Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medical Surgical GI Exam 3 > Gallbladder Disease > Flashcards

Gallbladder Disease Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

What are the 2 common types?

A

Cholelithiasis

Cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Cholelithiasis

A

Most common disorder of biliary system

Stones in the gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Cholecystitis

A
  • Inflammation of the gallbladder
  • Usually associated with cholelithiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes Cholelithiasis

A
  • Cause of gallstones unknown
  • Develops when balance that keeps cholesterol, bile salts, and calcium in solution is altered, leading to precipitation
  • Bile secreted by liver supersaturated with cholesterol (lithogenic)
  • Stasis of bile → supersaturation and changes in composition of bile (biliary sludge)
  • Immobility, pregnancy, and inflammatory or obstructive lesions of biliary system ↓ bile flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of pain

A
  • Stones may remain in gallbladder or may migrate to cystic or common bile duct
  • Cause pain as they pass through ducts
  • May lodge in ducts and produce an obstructio•Stones may remain in gallbladder or may migrate to cystic or common bile duct
  • Cause pain as they pass through ducts
  • May lodge in ducts and produce an obstructionn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes Cholecystitis

A

•Most commonly associated with obstruction from stones or sludge

•Acalculous cholecystitis: Inflammation without stones. Could be critically ill pts, TPN, DM, Ecoli

  • Older adults and critically ill
  • Prolonged immobility, fasting, parenteral nutrition, diabetes
  • Bacteria or chemical irritants
  • Adhesions, neoplasms, anesthesia, opioids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cholecystitis where is the inflammation Inflammation

A
  • Confined to mucous lining or entire wall
  • Gallbladder is edematous and hyperemic-increased blood supply
  • May be distended with bile or pus
  • Cystic duct may become occluded
  • Scarring and fibrosis after attack
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical manifestations

A
  • Vary from severe to none at all
  • Pain more severe when stones moving or obstructing
  • Steady, excruciating
  • Tachycardia, diaphoresis, prostration: extremely weak
  • May be referred to shoulder/scapula
  • Residual tenderness in RUQ
  • Occur 3–6 hours after high-fat meal or when patient lies down
  • Inflammation
  • Leukocytosis
  • Fever
  • Physical examination findings
  • RUQ tenderness (Murphy’s sign)
  • Abdominal rigidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cinical manifestations of Chronic cholecystitis

A
  • Fat intolerance
  • Light-colored stools- no bile due to liver obstructed
  • Dyspepsia
  • Heartburn
  • Flatulence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Symptoms of total obstruction

A

Jaundice: Lack of bile in blood
Dark amber urine-increased water soluble bilirubin
Clay-colored stools
Pruritus- itching due to bile salts in our skin tissue
Intolerance of fatty foods
Bleeding tendencies: Issues with absorption of Vitamin K= decreased production of prothrombin
Steatorrhea- Oily and foul odor in stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnostic Studies

A
  • Ultrasonography
  • Endoscopic Retrograde Cholangio-pancreatography (ERCP): Involves cystic and liver fatty duct and common bile duct. Allows us to look at those structures and do biopsies
  • Percutaneous transhepatic cholangiography- insertion of needle int•Ultrasonography
  • Endoscopic Retrograde Cholangio-pancreatography (ERCP): Involves cystic and liver fatty duct and common bile duct. Allows us to look at those structures and do biopsies
  • Percutaneous transhepatic cholangiography- insertion of needle into gallbladder injects dye into ito gallbladder injects dye into it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Laboratory Tests

A

↑ WBC count
↑ Serum bilirubin level
↑ Urinary bilirubin level
↑ Liver enzyme levels
↑ Serum amylase level: Pancrease is involved. Secondary pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment

A
  • Treatment dependent on stage of disease
  • Oral dissolution therapy
  • Ursodeozycholic acid (ursodiol [Actigall])
  • Chenodeozycholic acid (chenodiol)
  • ERCP with sphincterotomy
  • Visualization
  • Dilation
  • Placement of stents
  • Open the sphincter of Oddi, if needed
  • Endoscope passed to duodenum
  • Stones removed with basket or allowed to pass in stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Collaborative Care

