Gallbladder disease Flashcards
The following flashcards are going to be on gallbladder disease that is a recording posted on blackboard
there are two types of gallbladder disease, which are?
Cholelithiasis
Cholecystisis
what is cholelithiasis?
most common disorder of biliary system
- stones in the gallbladder
what is cholecystitis?
inflammation of gallbladder
- usually associated with gallstones
what are risk factors for those on gallbladder disease?
fertilize, 40 fat, female
what is the pathophysiology with cholelithiasis ( gallstones ) ?
stones develop when balance that keeps cholesterol, bile salts, calcium changes.
typically its the calcium in our body that will change and cause a disruption in our biliary system that ends up causing gallstones.
however this is not the only way, bile secreted by the liver can be supersaturated with ____(lithogenic) can cause it
cholesterol
just something to note so I dont get confused when reviewing my flashcards
you either have biliary issues due to a gallstone, so like the physical change in the calcium, cholesterol, or bile
but you can also have biliary sludge, from the accumulation of the bile in a certain area in the body that remains stationary cause it isn’t flowing properly and it becomes thick.
cholecystitis is an inflammation of the gallbladder that is often associated with ?
obstruction from stones or sludge
what is acalculous cholecystitis ?
no obstruction
- just inflammation of the gallbladder
typically patients who have acalculous cholecystitis, usually get this from what?
immobile, older adults, cancer, biliary statisis
what are clinical manifestations of these two conditions?
vary from none at all to severe
( colicky pain - it comes and goes )
steady, excruciating, tachycardia, diaphoresis, prostration, residual tenderness in RUQ
patients with gallstones typically have more severe pain when what is going on?(2)
the gallstones are moving
gallstones are obstructed
which quadrant typically are patients with gallstones going to feel the pain in ?
right upper quadrant
typically patients with these two conditions of the gallbladder will have pain that occurs from ___to___ after (2)
3-6 hours
after
high fat meal or lying down
she mentions how in patients who have pancreasitis, also experience the same excruciating pain when they lay down just like gallbladder diseases. however to help differentiate between the two conditions, what are we going to ask a patient if we think its an gallbladder issue?
do you get pain after eating a high-fat meal 3-6hours later?
if a total obstruction occurs what are some Clincal manifestions we will see?(5)
what color urine ?
what 2 stools ?
what are they feeling?
intolerance to what?
they are more likely to ?
dark amber urine
clay colored-steatorrhea
pruritus
intolerance to fatty foods
bleeding tendencies
remember the gallbladder is hidden within the liver in the right upper quadrant, however patients with gallbladder diseases, typically the pain can radiate up to where?
right shoulder, scapula
typically patients with gallstones, they are going to have severe inflammation due to the gallstones causing obstruction in the body, so we typically will see what in the CBC and on vital signs?
white blood cells
fever
if a patient develops peritonitis with gallstones, we will see the abdomen be what?
why are we worried about this ?
rigid(firm)
peritontisits, because of lack of blood flow reaching there
patients can have chronic cholecystitis, they have what 4 things?
fat intolenace
dyspepsia ( burping acid )
heart burn
flatulence
how do we diagnose these conditions ? (2)
ERCP
- endoscope into the small intestine, use contrast and see it, and remove the stones or dilate strictures
percutaneous transhepatic cholangiography
- needle passed into the liver and remove bile
what are the labs going to present ? (4)
increase WBC
increase Bilirubin
increase liver enzymes
increase serum amylase
why are we going to see that dark amber color urine in patients with gallbladder disease?
because of the increase in urinary bilirubin levels from their lab work
how do we treat cholelithiasis ?
typically treatment depends on the stage of disease
we can use medication to dissolve gallstones
we can just surgical remove the gallbladder
and or we can do ERCP with spincterotomy and just remove the stones
we can also use extracorporeal shock-wave lithotripsy (ESWL)
which is just high energy shock will disintegrate the stones
shaking it until its small enough to pass
with cholecystitis, how are we going to help treat? (3)
antibiotic treatment
choleycstotomy
anticholinergics
why do we give antibiotic treatment to help aid with cholecystitis?
why do we do a cholecystotomy?
why do we give anticholinergics ?
possible infection causing inflammation
to just remove the problem all at once and then give opioids after to help with pain
to help decrease gi secretions since we dont know the direct cause, but it can help aid the inflammation
what are the 2 types of surgeries for gallbladder disease?
laparoscopic cholecystectomy
open(incisional) cholecystectomy
what is laparoscopic cholecystectomy ?
