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Gallbladder > Gallbladder > Flashcards

Gallbladder Flashcards

1
Q

What is cholecystitis?

A

With or without stones

Acute infection of the gallbladder = filled with purulent fluid

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2
Q

S/Sx of cholecystitis

A

Causes pain, tenderness, rigid RUQ, N/V

  • Very painful; the patient is usually in the fetal position and won’t let you touch their abdomen
    1. Could be silent in old people
    2. Fever
    3. Low BG
    4. High WBC
    5. Pain radiating to shoulder
    6. Pain that worsens after high fat meal
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3
Q

Types of cholecystitis

A
  1. Calculous (90%) = with stones

2. Acalculous = without stones

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4
Q

Calculous cholecystitis pathophysiology

A
  1. GB stone obstructs outflow of bile
  2. Bile remaining in GB initiates chemical reaction resulting in autolysis/edema
  3. Blood vessels are compressed in the GB
  4. Vascular supply is compromised
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5
Q

Potential Complications of calculous cholecystitis

A
  1. Gangrene/perforation of GB
  2. E. coli infection
  3. Bile peritonitis
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6
Q

Causes of acalculous cholecystitis

A
  1. Major surgery
  2. Trauma
  3. Burns
    * An alteration in F/E in visceral circulation leads to bile stasis which increases bile viscosity (sludgy bile)
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7
Q

What is cholelithiasis?

A
  1. Formed in GB from solid constituents of bile
  2. Vary in size, shape, and composition
  3. Uncommon in children
  4. Increased risk after the age of 40
  5. Affects 1 in 3 over the age of 75 (but they usually have silent cholelithiasis)
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8
Q

Types of cholelithiasis stones

A
  1. Pigmented

2. Cholesterol

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9
Q

Pigmented Gallstones

A
  1. 25% of cases
  2. Formed from unconjugated pigment
  3. Increased in cirrhosis, hemodialysis, infected biliary tree
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10
Q

Cholesterol Gallstones

A
  1. 75% of cases
  2. 4 times higher in women over 40
  3. The 4 F’s (fat, fertile, fair, forty)
  4. Increased incidence in DM, GI disease, increased age
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11
Q

S/Sx of gallbladder disease

A
  1. Pain/biliary colic
  2. Jaundice
  3. Change in urine and stool color
  4. Vitamin deficiency
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12
Q

Why would someone with gallbladder disease experience jaundice?

A

Due to increased bile absorbed in the blood excreted through the skin (can be itchy)

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13
Q

What is Murphy’s sign?

A

Pain on palpation to RUQ

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14
Q

S/Sx of pain/biliary colic

A
  1. GB distended
  2. GB infected
  3. Murphy’s sign
  4. A/N/V
  5. Pain after high fat meal
  6. Unable to fully inspire (because they keep their diaphragm as high as they can; risk for respiratory issues like atelectasis)
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15
Q

Why can’t we give morphine sulfate for pain/biliary colic?

A

Because it spasms the Sphincter of Oddi which will aggravate the GB

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16
Q

Why would a patient experience vitamin deficiencies with gallbladder disease?

A

Because obstruction of bile flow interferes with ADEK absorption = monitor PT for low vitamin K

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17
Q

Diagnostic Tests for Gallbladder

A
  1. Abdominal X-ray
  2. Ultrasonography or ultrasound
  3. Cholecystography or gallbladder series
  4. Radionuclide Imaging or Cholescintography
  5. Endoscopic Retrograde Cholangiopancreatography (ERCP)
  6. Percutaneous Transhepatic Cholangiography
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18
Q

Abdominal X-rays

A

Note gallstones but only 15-20% are calcified

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19
Q

Gold Standard of diagnostic gallbladder tests

A

Ultrasonograpy or ultrasound

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20
Q

Ultrasonography or ultrasound

A

Procedure of choice because it’s fat, accurate, and noninvasive

  1. NPO after midnight to distend GB
    * Visualize the stones = 95% accurate
21
Q

Radionuclide Imaging or Cholescintography

A

Radioactive agent given IV, then scan GB, biliary tree

  • Expensive and long procedure
  • Can’t visualize stones
  • Radiates the patient
22
Q

Cholecystography or gallbladder series

A
  1. Oral iodine contrast given 12 hours before xray = check for allergies
  2. NPO for 12 hours
  3. Xray RUQ = visualizes gallbladder and stones
23
Q

Endoscopic Retrograde Cholangiopancreatography (ERCP)

A
  1. NPO with sedation
  2. MD numbs the throat to decrease gag reflex
  3. Fiberoptic scope inserted into the esophagus, descends to the duodenum
  4. Uses fluoroscopy and xrays to detect stones
  5. Can remove stones once inside
  6. Maintain NPO until gag reflex returns
24
Q

Percutaneous Transhepatic Cholangiography

A
  1. NPO with sedation
  2. Inject dye into biliary tree
  3. Needle into gallbladder
  4. Withdraw bile
  5. Inject dye
  6. Xray
  7. Aspirate dye
    * Most diagnostic procedure
25
Q

