Gallbladder Probs Flashcards
cholelithiasis
Stones in the gallbladder
Abnormal accumulation of bile salts/cholesterol
Etiology of cholelithiasis
Unknown
risk factors of cholelithiasis
Women
Age >40 yrs
High estrogen levels
Lifestyle– obesity/sedentary
diet – high cholesterol, fat, low fiber
Family history
Where does bile come from?
Liver
where is bile stored?
gallbladder
bile function
helps digest lipids and transport waste products
bile components
Bilirubin
Cholesterol
Bile salts
Water
Protein
Calcium
what gives bile it’s dark brown color?
Bilirubin
pathogenesis of cholelithiasis
Bile stasis
Super saturated with cholesterol
Precipitation
Formation of gall stones
describe the movement of cholelithiasis
Can remain in gallbladder or migrate through ducts
what are possible results of cholelithiasis?
Pain
Obstruction
Cholecystitis
can cholelithiasis be asymptomatic?
Yes, sometimes silent
s/sx cholelithias
Severity depends on movement, obstruction
Biliary colic
Stones have moved into biliary tree
Steady, severe pain – one hour
RUQ- play radiate to right shoulder
Tachycardia, diaphoresis, epigastric pain
When does the pain occur in biliary colic?
3-6 hours after fatty meal
obstructed bile flow – cause of jaundice
bile cannot flow into duodenum
What does dark amber urine that foams when shaken occur from with obstructed bile flow?
Soluble bilirubin in urine
if bilirubin doesn’t reach the small intestine to become urobilinogen, what occurs?
Clay colored stools
what is steatorrhea?
Fatty stool
how does steatorrhea occur?
No bile salts in duodenum, preventing fat digestion
deposits of bile salts into skin tissue causes what?
Pruritus
why do people develop and tolerance to fatty foods?
No bile in small intestine to help with fat digestion
Cholecystitis most common cause
Obstruction of gall stones, or biliary sludge
cholecystitis
Inflammation of the gallbladder
what are other causes of cholecystitis?
Prolonged immobility/fasting – NPO
Bacterial infection
Parenteral nutrition – TPN
Diabetes
Pathogenesis of cholecystitis
obstruction – inflammation
Gallbladder becomes edematous, hyperemic, distended
what can happen overtime with cholecystitis?
Scarring and decreased function
May need to remove gallbladder, if severe
s/sx of cholecystitis
Colic pain – right shoulder
Systemic: fever, N/V, restless, diaphoresis
what labs are involved in identifying cholecystitis?
Bilirubin– increased
liver enzymes – increased
WBC – increased
Amylase – increased
Some peritoneal involvement from infection
what does amylase have to do with cholecystitis?
Pancreatic enzyme that leads to bile duct
If bile duct is blocked, pancreas is at risk
pharm therapy for pain control
Analgesic – ketorolac
Morphine, Hydromorephone, if not controlled
pharm therapy for N/V
Anti-emetics
pharm therapy for decreased gallbladder, secretion and stop smooth muscle spasms
Anti-cholinergics
pharm therapy to dissolve stones
bile acids
Rarely used
what makes patients with cholelithiasis at risk for bleeding
vitamin K can’t be absorbed
bile is needed in aid to absorb vitamin K which the liver needs for clotting factors
