Wk 4 Gallbladder Problems Flashcards
What is cholelithiasis?
Gallstones
What is cholyecycstitis?
Inflammation of the gallbladder
What is the etiology of cholelithiasis?
Unknown
How are gallstones removed?
Surgery
What are 7 risk factors for cholelithiasis?
Gender
Age, over 40
Estrogen
Obesity
Sedentary lifestyle
Diet
Family history
What causes severe pain of cholelithiasis?
Gallstones migrate and get stuck in the bile duct
Gallstones affect what percentages of men and women?
6% of men
9% of women
What diet is a risk factor for gallstones?
High in cholesterol and fat
Low in fiber
Where does bile come from?
Liver
Where is bile stored?
Gallbladder
Why does the gallbladder release bile?
After we eat to help with fat digestion
What is the function of bile?
It helps to digest lipids and transport waste products
What are the 6 components of bile?
Bilirubin
Cholesterol
Bile salts
Water
Protein
calcium
What gives bile its color?
Bilirubin, it’s dark brownish color
How does the pathogenesis of cholelithiasis start?
Bile stasis
What happens when there is bile stasis?
It becomes super saturated with cholesterol
What happens when bile is saturated with cholesterol?
It forms precipitates which form the gallstones
3 steps to gallstone formation
Bile stasis
Cholesterol accumulation
Precipitate formation
What are 3 things that can happen if the gallstones migrate?
Pain
Obstruction
Cholecystitis
What quadrant is the pain located?
RUQ
What symptom will the patient present with if there is a bile duct obstruction?
obstructive jaundice with increased conjugated bilirubin
What is conjugated bilirubin?
Water-soluble bilirubin
If the stones are small, few and not moving the cholelithiasis manifestations will be
Silent
Severity of manifestations depends on…
Movement of stones
Obstruction
The pain associated with gallstones in the bile duct is known as what?
Biliary colic
Biliary colic is a __ __ pain
Steady severe pain
How long does biliary colic last?
About an hour
Where is biliary colic located?
RUQ
Where can biliary colic radiate to?
right shoulder
When does biliary colic occur?
Roughly 3-6 hours after a fatty meal has been consumed
What does a patient present with during biliary colic pain?
Tachycardia
Diaphoresis
Epigastric pain
Why does a patient with cholelithiasis look jaundice?
Bile cannot flow into duodenum
What does the urine look like of a patient with cholelithiasis?
Dark amber color that foams when shaken
What causes a patient’s urine to look like that with cholelithiasis?
Soluble bilirubin in urine
What color are the stools of a patient with cholelithiasis?
Clay colored
Why do patients with cholelithiasis have clay colored stools?
Bilirubin does not reach small intestine to be converted into urobilinogen
What is steatorrhea?
Increased fat in stools
Why does a patient with cholelithiasis have steatorrhea?
No bile salts in duodenum, preventing fat digestion
Why does a patient with cholelithiasis have pruritis?
Deposit of bile salts into skin tissues
Why does a patient with cholelithiasis have an intolerance to fatty foods?
There is no bile in the small intestine to help with fat digestion
Why does a patient with cholelithiasis have bleeding tendencies?
Decreased absorption of vitamin K
What is needing for the absorption of vitamin K?
Bile
Vitamin K is an essential to produce…
Clotting factors
What type of vitamin is vitamin K?
Fat-soluble
What labs might you see with a patient with cholelithiasis?
Prolonged INR
Prolonged PTT
What does a patient with cholelithiasis have a prolonged INR and PTT?
Because they have decreased absorption of Vitamin K, which is needed to make clotting factors.
What is the most common cause of cholecystitis?
Obstruction from gallstones and biliary sludge
What are 5 other potential causes of cholecystitis?
Prolonged immbolity
Fasting
Bacterial infection
TPN
Diabetes mellitus
If a patient is NPO for a long time, and they start to develop a fever it may be…
their gall bladder
How does the pathogenesis of cholecystitis start?
Obstruction that causes inflammation
When the gallbladder is inflamed it becomes… (3)
Edematous
Hyperemic
Distended
Overtime if the inflammation continues, what will happen to the gallbladder?
Scarring and decreased function
What are the s/s of cholecystitis?
Fever
N/V
Restlessness
Diaphoresis
colic pain
With cholecystitis what will the lab value of bilirubin look like?
Increased (of conjugated bilirubin)
What produces the conjugated bilirubin?
Liver
Why does a patient with cholecystitis have elevated liver enzymes?
Backup of bile
Will the liver enzymes of a patient with cholecystitis be high or low?
High
Why does a patient with cholecystitis have leukocytosis?
Due to the inflammation process
What is amylase?
A pancreatic enzyme that releases into the common bile duct
When would we see damage to the pancreas in a patient who has cholecystitis
If the blockage is low enough in the common bile duct that it is blocking the pancreatic duct
If a patient with cholecystitis has damage to their pancreas, what would we see an increase in?
Amylase
With cholecystitis, if there is an infection it can lead to…
Peritonitis and death
The peritoneum is supposed to be…
sterile
What analgesic is typically prescribed for pain control concerning cholecystitis?
ketorolac (Toradol)
What type of drug is given for the nausea and vomiting associated with cholecystitis?
Antiemetics
Why are anticholinergics given to patients with cholecystitis?
To decrease gallbladder secretion and stop smooth muscle spasms
Why are bile acids sometimes given to patients with cholecystitis?
To dissolve stones
If a patient with cholecystitis can’t control their pain with ketorolac (Toradol), what would we bump them up to?
morphine
hydromorphone (dilaudid)
Anticholinergics have the __ effect
drying
