Hepatic System: Cholelithiasis and Bile Duct Issues Flashcards
(46 cards)
1
Q
What is Cholelithiasis?
A
• The presence of gallstones in the gallbladder
2
Q
What is Choledocholithiasis?
A
• The presence of at least one gallstone in the common bile duct
3
Q
What is Cholangitis?
A
• Redness, inflammation of the bile duct system
4
Q
What is Cholecystitis?
A
• Redness, inflammation of the gallbladder
5
Q
What is a Cholecystectomy?
A
• Removal of the gallbladder
6
Q
What causes gallstones to form?
A
- Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts.
- They may also form if the gallbladder does not empty completely or often enough
7
Q
What are the 5 F’s that are risk factors for gallstones?
A
- Fair
- Fat
- Forty
- Fertile
- Female
8
Q
Why is fertility a factor in gallstone formation?
A
• Increased estrogen is thought to increase cholesterol levels in bile and decrease gallbladder contraction
9
Q
What are the clinical manifestations of cholelithiasis?
A
- 30 mins after eating there will be complaints of
- Pain in the URQ
- Fullness, abdominal distension, may occur after fatty meal
- N/V
- Leukocytosis
- Sometimes fever
- Pain in the URQ
10
Q
When would acute s/s occur and what are they?
A
- They would occur with inflammation, obstruction or infection of the biliary organs.
- S/S
- Fever
- Palpable abdominal mass
- Severe URQ pain that radiates back or to the right shoulder
- N/V
11
Q
What is biliary colic?
A
- Biliary colic is a common presentation of a stone in the cystic duct or common bile duct of the biliary tree.
- Colic refers to the type of pain that “comes and goes,” typically after eating a large, fatty meal which causes contraction of the gallbladder.
- However, the pain is usually constant and not colicky.
12
Q
When do biliary colic episodes of severe pain with N/V usually occur?
A
- Several hours after a heavy meal
13
Q
What are two diagnostic tests for cholelithiasis?
A
- CT scan
- Murphy’s sign
14
Q
Explain Murphy’s Sign.
A
- Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area.
- If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive
15
Q
What are two drugs used to dissolve small gallstones?
A
- Ursodiol (on the drug list!)
- Chenodiol
16
Q
What is the cause of Cholangitis?
A
- Choledocholithias
17
Q
What is Charcot’s triad?
A
- Charcot’s triad is the manifestation of biliary obstruction with upper abdominal pain, fever and jaundice.
18
Q
What can Charcot’s triad advance to?
A
- Raynaud’s pentad
19
Q
What are the s/s of Raynaud’s pentad
A
- Same as Charcot’s triad with the addition of confusion and hypotension
20
Q
What is the treatment for Cholangitis?
A
- Correction of coagulopathy (obstruction)
- Restore fluid and electrolyte balance
- Abx
- Biliary drainage w/ Endoscopic Retrograde Cholangiopancreatography (ERCP)
21
Q
What is an Endoscopic Sphincterotomy?
A
- A procedure that cuts the sphincter between the common bile duct and pancreatic duct.
- This procedure uses a catheter and wire to remove gallstones or any other blockages
22
Q
What is an ERCP?
A
- ERCP combines X-rays and an endoscopic procedure to help doctors diagnose and treat gallstones and other bile or pancreatic duct problems
23
Q
Explain an ERCP with sphincterotomy procedure.
A
- Pass endoscope through mouth, esophagus, stomach and into the duodenum
- Pass into the sphincter of Oddi to access pancreatic and bile ducts
- Remove stones or stent narrow ducts
24
Q
If stones cannot be removed via endoscope, what is another procedure that may be used, and how does it work?
A
- Extracorporeal shock-wave lithotripsy (ESWL)
- In conjunction with bile acids, It will disintegrate gallstones with high-energy shock waves
- Process takes about 1-2hrs
25
Pain in the right shoulder could be referred pain from…
* Liver
* Duodenal ulcer
26
Pain in the back left shoulder could be referred pain from…
* The pancreas
27
Lower back pain can be indicative of what conditions?
* Pancreatitis
* Renal issues
28
Cholecystitis pain can be triggered by what type of meal?
* High fat or
* High volume meal
29
Rebound tenderness is also called…
* Blumberg’s sign
30
Why does cholecystitis result in jaundice and clay-colored stool?
* If the bile ducts are blocked, bile will not enter the digestive tract (clay-colored stool) and bilirubin will back up into the blood stream (jaundice)
31
What is steatorrhea?
* The excretion of fat with the feces owing to reduced absorption of fat by the intestine
32
What digestive enzyme breaks down fat and what organ produces it?
* Lipase
* Pancreas
33
What is a cholecystectomy?
* Removal of the gall bladder
34
What is the suggested post cholecystectomy diet?
* Soft, bland foods are easiest to digest:
* bananas, white rice, boiled potatoes, plain pasta, dry toast, and crackers.
* Gradually, the diet can advance add more flavorful foods.
* Your body will have problems digesting fat right after surgery
35
Why is it important to have the pt ambulate after surgery?
* Ambulation stimulates circulation which can help stop the development of stroke-causing blood clots.
* Walking improves blood flow which aids in quicker wound healing.
* The gastrointestinal, genitourinary, pulmonary and urinary tract functions are all improved by walking.
36
What action indicates proper bowel function after surgery?
* Flatulence
37
What is a Cholecystostomy tube?
* It is a tube that is inserted through the abdominal wall into the gallbladder, and serves as a drain to an inflamed gallbladder in patients with acute cholecystitis
38
What is a “T-tube”?
* A draining tube placed in the common bile duct after Common Bile Duct (CBD) post gallbladder removal.
* It provides external drainage of bile into a controlled route allowing time for the healing process
39
What type of suction is attached to a T-tube in the bile duct?
* Jackson-Pratt
40
What color should the drainage form a T-tube be?
* Yellow-green (bile colored), anything else needs to be investigated.
41
How is pain controlled post cholecystectomy?
* NSAIDs
* Morphine
42
Why would anticholinergics be used post cholecystectomy?
* To slow bowel activity and help the healing process
43
Why is atropine used post cholecystectomy?
* Bradycardia is a known problem in laparoscopic cholecystectomy especially during gall bladder dissection
* Atropine increases the heart rate and improves the atrioventricular conduction by blocking the parasympathetic influences on the heart
44
What fat-soluble vitamins should be taken post cholecystectomy and why?
* Vitamins A, D, E, K
* Gallbladder removal results in lower absorption rates of these vitamins
45
What mineral absorption may be reduced by cholecystectomy?
* Magnesium
* Iron
* Calcium
46
What do bile salts do?
* If the gallbladder is still present, bile salts help to promote gallbladder and liver function by reducing inflammation of the bile ducts and help normalize blood flow.
* They help dissolve gallstones
* They also help relieve gas and bloating that can be caused by gallbladder problems
