Gallbladder Flashcards
Cholelithiasis
stones in the gallbladder from impaired metabolism of cholesterol, bilirubin, and bile acids
Types of cholelithiasis
Cholesterol, pigmented, mixed stones
Cholelithiasis patho
Crystals saturate with bile and sit and form stones
Risk factors for cholelithiasis
Obese, female, middle ages (around 40), oral contraceptives, rapid wt loss, indigenous Americans or white people, genetic predisposition, pancreatic/lipase disease
What are CM for cholelithiasis based on?
Severity and location of the obstruction
When will cholelithiasis be asymptomatic
If stones are just in the gallbadder
CM of cholelithiasis
Epigastric and RUQ pain, intolerance to fatty foods, heartburn, flatulence, epigastric discomfort, biliary colic, jaundice, dark amber urine that foams when shaken, clay colored stool, steatorrhea, pruritis, bleeding
Why does cholelithiasis cause epigastric pain
when stones are lodged in the cystic duct or common bile duct
Why does cholelithiasis cause intolerance to fatty foods and cabbage?
no bile in small intestine to help with digestion
When does biliary colic occur after eating fatty meals
30 minutes to several hours after eating fatty meals
Why does cholelithiasis cause jaundice
When stones are lodged in the bile duct so bile can’t flow into the duodenum
Why does cholelithiasis cause dark amber urine
Conjugated bilirubin builds up into the blood and solube bile seeps into the urine
Why does cholelithiasis cause clay colored stools
bilirubin can’t reach the small intestine to convert into urobilogen which is what usually gives stool its brown color
Steatorrhea
Occurs when there are no bile salts in the duodenum to prevent fat digestion
Why does cholelithiasis cause pruritis
bile salts deposit in the skin
Why does cholelithiasis cause bleeding
there is decreased absorption of vitamin K when bile is not present
Cholecystitis
acute or chronic inflammation and distention of the gallbladder
What is often the cause of cholecystitis
Gallstones are lodged in the cystic duct
Is pain with cholecystitis common?
Yes, pain is similar to that of biliary colic and cholelithiasis
Complications of distention of the wall of the gallbladder
decrease BF, ischemia, necrosis, perforation
Sx of cholecystitis
Abdominal distention, fever, leukocytosis, guarding, rebound tenderness, inc alk phos and bilirubin
What is the biggest risk with cholecystitis
Pressure on the distended wall of the gallbladder
Which sx are different between cholelithiasis and cholecystitis
Cystitis has fever, leukocytosis, guarding, and rebound tenderness and lithiasis doesn’t
What can cholecystitis lead to
scarring
What is often the tx for cholecystitis
Removal
Drug pharm for cholecystitis
- Ketorolac (NSAIDs) or opioids
- antiemetic for n/v
- anticholinergics
- bile acids
Bile acids for cholecystitis
dissolve stones; often used if pt can’t have surgery
How do anticholinergics help with cholecystitis
they dec gallbladder secretions and stop spasms that might lodge more stones in the ducts
