Gallbladder diseases Flashcards
Gallbladder
- pear shaped muscular sac
- stores bile from liver and concentrates it
- essential for emulsification (breakdown) of fats
- powerful antioxidant
Bile
- bitter, yellow fluid
- bile salts
- cholesterol
- calcium
- acids
- produces gallstones
- liver manufactures 1.1.5 quarts a day
Cholelithiasis
gallstone formation
Cholecystitis
inflammation of the gallbladder of cystic duct
Obstruction
caused by gallstones
Gallstones
- solid crystalline precipitates
- major component is cholesterol
- some are from calcium salts
- sand-like
- usually form in gallbladder or bile duct
- can cause life threatening infection of liver, bile duct and pancreas
What causes gallstones?
- stasis/stagnation of bile
- incomplete emptying of the GB
- pure cholesterol stones
Incomplete emptying of the GB
- bile coagulates and clumps together
- imbalance of cholesterol and bile salts
Pure Cholesterol Stones
- white diet: sugar, white bread, pasta, pastries
- soda and lots of meat
- not enough veges
Cholecystitis
inflammation of the gallbladder and/or cystic duct
acute versus chronic
Etiology of Cholecystitis
- gallstones usually
- bacterial infection
- tumor of pancreas or liver
- decreased blood supply to gallbladder
- gallbladder sludge
Symptoms of Cholecystitis
- may be asymptomatic
- attack lasts 2-3 days
- intense, sudden pain RUQ
- pain, may radiate up to right shoulder
- recurrent attacks several hours after meals
- N/V/indigestion
- rigid abdominal muscles or bloating
- slight fever/chills/leukocytes
- loose, light colored stools
Complications of Cholecystitis
- abscess
- pancreatitis
- biliary cirrhosis
- fistulas
- rupture of the gallbladder
- inflammation of biliary ducts
- bile peritonitis
- empyema
Gallstone formation
- bile stagnation
- solid crystalline
- changes in chemical composition
- decrease bile flow
- immobility
- pregnancy
- inflammation
- obstructive lesions
Symptoms of Cholelithiasis
- may be silent cholelithiasis
- dependent upon if stone are stationary or mobile
- biliary colic
if obstruction is present…
- amber (tea) colored urine
- clay colored stools
- jaundice
- pruritus
- steatorrhea
- bleeding tendencies
steatorrhea
the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine.
Biliary Colic
- severe steady pain due to spasm
- accompanied by tachycardia, diaphoresis and prostration
- pain may last as long as 1 hour with residual RUQ tenderness
- occurs 3-6 hours after heavy meal
Complications of Cholelithiasis
- inflammation of biliary ducts
- biliary cirrhosis
- carcinoma
- obstruction
- peritonitis
Cholecystogram
- gall bladder series
- oral contrast, pills
- abdominal xrays
Cholangiogram
- IV contrast
- series of xrays
ERCP
Endoscopic Retrograde Cholangio Pancreatography
- use of endoscope
- injection of dye
- series of xrays
CT Scan
- with or without contrast
- 2 dimensional image
LFTs
Looks for obstruction
-direct and indirect bilirubin
Serum enzymes
may be elevated
AST, alkaline phosphastase
CBC
elevated WBC
Serum Amylase
pancreas involvment
Prothrombin Time
prolonged clotting due to lack of vitamin K absorption
Medications
- antibiotics
- correct/maintain balance
- pain control
Narcotics
- dilaudid, morphine
- can increase biliary colic
Antispasmotics
-anticholinergics (Atropine)
Antiemetrics
Phenergan, Zofran
Give fat soluble vitamins…
for chronic GB disease
-any type of obstruction
Urso
(Ursodiol)
- naturally occurring bile acid
- small quantities in humans
- large quantities in BEARS
- Action: replace/displace toxic bile acids, cytoprotection of injured bile duct epithelial cells, assists to shrink gall stones
Lithotripsy
(ESWL)
- extracorporeal shock wave lithotripsy
- pulverizes stones
- passes into duodenum
- passed in stool
Laproscopic Cholesystecomy
- less invasive
- 3 to 4 small incisions
- same day surgery (90 percent) or overnight
- return to normal ADL’s in 2-3 days
Incisional/open CHOLEYCYCTECTOMY
- invasive with skin incision
- hospital stay 4-7 days
- may require T-tube insertion
T-tube
- used if common bile duct is explored
- used pre-op for biliary obstruction
- attached to closed drainage system
Open Choleycyctectomy
- bleeding
- common duct injury
- infection
Post op:
- monitor bleeding/complications
- difficulty breathing
- pain control
- monitor I and Os, NG drainage
- IV therapy
The primary substance in bile
bile salts