Potential Complications of Percutaneous Transhepatic Cholangiography

A
  1. Bleeding
  2. Bile peritonitis
  3. Sepsis
26
Q

Medical Management of Cholecystitis

A
  1. Supportive and Dietary Management
  2. Pharmacologic Therapy
  3. Nonsurgical Removal of Stones
  4. Surgical Removal of Stones
27
Q

Supportive and Dietary Management of Cholecystitis

A
  1. 80% remission with rest, IVF, NG suction, analgesia, and antibiotics
  2. Delay surgery until acute s/sx subside
  3. Low fat liquid diet, powder supplement with high protein and high carbs, skim milk
  4. Add cooked fruits, lean meats, mashed potato, nongassy veggies, bread, coffee, and tea
  5. No egg, cream, pork, fried foods, cheese, rich dressing, or alcohol
28
Q

Pharmacologic Therapy for Cholecystitis

A

UDCA/CDCA dissolve small stones or decrease the size of the stones

  1. 6-12 months of treatment
  2. Does not work with pigmented stones
  3. No frequent episodes
  4. Usually given if patient refuses surgery
29
Q

Nonsurgical Removal of Gallstones

A
  1. MTBE solvent
  2. ERCP
  3. Extracorporeal Shock Wave Lithotripsy (ESWL)
  4. Intracorporeal Lithotripsy
30
Q

MTBE Solvent

A

Used to dissolve gallstones = not widely used

31
Q

ERCP removal of gallstones

A

Endoscope enlarges openings and ducts, allows stones to pass to duodenum for excretion, or grab with basket and extract

32
Q

Extracorporeal Shock Wave Lithotripsy

A

Shock waves dissolves the stones via waterbath or fluid filled bag

33
Q

Intracorporeal Lithotripsy

A

U/S laser through endoscope directly to gallstones, then stones removed with irrigation or aspiration; drain is placed after

34
Q

Pre-Op Surgical Removal of Gallstones

A
  1. CXR, ECG, LFT, GB XR
  2. NPO before
  3. If poor nutrition = IV glucose with protein
  4. NG with suction
  5. TCDB
35
Q

Laparoscopic Cholecystectomy

A

“Lap chole”; Surgery of Choice for Gallbladder Removal

  1. Umbilical incision to inflate abdomen and insert camera for visualization
  2. Small incisions made in abdomen where other surgical instruments are introduced
  3. General anesthesia
  4. Outpatient or home the next day
  5. GB removed
36
Q

Cholecystectomy

A
  1. Abdominal incision 3-5 inches
  2. CO2 in abdominal cavity
  3. GB removed
  4. Drain in place (Penrose/Davol) for drainage of blood and bile
  5. Replaced by the lap chole
37
Q

Minicholecystectomy

A
  1. Like the cholecystectomy but the incision is smaller (3-5 cm)
  2. GB removed
38
Q

Choledochostomy

A
  1. Incision into bile duct for stones
  2. Insert drainage tube
  3. Chole done at the same time
39
Q

Surgical Cholecystostomy

A
  1. For the fragile patient
  2. GB is opened
  3. Stones are removed
  4. Drain is placed
  5. Later the chole is done when the acute s/sx resolve
40
Q

Percutaneous Cholecystostomy

A
  1. For poor surgery/anesthesia risk patient
  2. Local anesthetic given
  3. Needle inserted with U/S or CT guide
  4. Bile aspirated
  5. Catheter inserted
    * Immediate relief
41
Q

Patient should expect what post-op gallbladder surgery?

A
  1. Intrabdominal complications
  2. Loss of appetite
  3. Vomiting
  4. Pain
  5. Abdominal distention
  6. Increased temperature
  7. Pain in R shoulder could be from CO2 inflation
42
Q

Post-Op care for gallbladder surgery

A
  1. Low Fowler
  2. IVF
  3. NG tube
  4. Water and fluids after 24 hours
  5. Soft diet after bowel sounds return
43
Q

Nursing Focus After Gallbladder Surgery

A
  1. Relieving Pain
  2. Protecting or Improving Respiratory Status
  3. Skin Care and Biliary Drainage
  4. Diet
44
Q

Relieving Pain Post Gallbladder Surgery

A
  1. Meperidine PRN
  2. TCDB = binder over incision
  3. Position on left side
  4. Ambulate
45
Q

Protecting or Improving Respiratory Status Post Gallbladder Surgery

A
  1. DB Q1h
  2. Incentive spirometer
  3. Increase in complications in elderly and obese
  4. Ambulate
46
Q

Skin Care and Biliary Drainage Post Gallbladder Surgery

A
  1. Drain with bag
  2. Penrose dressing change (sterile)
  3. Zinc oxide/skin protectant
  4. Observe site for infection/bile leakage
  5. Record output Q2h (should be 500 mL/day)
  6. Monitor stool color (should go from gray to brown)
  7. RUQ drain possibly
  8. Watch for skin excoriation
  9. T-tube DCd after 1-2 weeks
  10. Observe abdomen for peritonitis
  11. Never clamp tube unless ordered
47
Q

Diet Post Gallbladder Surgery

A
  1. Low fat
  2. High carb
  3. High protein
  4. Fat restriction lifted after 4-6 weeks
48
Q

Potential Complications of Gallbladder Surgery

A
  1. Bleeding - check VS, incision inspected

Gallbladder (1 decks)

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