Gallbladder disease Flashcards
how does cholelithiasis develop?
balance of cholesterol, bile salts, calcium changes–biliary sludge
Cholecystitis is related to
acute/chronic
inflammation; can lead to pancreatitis; gallbladder is edematous & hyperemic (increased blood flow)
Manifestations
Pain: most common RUQ tachycardia diaphoresis prostration 3-6 hrs post high fat meal murphys sign (takin g a deep breath)
Inflammation
leukocytosis, fever
total obstruction mainfestations
dark amber urine clay-colored stools pruritis intolerance to fatty foods bleeding tendencies steatorrhea
how to diagnose
ultrasound
ERCP
Labs increased
WBC Serum bilirubin urinary bilirubin liver enzymes serum amylase (if pancreas is infected)
ERCP with spincterotomy
visualization of gallbladder
stones removed with basket
Post ERCP care
assess for complications vital signs/p! Bed rest NPO until return of gag reflex Sore throat; cannot drive for 12-18 hrs
ESWL
shock energy to break up stones; eventually passes into intestines
takes 1-2hrs
may have some bruising
Treatment of choice
laparoscopic cholecystectomy
laparoscopic cholecystectomy post op
get them up ASAP due to gas no heavy lifting gradually resume activités remove bandages day after surgery low fat diet
laparoscopic cholecystectomy patient comfort
referred pain to shoulder p! from CO2
Sims position
Deep breathing, ambulation, analgesia
clear liquids
discharge same day
Incisional (open) cholecystectomy post op care T tube insertion
adequate ventilation
prevent respiratory complications
maintain drainage tube
replace lost fluids and electrolytes
T tube treatment for meals
1 hr before meals/1 hr after meals
