Hepatic System: Cholelithiasis and Bile Duct Issues Flashcards
What is Cholelithiasis?
• The presence of gallstones in the gallbladder
What is Choledocholithiasis?
• The presence of at least one gallstone in the common bile duct
What is Cholangitis?
• Redness, inflammation of the bile duct system
What is Cholecystitis?
• Redness, inflammation of the gallbladder
What is a Cholecystectomy?
• Removal of the gallbladder
What causes gallstones to form?
- 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
What are the 5 F’s that are risk factors for gallstones?
- Fair
- Fat
- Forty
- Fertile
- Female
Why is fertility a factor in gallstone formation?
• Increased estrogen is thought to increase cholesterol levels in bile and decrease gallbladder contraction
What are the clinical manifestations of cholelithiasis?
- 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
When would acute s/s occur and what are they?
- 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
What is biliary colic?
- 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.
When do biliary colic episodes of severe pain with N/V usually occur?
- Several hours after a heavy meal
What are two diagnostic tests for cholelithiasis?
- CT scan
- Murphy’s sign
Explain Murphy’s Sign.
- 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
What are two drugs used to dissolve small gallstones?
- Ursodiol (on the drug list!)
- Chenodiol
What is the cause of Cholangitis?
- Choledocholithias
What is Charcot’s triad?
- Charcot’s triad is the manifestation of biliary obstruction with upper abdominal pain, fever and jaundice.
What can Charcot’s triad advance to?
- Raynaud’s pentad
What are the s/s of Raynaud’s pentad
- Same as Charcot’s triad with the addition of confusion and hypotension
What is the treatment for Cholangitis?
- Correction of coagulopathy (obstruction)
- Restore fluid and electrolyte balance
- Abx
- Biliary drainage w/ Endoscopic Retrograde Cholangiopancreatography (ERCP)
What is an Endoscopic Sphincterotomy?
- 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
What is an ERCP?
- ERCP combines X-rays and an endoscopic procedure to help doctors diagnose and treat gallstones and other bile or pancreatic duct problems
Explain an ERCP with sphincterotomy procedure.
- 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
If stones cannot be removed via endoscope, what is another procedure that may be used, and how does it work?
- Extracorporeal shock-wave lithotripsy (ESWL)
- In conjunction with bile acids, It will disintegrate gallstones with high-energy shock waves
- Process takes about 1-2hrs
Pain in the right shoulder could be referred pain from…
- Liver
- Duodenal ulcer
Pain in the back left shoulder could be referred pain from…
- The pancreas
Lower back pain can be indicative of what conditions?
- Pancreatitis
- Renal issues
Cholecystitis pain can be triggered by what type of meal?
- High fat or
- High volume meal
Rebound tenderness is also called…
- Blumberg’s sign
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)
What is steatorrhea?
- The excretion of fat with the feces owing to reduced absorption of fat by the intestine
What digestive enzyme breaks down fat and what organ produces it?
- Lipase
- Pancreas
What is a cholecystectomy?
- Removal of the gall bladder
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
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.
What action indicates proper bowel function after surgery?
- Flatulence
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
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
What type of suction is attached to a T-tube in the bile duct?
- Jackson-Pratt
What color should the drainage form a T-tube be?
- Yellow-green (bile colored), anything else needs to be investigated.
How is pain controlled post cholecystectomy?
- NSAIDs
- Morphine
Why would anticholinergics be used post cholecystectomy?
- To slow bowel activity and help the healing process
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
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
What mineral absorption may be reduced by cholecystectomy?
- Magnesium
- Iron
- Calcium
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
