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NURS 3512 - Class 1-6 > Week 6 - Cholelithiasis/Cholecystitis > Flashcards

Week 6 - Cholelithiasis/Cholecystitis Flashcards

1
Q

what is cholelithiasis

A
  • stones in the gallbladder
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2
Q

what is cholecystitis

A
  • inflammation of the gall bladder
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3
Q

cholecystitis is usually associated w?

A
  • cholelithiasis –> obstruction caused by gallstones or biliary sludge
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4
Q

what factors can increase the risk of gallbladder disease? (5)

A
  • female
  • oral contra
  • sedentary lifestyle
  • familial tendency
  • obesity
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5
Q

what are 3 types of gallstones

A
  • cholesterol
  • black pigment
  • brown pigment
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6
Q

where can the stones be located in cholelithiasis?

A
  • can remain in the gallbladder

- or can migrate to cystic or common bile duct

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7
Q

what happens as gallstones move thru the ducts

A
  • pain
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8
Q

what can gallstones lead to

A

obstruction

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9
Q

what is the function of the gallbladder

A
  • stores bile created by the liver

- releases the bile into the duodenom via the common bile duct, to help emulsify fats

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10
Q

what ducts play a role in the transport of bile and how (3)

A
  • common hepatic duct = drain bile from liver to gallbladder
  • cystic duct = connects the gallbladder to common bile duct
  • common bile duct = carries bile from the liver and the gallbladder through the pancreas and into the duodenum
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11
Q

if a gallstone blocks the cystic duct, what happens?

A
  • bile can continue to flow into the duodenom directly from the liver
  • however, it cannot escape the gall bladder= stasis of bile = cholecystitis
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12
Q

what happens if gallstones block the common bile duct

A

= no bile to duodenom

= severe

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13
Q

describe symptoms of gallstones, what determines them?

A
  • range from severe to no symptoms

- severity depends on if they are stationary or mobile, and if there is obstruction

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14
Q

when gallstones are lodged in ducts or moving through the ducts, which symptoms does this cause

A
  • causes spasms –> gallbladder spasms in response to the stone
    = spasms causes severe pain called biliary colic
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15
Q

describe biliary colic (3)

A
  • severe pain in R upper quad
  • rarely colicky, usually steady
  • can be excruciating
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16
Q

biliary colic can be accompanied by? (3)

A
  • tachycardia
  • diaphoresis
  • prostration
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17
Q

describe how long biliary colic typically lasts and when it usually occurs

A
  • can last up to an hour, tenderness present when subsides

- frequently occur 3-6 hr after a high-fat meal or when pt lies down

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18
Q

what gallstones cause obstruction, what will the pts urine look like (3)

A
  • dark amber
  • foams when shaken
  • no urobilinogen in urine (not reaching sm. intestine to be converted)
19
Q

when gallstones cause obstruction, what will the pts bowel movements look like (2)

A
  • steartorrhea

- clay-colored

20
Q

list other symptoms gallstones cause when they cause obstruction (4)

A
  • obstructive jaundice
  • pruritis (deposition of bile salts in skin)
  • intolerance of fatty foods
  • bleeding tendencies (no bile = cant absorb vitamin k)
21
Q

what are signs on intolerance to fatty foods (3)

A
  • nausea
  • sensation of fullness
  • anorexia
22
Q

what are signs of cholecystitis (7)

A
  • pain & tenderness to RUQ
  • indigestion
  • NV
  • restlessness
  • diaphoresis
  • inflammation symptoms
  • abdominal rigidity
23
Q

pain in cholecystitis can radiate to? (2)

A
  • right shoulder

- scapula

24
Q

what manifestations of inflammation may be present in cholecystits (2)

A
  • leukocytosis

- fever

25
Q

what are some complications of cholecystitis (6)

A
  • subphrenic abscess
  • acute pancreatitis
  • cholangitis (inflammation of bile ducts)
  • biliary cirrhosis
  • fistulas
  • rupture of gallbladder –> bile peritonitis
26
Q

what are some complications of cholelithiasis (5

A

similar to cholecystitis

  • cholangitis
  • biliary cirrhosis
  • carcinoma
  • peritonitis
  • choledocholithiasis (stone in common bile duct) = obstruction
27
Q

what can be used to diagnose cholelithiasis (5)

A
  • US
  • ERCP
  • labs
  • WBC (increased d/t inflammation)
  • direct and indirect bilirubin (increased)
28
Q

what is ERCP

A

Endoscopic retrograde cholangiopancreatography

29
Q

what does ERCP allow visualization of (5)

A
  • gallbladder
  • cystic duct
  • common hepatic duct
  • common bile duct
  • can also take bile samples
30
Q

what labs can indicate gallbladder stones (2)

A
  • liver enzymes (AST and ALT)

- amylase (if pancrease involved)

31
Q

what are the goals of treatment for gallbladder disease (3)

A
  • relief pain & discomfort
  • no postop comp
  • no recurrent attacks of cholelithiasis or cholecystitis
32
Q

during an acute episode of cholecytitis, what are the care goals (7)

A
  • pain control
  • prevent infection w ab
  • maintain fluid & electrolytes
  • NG tube if NV severe or for gastric decompression ( to prevent further gallbladder stimulation)
  • control NV
  • NPO in acute phase
33
Q

why are anticholinergics used for gallstones

A
  • decrease secretion

- counteract sm. muscle spasms

34
Q

treatment of gallstones depend on

A
  • stage of disease
35
Q

what are 3 treatment options for gallstones

A
  • bile acids
  • nonsurgical
  • surgical option
36
Q

what are 2 nonsurgical approaches for stone removal

A
  • ERCP with sphincterotomy

- extracorporeal shock-wave lithotripsy

37
Q

what is ERCP with sphincterotomy

A
  • type of treatment done w ERCP

- involves cutting the muscle that surrounds the opening of the ducts, or the papilla = enlarged opening

38
Q

what is extracorporeal shock-wave lithotripsy

A

uses high-energy sound waves to produce shock waves. The shock waves are strong enough to fracture and disintegrate the gallstones.

39
Q

describe the use of bile acids to dissolve stones

A
  • oral

- help dissolve stones but gallstones may recur

40
Q

what are 2 surgical options for cholelithiasis

A
  • laparoscopic cholecystectomy (most common)

- open cholecystectomy (when lap not possible)

41
Q

what is a laparoscopic cholecystectomy

A
  • minimally invasive surgery to remove the gallbladder
42
Q

what drug therapy is used for gallstones (6)

A
  • bile salts
  • anticholinergics
  • antiemetics
  • fat sol vitamins
  • pain meds
  • antibiotics to prevent infection
43
Q

describe nutritional therapy for gallstones/cholecystitis on discharge (5)

A
  • low sat fat
  • high fiber
  • high calcium
  • reduced cal if obese
  • small, freq meals

remember NPO in acute phase

44
Q

describe nursing care for gall stones/cystitis (4)

A
  • monitor for obstruction (possible NG)
  • NPO (rest gallbladder)
  • I&O
  • monitor urinary bilirubin (increase = bile flow obstruction

NURS 3512 - Class 1-6 (47 decks)

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