TUBE; REPLACE DRESSING
• EMPTY DRAINAGE BAG SAME TIME EVERY DAY
• MONITOR AMT, COLOR, ODOR OF DRAINAGE: REPORT ABDOMINAL PAIN, FEVER, VOMITING TO MD
• CLAMP TUBE 1-2 HRS BEFORE & AFTER MEALS
• OBSERVE FOR RETURN OF BROWN COLORED STOOLS IN 7-10 DAYS

Question 17

NURSING DIAGNOSIS FOR DISORDERS OF THE GALLBLADDER

Answer 17

• PAIN
• RISK FOR IMPAIRED GAS EXCHANGE
• RISK FOR INFECTION
• ALTERED NUTRITION LESS THAN BODY REQUIREMENTS
• RISK FOR FLUID VOLUME DEFICIT
• IMPAIRED SKIN INTEGRITY