UNIT 8 Cholecystitis and Cholelithiasis CHAPTER 54 Flashcards
What is Cholecytitis?
Cholecystitis: Inflammation of
gallbladder
Can Cholecytitis be Acalculous or Calculouous?
Two types of acute cholecystitis can occur: calculous and acalculous cholecystitis. The most common type is calculous cholecystitis, in which chemical irritation and inflammation result from gallstones, or calculi (cholelithiasis), that obstruct the cystic duct (most often), gallbladder neck, or common bile duct (choledocholithiasis)
Is it true that one of the findings of Cholecytitis is fever?
A. Yes
B. No
A. Yes
Sx:
Fever
RUQ pain
N/V
Dyspepsia
Flatulence
Rebound tenderness
Murphy’s Sign (Inspiratory arrest with palpation of RUQ)
Jaundice
* Jaundice, clay-colored stools, dark urine
* Steatorrhea- FATTY STOOLS(most common with chronic cholecystitis)
Is acalculus more common than calculous cholecystitis?
A. Yes
B. No
B. No
Most common – Calculous cholecystitis (95% of the time
Calculous cholecystitis
Cholecystitis: Results from stone in the cystic duct, bile
can’t flow out. Bile stasis triggers release of enzymes that cause inflammation in the gallbladder.
A patient with Cholecytitis has currently been prescribed 4 diagnostic test , which of the following results is un common with a pt with Cholecytitis?
A. 45 AST
B. PLT count 170,00
C. 170 ALK
D. 15,000 WBC
B. PLT count 170,00
Where would a patient normally report pain when they have Cholecytitis
A.LUQ
B. RUQ
C. LLQ
D. RLQ
B. RUQ
What are some Risk Factors for Cholecytitis?
Women of all ages (risk of calculus increases with age)
* American Indian, Mexican American, or Caucasian
* Obesity
* Rapid weight loss or prolonged fasting; low-fat diet
* Increased serum cholesterol and lipids
* Women on hormone replacement therapy
- Cholesterol-lowering drugs
- Family history of gallstones
*Prolonged total parenteral nutrition - Crohn’s disease
- Gastric bypass surgery
- Sickle cell disease
- Glucose intolerance/diabetes mellitus type 2
- Genetic Factor
- Pregnancy
What would be the first sign of gallbladder disease in an elderly patient?
A. nausea and vomiting
B. Confusion
C. WBC 15,000
D. 101.8 temperature
B. Confusion
Older adults and patients with diabetes mellitus may have atypical symptoms of cholecystitis, including the absence of pain and fever. Localized tenderness may be the only presenting sign. The older patient may become acutely confused (delirium) as the first symptom of gallbladder disease.
Treatment for Cholecytitis
Ursodeoxycholic Acid—Dissolves tiny
gallstones
ERCP: Endoscopic Retrograde Cholangiopancreatography
ERCP: Endoscopic Retrograde Cholangiopancreatography
When the cause of cholecystitis or cholelithiasis is not known or the patient has symptoms of biliary obstruction (e.g., jaundice), an endoscopic retrograde cholangiopancreatography (ERCP) may be performed.
Procedure for Endoscopic Retrograde Cholangiopancreatography
Usually done d/t obstruction at
level of CBD
Looks like endoscope for EGD,
goes to second part of
duodenum, additional tool gets
to ampulla of vater and CBD.
Dye injected into biliary tract.
Stone retrieved. Elective lap
choley may follow.
Complication: Acute
pancreatitis; dye injected into
pancreatic duct
Post Op. Nursing Interventions for Endoscopic Retrograde Cholangiopancreatography
PROCEDURE PATIENT EDUCATION and
NURSING CARE
NPO > 6 hours
No blood thinners
Local anesthetic to numb
throat: Make sure gag reflex
returned before offering
food/fluids
Sedation: Someone must drive
patient home
Bloating/gas expected after,
but not pain, N/V, or fever!!
PROCEDURE PATIENT EDUCATION and
NURSING CARE
How is an ERCP performed?
During an ERCP, the doctor uses a special narrow, flexible tube (endoscope) that has a video camera. While the pt is sedated, the tube is placed through the pt’s mouth into the upper digestive system. Contrast dye with X-rays allow the doctor to see stones, abnormal narrowing or blockages in the ducts.
What is Cholethiasis?
Stones in the Gallbladder
Is it common for a patient with Cholethiasis to have a fever?
A. No
B. Yes
A. No
