part 6

Question 1

What labs might be seen when a pt has gallbladder disease?

Answer 1

increased WBC 
increased serum bilirubin level 
increased urinary Bilirubin level 
increased liver enzyme levels 
increased serum amylase level ( if pancreatic involvement)

Question 2

How do we treat cholelithiasis?

Answer 2

• oral dissolution therapy (gallstones may reoccur)
• surgical cholecystectomy (laparoscopic)
• stent placement
• push the stone to duodenum to pass through poo

Question 3

What is ESWL?
Why is it used?
What is it used in conjunction with?

Answer 3

• extracorporeal shock-wave lithotripsy (ESWL) high energy shock waves
• used if stones can’t be removed via endoscope
• takes 1-2 hours
• used in conjunction with bile acids

Question 4

What does the nursing management look like during an acute episode of cholecystitis?

Answer 4

• antibiotic

- NG tube for severe N/V

Question 5

What is a cholecystostomy and what is the nursing management of it?

Answer 5

• drains material from the obstructed gallbladder
• give opioids for pain
• anticholinergics to decrease GI secretions

Question 6

What is the treatment of choice for removal of the gallbladder and why?

Answer 6

laparoscopic cholecystectomy

• removal through one of 4 puncture holes
• minimal pain
• resume normal activities within a week
• few complications
• same day or day after discharge

Question 7

What is an open (incisional) cholecysectomy?

Answer 7

• removal of gallbladder and T-tube inserted into common bile duct
• no heavy lifting and low fat diet for 4-6 weeks after

Question 8

What dietary teaching do we need to do for a pt with gallbladder surgery?

Answer 8

• low fat
• weight reduction
• fat soluble vitamins (A,D,E,K)

Question 9

What things should a pt report if they have had gallbladder surgery?

Answer 9

things that indicate obstruction:

• stool and urine changes
• jaundice
• pruritus
• follow-ups

Question 10

erosion of GI mucosa resulting from digestive action of HCL acid and pepsin

Answer 10

PUD peptic ulcer disease

Question 11

What are the types of PUD?

Answer 11

• acute: superficial, short duration
• chronic: long duration or intermittent, muscular wall erosion
• gastric or duodenal

Question 12

What causes PUD?

Answer 12

• H. pylori
• stress related mucosal disease
• lifestyle: alcohol, coffee, smoking, stress/depression
• meds: NSAIDs, SSRIs, corticosteroids, anticoagulants