Gallbladder Probs

Question 1

cholelithiasis

Answer 1

Stones in the gallbladder
Abnormal accumulation of bile salts/cholesterol

Question 2

Etiology of cholelithiasis

Answer 2

Unknown

Question 3

risk factors of cholelithiasis

Answer 3

Women
Age >40 yrs
High estrogen levels
Lifestyle– obesity/sedentary
diet – high cholesterol, fat, low fiber
Family history

Question 4

Where does bile come from?

Answer 4

Liver

Question 5

where is bile stored?

Answer 5

gallbladder

Question 6

bile function

Answer 6

helps digest lipids and transport waste products

Question 7

bile components

Answer 7

Bilirubin
Cholesterol
Bile salts
Water
Protein
Calcium

Question 8

what gives bile it’s dark brown color?

Answer 8

Bilirubin

Question 9

pathogenesis of cholelithiasis

Answer 9

Bile stasis
Super saturated with cholesterol
Precipitation
Formation of gall stones

Question 10

describe the movement of cholelithiasis

Answer 10

Can remain in gallbladder or migrate through ducts

Question 11

what are possible results of cholelithiasis?

Answer 11

Pain
Obstruction
Cholecystitis

Question 12

can cholelithiasis be asymptomatic?

Answer 12

Yes, sometimes silent

Question 13

s/sx cholelithias

Answer 13

Severity depends on movement, obstruction

Question 14

Biliary colic

Answer 14

Stones have moved into biliary tree

Steady, severe pain – one hour
RUQ- play radiate to right shoulder
Tachycardia, diaphoresis, epigastric pain

Question 15

When does the pain occur in biliary colic?

Answer 15

3-6 hours after fatty meal

Question 16

obstructed bile flow – cause of jaundice

Answer 16

bile cannot flow into duodenum

Question 17

What does dark amber urine that foams when shaken occur from with obstructed bile flow?

Answer 17

Soluble bilirubin in urine

Question 18

if bilirubin doesn’t reach the small intestine to become urobilinogen, what occurs?

Answer 18

Clay colored stools

Question 19

what is steatorrhea?

Answer 19

Fatty stool

Question 20

how does steatorrhea occur?

Answer 20

No bile salts in duodenum, preventing fat digestion

Question 21

deposits of bile salts into skin tissue causes what?

Answer 21

Pruritus

Question 22

why do people develop and tolerance to fatty foods?

Answer 22

No bile in small intestine to help with fat digestion

Question 23

Cholecystitis most common cause

Answer 23

Obstruction of gall stones, or biliary sludge

Question 24

cholecystitis

Answer 24

Inflammation of the gallbladder

Question 25

what are other causes of cholecystitis?

Answer 25

Prolonged immobility/fasting – NPO
Bacterial infection
Parenteral nutrition – TPN
Diabetes

Question 26

Pathogenesis of cholecystitis

Answer 26

obstruction – inflammation
Gallbladder becomes edematous, hyperemic, distended

Question 27

what can happen overtime with cholecystitis?

Answer 27

Scarring and decreased function
May need to remove gallbladder, if severe

Question 28

s/sx of cholecystitis

Answer 28

Colic pain – right shoulder
Systemic: fever, N/V, restless, diaphoresis

Question 29

what labs are involved in identifying cholecystitis?

Answer 29

Bilirubin– increased
liver enzymes – increased
WBC – increased
Amylase – increased

Some peritoneal involvement from infection

Question 30

what does amylase have to do with cholecystitis?

Answer 30

Pancreatic enzyme that leads to bile duct

If bile duct is blocked, pancreas is at risk

Question 31

pharm therapy for pain control

Answer 31

Analgesic – ketorolac
Morphine, Hydromorephone, if not controlled

Question 32

pharm therapy for N/V

Answer 32

Anti-emetics

Question 33

pharm therapy for decreased gallbladder, secretion and stop smooth muscle spasms

Answer 33

Anti-cholinergics

Question 34

pharm therapy to dissolve stones

Answer 34

bile acids
Rarely used

Question 35

what makes patients with cholelithiasis at risk for bleeding

Answer 35

vitamin K can’t be absorbed

bile is needed in aid to absorb vitamin K which the liver needs for clotting factors