Gallbladder Disease Flashcards
Cholecystitis: gallbladder inflammation (4)
- with or without obstruction (after major surgery, trauma, burns, cystic duct obstruction)
- gallstones 90% acute cases
- obstruction of bile flow leading to inflammation and compromised blood perfusion
- risk for gangrene and perforation (peritonitis)
Cholelithiasis: presence of calculi (3)
- pigment (bilirubin) stones
- cholesterol stones: precipitation cholesterol-saturated bile: 75% of US cases
- cholesterol-saturated bile: irritant producing inflammatory changes to gallbladder
Cholelithiasis: risk factors (4)
- increased age, obesity, frequent changes in weight, rapid weight loss
- female, oral contraceptives, bowel resection/bypass
- multiple pregnancies
- diabetes
Gallbladder disease: clinical manifestations (5)
- RUQ pain, and biliary colic (N/V, hours after heavy meal)
- fever, palpable abd mass
- rigid abdomen (peritonitis)
- referred pain to right shoulder or back
- changes in urine and stool color
Gallbladder disease with total common bile duct obstruction s/s (7)
- jaundice
- dark foaming urine
- clay-colored stools
- pruritus
- steatorrhea (floating fat)
- bleeding tendencies
- vitamin deficiencies: fat soluble (ADEK)
Gallbladder disease: assessment and diagnostic findings
- abdominal xray, US
- ERCP: endoscopic retrograde cholangiopancreatography
- MRCP: magnetic resonance cholangiopancreatography
gallbladder disease: collaborative management (3) (non surgical options, nutrition)
- non surgical option for patients who are not surgical candidates
- dissolution, instrumental removal, extracorporeal lithotripsy
- nutrition: high protein, low fat
gallbladder disease: collaborative management (surgical ) (3)
- ERCP with spincterectomy (monitor for post procedure risks- bleeding, perforation), cholecystectomy
- Lap cholecystectomy: no paralytic ileum, less abdominal pain, same day d/c, risk for bile duct injury –> bile leak
- open: if significant inflammation, necrosis
gallbladder disease: collaborative management (6) –> post surgical
- post surgical: high abdominal incision
- pain management (referred pain to shoulder)
- maintain respiratory function
- promote biliary drainage (if drainage tube), improve nutrition
- prevent and managing complications: bleeding, peritonitis (rigid abdomen, pain)
- patient teaching: IS, C&DB, nutrition
gallbladder disease: gero considerations (4)
- incidence of gallstones increases with age
- may not exhibit fever, chills, pain, jaundice
- symptoms may only present when septic shock (tachycardia, hypotension, ALOC, oliguria)
- higher risk for complications
Managing self care after laparoscopic cholecystectomy (managing pain)
- may be pain in right shoulder –> sitting upright in bed or chair, walking or using a heating pad
- take medications as needed
Managing self care after laparoscopic cholecystectomy (resuming activity)
- begin light exercise immediately
- take a shower or bath after 1-2 days
- drive a car after 3-4 days
- avoid lifting more than 5 lb
- resume sexual activity when desired
Managing self care after laparoscopic cholecystectomy (Caring for the wound)
- check site daily for infection
- wash with mild soap and water
- allow special adhesive strips to fall off (do not pull them off)
Managing self care after laparoscopic cholecystectomy (resuming eating)
- resume normal diet
- If pt had a fat intolerance before surgery, gradually add fat back into diet
Managing self care after laparoscopic cholecystectomy (managing follow up care)
- make appt with surgeon 7-10 days after surgery
- call surgeon if there are s/s infection at puncture site
- call surgeon if fever 100F for 2 days
- call surgeon if you develop N/V or add pain