BETTER TREATMENT^
removal of the gallbladder through 1 to 4 puncture holes
what is open(incisional) cholecystectomy?
removal of the gallbladder through right subcostal incision
we can also do something called transhepatic biliary catheter, which is what?
typically we only do this under what 2 conditions?
a catheter that is inserted through the skin to help drain out all the extra bile out in the drainage bag
if the patient has cancer, so taking the gallbladder out isn’t going to change their outcome
or
if the patient has so much swelling and inflammation of bile before surgery, so its a much safer and easier surgery to perform after the drainage of fluid
what are our 2 main concerns when it comes to having patients with transhepatic biliary catheter?
fluid and electrolyte
- remember we are draining out all this fluid from them
skin care
- it is another catheter that is inserted through the skin, so we must be mindful of inflammation, infection, redness, and irritation
gallbladder disease is super painful, what are some medications we are going to give? (2)
morphine (analgesics)
atropine ( anticholinergic )
we also need to be worried about vitamin deficiency in these patients with gallbladder disease, so what might we give them? (4)
A,D,E,K
remember these patients are going to feel a lot of itching, so what medication might we give them ?
how do we give it?
cholestyramine
it comes as a powder, and you mix it with milk or juice
cholestyramine is the medication of choice to help aid patients with gallbladder disease for their pruirtus, but we have to be mindful for side effects so what are some that we should look out for or education our patient on?
nausea/vomiting
diarrhea
constipation
skin reactions
cholestyramine is famous for having drug on drug interaction, so we have to do what to prevent this ?
2 hours before
or 4 hours after
any other medication the patient may be on
what is going to be nutritional therapy for these patients with gallbladder disease? (4)
small, frequent meals
high in fiber
reduce calories
low fat
nursing assessment notes
Subjective data
Assess for risk factors
Ask about family history
Assess for medications that increase risk
Previous abdominal surgeries
Assess for clinical manifestations
Objective data
Fever
Restlessness
Jaundice, icteric sclera
Diaphoresis
Tachypnea
Splinting
Tachycardia
Palpable gallbladder
Abdominal guarding and distention
Abnormal labs or studies
nursing diagnosis notes
Acute pain
Knowledge deficit
nursing health promotion
Screen for predisposing factors
Teaching for at-risk ethnic groups
Early detection of chronic cholecystitis
Manage with low-fat diet
pain management notes
Give drugs as needed before pain becomes severe
Observe for side effects
Comfort measures
Clean bed
Positioning
Oral care
nausea and vomiting
NG tube, gastric decompression
Oral hygiene, care of nares
Accurate intake and output
Maintaining suction
Antiemetics
nursing implementation
pruritus relief notes
Pruritus relief measures
Antihistamines
Baking soda or Alpha Keri baths
Lotions
Soft linen
Control of temperature
Short, clean nails
Scratch with knuckles rather than nails
nursing implementation : complications notes
Acute care
Monitor for complications
Obstruction
Bleeding
Infection
Post-ERCP care
Assessment for complications
Vital signs, pain
Bed rest
NPO until return of gag reflex
Patient teaching
postoperative care
Laparoscopic cholecystectomy
Monitor for complications
Patient comfort
Referred pain to shoulder pain from CO2
Sims’ position (left side, right knee flexed)
Deep breathing, ambulation, analgesia
Clear liquids
Discharged same day
after a surgery of the removal of gallbladder, we put them in a sims position which is?
left side, right knee flexed
notes
Postoperative care
Incisional cholecystectomy
Maintain adequate ventilation
Prevent respiratory complications
General postoperative nursing care
Maintain drainage tubes (T-tube, Penrose tube, or Jackson-Pratt tube), if present
Replace lost fluids and electrolytes
Ambulatory care
Laparoscopic cholecystectomy
Remove bandages day after surgery and then can shower
Report signs of infection
Gradually resume activities
Return to work in 1 week
May need low-fat diet for several weeks
Ambulatory care
Open-incision cholecystectomy
No heavy lifting for 4 to 6 weeks
Usual activities when feeling ready
May need low-fat diet for 4 to 6 weeks
Expected outcomes
Appear comfortable and has pain relief
State knowledge of activity level and dietary restrictions
in the study guide prep thing
we need to understand pre and post up from the surgery
just remember laparoscopic cholecystectomy
- minimal
- 1-4 holes
- can go back to work within a week
- few complications
- sims position
- clear liquids day 1 then normal
- low fat 1 week
open
- removal with 8inch incision
- t use can be used
- drainage tubes
- prevent repsiraoty complications due to needing 8 days of resting
- no heavy lift for 4-6 weeks
- low fat 4-6 weeks
