Week 6 - Cholelithiasis/Cholecystitis Flashcards
what is cholelithiasis
- stones in the gallbladder
what is cholecystitis
- inflammation of the gall bladder
cholecystitis is usually associated w?
- cholelithiasis –> obstruction caused by gallstones or biliary sludge
what factors can increase the risk of gallbladder disease? (5)
- female
- oral contra
- sedentary lifestyle
- familial tendency
- obesity
what are 3 types of gallstones
- cholesterol
- black pigment
- brown pigment
where can the stones be located in cholelithiasis?
- can remain in the gallbladder
- or can migrate to cystic or common bile duct
what happens as gallstones move thru the ducts
- pain
what can gallstones lead to
obstruction
what is the function of the gallbladder
- stores bile created by the liver
- releases the bile into the duodenom via the common bile duct, to help emulsify fats
what ducts play a role in the transport of bile and how (3)
- 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
if a gallstone blocks the cystic duct, what happens?
- bile can continue to flow into the duodenom directly from the liver
- however, it cannot escape the gall bladder= stasis of bile = cholecystitis
what happens if gallstones block the common bile duct
= no bile to duodenom
= severe
describe symptoms of gallstones, what determines them?
- range from severe to no symptoms
- severity depends on if they are stationary or mobile, and if there is obstruction
when gallstones are lodged in ducts or moving through the ducts, which symptoms does this cause
- causes spasms –> gallbladder spasms in response to the stone
= spasms causes severe pain called biliary colic
describe biliary colic (3)
- severe pain in R upper quad
- rarely colicky, usually steady
- can be excruciating
biliary colic can be accompanied by? (3)
- tachycardia
- diaphoresis
- prostration
describe how long biliary colic typically lasts and when it usually occurs
- 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
what gallstones cause obstruction, what will the pts urine look like (3)
- dark amber
- foams when shaken
- no urobilinogen in urine (not reaching sm. intestine to be converted)
when gallstones cause obstruction, what will the pts bowel movements look like (2)
- steartorrhea
- clay-colored
list other symptoms gallstones cause when they cause obstruction (4)
- obstructive jaundice
- pruritis (deposition of bile salts in skin)
- intolerance of fatty foods
- bleeding tendencies (no bile = cant absorb vitamin k)
what are signs on intolerance to fatty foods (3)
- nausea
- sensation of fullness
- anorexia
what are signs of cholecystitis (7)
- pain & tenderness to RUQ
- indigestion
- NV
- restlessness
- diaphoresis
- inflammation symptoms
- abdominal rigidity
pain in cholecystitis can radiate to? (2)
- right shoulder
- scapula
what manifestations of inflammation may be present in cholecystits (2)
- leukocytosis
- fever
what are some complications of cholecystitis (6)
- subphrenic abscess
- acute pancreatitis
- cholangitis (inflammation of bile ducts)
- biliary cirrhosis
- fistulas
- rupture of gallbladder –> bile peritonitis
what are some complications of cholelithiasis (5
similar to cholecystitis
- cholangitis
- biliary cirrhosis
- carcinoma
- peritonitis
- choledocholithiasis (stone in common bile duct) = obstruction
what can be used to diagnose cholelithiasis (5)
- US
- ERCP
- labs
- WBC (increased d/t inflammation)
- direct and indirect bilirubin (increased)
what is ERCP
Endoscopic retrograde cholangiopancreatography
what does ERCP allow visualization of (5)
- gallbladder
- cystic duct
- common hepatic duct
- common bile duct
- can also take bile samples
what labs can indicate gallbladder stones (2)
- liver enzymes (AST and ALT)
- amylase (if pancrease involved)
what are the goals of treatment for gallbladder disease (3)
- relief pain & discomfort
- no postop comp
- no recurrent attacks of cholelithiasis or cholecystitis
during an acute episode of cholecytitis, what are the care goals (7)
- 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
why are anticholinergics used for gallstones
- decrease secretion
- counteract sm. muscle spasms
treatment of gallstones depend on
- stage of disease
what are 3 treatment options for gallstones
- bile acids
- nonsurgical
- surgical option
what are 2 nonsurgical approaches for stone removal
- ERCP with sphincterotomy
- extracorporeal shock-wave lithotripsy
what is ERCP with sphincterotomy
- type of treatment done w ERCP
- involves cutting the muscle that surrounds the opening of the ducts, or the papilla = enlarged opening
what is extracorporeal shock-wave lithotripsy
uses high-energy sound waves to produce shock waves. The shock waves are strong enough to fracture and disintegrate the gallstones.
describe the use of bile acids to dissolve stones
- oral
- help dissolve stones but gallstones may recur
what are 2 surgical options for cholelithiasis
- laparoscopic cholecystectomy (most common)
- open cholecystectomy (when lap not possible)
what is a laparoscopic cholecystectomy
- minimally invasive surgery to remove the gallbladder
what drug therapy is used for gallstones (6)
- bile salts
- anticholinergics
- antiemetics
- fat sol vitamins
- pain meds
- antibiotics to prevent infection
describe nutritional therapy for gallstones/cholecystitis on discharge (5)
- low sat fat
- high fiber
- high calcium
- reduced cal if obese
- small, freq meals
remember NPO in acute phase
describe nursing care for gall stones/cystitis (4)
- monitor for obstruction (possible NG)
- NPO (rest gallbladder)
- I&O
- monitor urinary bilirubin (increase = bile flow obstruction
