gallbladder d/o and dysfunction

Question 1

what issues are common in gallbladder problems?

Answer 1

motility disturbances, biliary sludge, and biliary stasis (not moving)

Question 2

what is cholelithiasis?

Answer 2

presence of gallstones in gallbladder

Question 3

what is cholecystitis?

Answer 3

gallbladder inflammation, obstruction, infection caused from biliary sludge or biliary colic

Question 4

what is choledocholithiasis?

Answer 4

gallstones occluding the common bile duct

Question 5

what are the risk factors for gallbladder dysfunction?

Answer 5

1. age > 40 y/o
2. female, estrogen level, multiparous
3. low calorie diets
4. fatty, high cholesterol foods
5. obesity, sedentary lifestyle
6. disturbances in metabolism

Question 6

what kind of disturbances in metabolism will cause a gallbladder dysfunction?

Answer 6

1. diabetics

2. pregnant, multiparous, menopausal, or using birth control pills

Question 7

what are the clinical manifestations of acute cholecystitis?

Answer 7

1. RUQ pain- guarding, radiating occurring after a meal
2. fever
3. N/V
4. anorexia
5. jaundice may occur

Question 8

what is murphy’s sign seen in acute cholecystitis?

Answer 8

press down under right side of rib cage, ask the patient to take a deep breath. when pt takes the deep breath it forces gallbladder into HCP’s hand causing the patient pain. this would be a positive sign

Question 9

rupturing of the gallbladder does what?

Answer 9

relieves pain!!

Question 10

when may acute acalculous cholecystitis occur? (AAC)

Answer 10

complication that may occur due to other various medical or surgical complications such as:

1. prolonged immobility or fasting
2. TPN
3. Diabetes

Question 11

what are the clinical manifestations of chronic cholecystitis?

Answer 11

1. chronic inflammation
2. calculi
3. fibrosis or thickening of gallbladder

Question 12

what are the complications for cholecystitis?

Answer 12

1. choledocholithiasis
2. gangrenous gallbladder
3. pancreatitis

Question 13

where is the gallbladder pain usually located?

Answer 13

RUQ and right shoulder

Question 14

what labs will be done to diagnose cholecystitis?

Answer 14

1. wbc
2. erythrocyte sedimentation rate (ESR)
3. c- reactive protein (CRP)
4. liver functions test: ALT, AST, bilirubin, alk phos

Question 15

what radiological diagnostic testing will be done to diagnose cholecystitis?

Answer 15

1. abd CT, MRI, X-ray, ultrasound
2. hepatobiliary imilodiacetic acid (HIDA scan, aka cholecystogram)
3. endoscopic retrograde cholangiopancreatography (ERCP)

Question 16

what are the acute care admission treatments for cholecystitis?

Answer 16

1. NPO/ possible NGT for bowel and pancreas rest
2. iv fluids
3. meds: ATBs, antiemetics, PPIs, Questran, oral meds to dissolve gallstones
4. pain meds: dilaudid recommended (morphine, codeine can cause spasms)

Question 17

what procedures will be done to treat cholecystitis?

Answer 17

1. ERCP
2. extracorporeal shockware lithotripsy (ESWL)
3. t-tube,
4. intraoperative cholangiography
5. direct cholelitholysis therapy

Question 18

what surgical procedures will be done to treat cholecystits? where may the patient have pain? why?

Answer 18

1. open vs laparoscopic removal of the gallbladder

2. post-op lap chole may have referred pain due to the CO2 used during surgery

Question 19

what are some discharge teachings for a patient with cholecystitis?

Answer 19

1. may need dietary changes initially, with small meals and decreased fat
2. short term activity restrictions
3. may shower in 1-2 days