A
  • Pain control
  • NSAIDs
  • Anticholinergics
  • Control infection
  • Antibiotic treatment
  • Cholecystectostomy
  • Maintenance of F&E balance
  • NG tube if severe nausea/vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Surgical Therapy

A

Laparoscopic cholecystectomy
Treatment of choice
Removal of gallbladder through one to four puncture holes
Minimal postoperative pain
Resume normal activities, including work, within 1 week
Few complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The surgical treatment of choice for the patient with symptomatic gallbladder disease is a

A

Laparoscopic cholecystectomy

17
Q

Transhepatic Biliary Catheter

A
  • Preoperative or palliative: when endoscopic drainage fails
  • Inserted percutaneously and attached to drainage bag
  • Skin care important
  • Patient may be discharged home with catheter in place: Need home health to assist or good family dynamics
18
Q

Drug therapy

A
  • Most common
  • Analgesics
  • Morphine
  • NSAIDs
  • Anticholinergics
  • Atropine
  • Fat-soluble vitamins (A, D, E, K)
  • Bile salts to facilitate digestion and vitamin absorption
19
Q

Cholestyramine (Questran) what is it given for and how?

A

may be given for pruritus
Given in powdered form, mixed with milk or juice
Monitor for side effects (nausea/vomiting, diarrhea or constipation, skin reactions)

20
Q

Nutritional therapy

A

•Small, frequent meals with some fat

•Diet low in saturated fat

  • High in fiber and calcium
  • Reduced-calorie diet if patient is obese
  • Avoidance of rapid weight loss
21
Q

Nutritional therapy after laparoscopic cholecystectomy

A
  • Liquids first day
  • Light meals for several days
22
Q

Nutritional therapy after incisional cholecystectomy

A

•Liquids to regular diet after return of bowel sounds

•May need to restrict fats for 4–6 weeks

23
Q

Nursing Assessment

A
  • Abnormal diagnostic findings
  • ↑ Serum liver enzymes
  • ↑ Alkaline phosphatase
  • ↑ Bilirubin
  • Absence of urobilinogen in urine
  • ↑ Urinary bilirubin
  • Leukocytosis
  • Abnormal gallbladder ultrasound findings
24
Q

Nursing Management:
Planning over all goals

A

•Relief of pain and discomfort: PCA- Monitor how many times they use. Sign off with next nurse on how many doses are left: Make sure you check their elimination pattern, continuous pulse ox, educate patient to use before pain is severe

  • No complications postoperatively
  • No recurrent attacks of cholecystitis or cholelithiasis
25
Q

•Acute interventions

A
  • Monitor for complications
  • Obstruction
  • Bleeding

Infection

26
Q

•Postoperative care

A
  • Laparoscopic cholecystectomy
  • Monitor for complications
  • Patient comfort

•Referred pain to shoulder from CO2

•Sims’ position

•Deep breathing, ambulation, analgesia

  • Clear liquids
  • Discharged same day if uncomplicated
27
Q
  • Immediate Postoperative care
  • Incisional cholecystectomy
A
  • Maintain adequate ventilation
  • Prevent respiratory complications
  • General postoperative nursing care
  • Maintain drainage tubes (T-tube, Penrose tube, or Jackson-Pratt tube), if present
28
Q

Ambulatory and home care Dietary teaching

A

•Low-fat diet

  • Weight reduction if needed
  • Fat-soluble vitamin supplements
  • Teach what to report

Follow-up care

29
Q

Nursing Management:
Nursing Implementation

Ambulatory and home care

Laparoscopic cholecystectomy

A
  • Remove bandages the 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
30
Q

Nursing Management:
Nursing Implementation

Ambulatory and home care

Open-incision cholecystectomy

A
  • Discharged in 2–3 days
  • No heavy lifting for 4–6 weeks
  • Usual activities when feeling ready
  • May need low-fat diet for 4–6 weeks
31
Q

Expected Outcomes

A
  • Appear comfortable and verbalize pain relief
  • Verbalize knowledge of activity level and dietary restrictions
32
Q
A

Medical Surgical GI Exam 3 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions