Topic 8: Cholelithiasis & Cholecystitis

Question 1

Cholelithiasis

Answer 1

stones on the gallbladder

Question 2

Cholecystitis

Answer 2

inflammation of the gallbladder

Question 3

cholecystitis is more common in

Answer 3

women over 40 years of age and women who are oral contraceptives, obesity in women

Question 4

s/s when stones are lodged/moving in ducts

Answer 4

Severe, steady pain (biliary colic)
· Tachycardia
· Diaphoresis
· Prostration
· When pain subsides, residual tenderness in RUQ

Question 5

pain with cholecystitis occurs 3-6 hours after…

Answer 5

a high fat meal or when the patient lies down

Question 6

Clinical Manifestations of Cholecystitis

Answer 6

· Indigestion to severe pain
· Fever
· Chills
· Jaundice
· Acute pain and tenderness in the RUQ that may be referred to the right shoulder and scapula

Question 7

where is the pain in Cholecystitis

Answer 7

in the RUQ that may be referred to the right shoulder and scapula

Question 8

Clinical Manifestations of Common Bile Duct Obstruction

Answer 8

Dark Amber to Brown urine because the bilirubin will not reach the small intestine and then the kidneys cannot excrete it

Question 9

Diagnostic Assessment of Cholecystitis

Answer 9

· Ultrasound to diagnose gallstones
· ERCP
· Percutaneous transhepatic cholangiography
· Liver function tests
· WBC count
Serum bilirubin

Question 10

Conservative Therapy (for acute episode of Cholecystitis)

Answer 10

· IV fluid
· NPO with NG tube (gastric decompression), later progressing to low-fat diet
· Observe for signs of obstruction of the ducts by stones
· Antiemetics
· Analgesics
· Fat soluble vitamins (A, D, E, K)
· Anticholinergics (antispasmodics)
· Antibiotics
· Transhepatic biliary catheter
· ERCP with sphincterotomy (papillotomy)

Question 11

s/s of obstruction of ducts by stones

Answer 11

o Jaundice, clay-colored stools, dark foamy urine, steatorrhea. fever, increase WBC

Question 11

what uses high-energy shockwaves to disintegrate stones

Answer 11

· Extracorporeal shock-wave lithotripsy

Question 12

Ursodeoxycholic acid is used for

Answer 12

dissolving gallstones

Question 13

surgical options for cholecystitis

Answer 13

· Laparoscopic cholecystectomy
· Incisional (open) cholecystectomy

Question 14

post op care for cholecystectomy

Answer 14

o Monitor for complications such as bleeding
o Patients may report referred pain to the shoulder
o Please patient in Sims position (on left side with right knee flexed) to help move the gas pocket from the diaphragm
o Encourage deep breathing along with movement and ambulation
o After an incisional cholecystectomy tell a patient to avoid heavy lifting for 4-6 weeks

Question 15

nutritional therapy for cholecystitis

Answer 15

· Smaller more frequent meals with some fat at each meal. To promote gallbladder emptying (usually diet is low in fat)
· Low in saturated fats (butter, shortening, lard)
· High in fiber and calcium
· Rapid weight loss should be avoided because it can promote gallstone formation

Question 16

After laparoscopic cholecystectomy nutrition therapy

Answer 16

teach patient to have liquids for the rest of the day and eat light meals for a few days

Question 17

After incisional cholecystectomy nutrition therapy

Answer 17

can progress from liquids to regular diet once normal bowel sounds have returned