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From Flashcardlet > (2) Exam 3- Disorders of the Biliary Tract > Flashcards

(2) Exam 3- Disorders of the Biliary Tract Flashcards

0
Q

Disorders of the Biliary Tract

What is cholelithiasis

A

Stones in the gallbladder

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1
Q

Disorders of the Biliary Tract

What is the most common disorder of the biliary system

A

Cholelithiasis

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2
Q

Disorders of the Biliary Tract

What is cholecystitis

A

Inflammation of the gallbladder

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3
Q

Disorders of the Biliary Tract

Why is the number of individuals with Cholelithiasis in the United States unknown

A

Many persons with stones are asymptomatic

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4
Q

Disorders of the Biliary Tract

Who is at greater risk for cholelithiasis

A

Women in persons over 40 years of age

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5
Q

Disorders of the Biliary Tract

What can cause increased secretion of cholesterol in bile

A

Obesity

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6
Q

Disorders of the Biliary Tract

What is in the city is gallbladder disease most common

A

Asian-Americans and it is especially high in the Native American population

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7
Q

Disorders of the Biliary Tract
Etiology and pathophysiology
Cholelithiasis

What substances precipitate in cholelithiasis

A

Cholesterol, bile salts, and calcium

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8
Q

Disorders of the Biliary Tract
Etiology and pathophysiology
Cholelithiasis

In cholelithiasis, The bile secreted by the liver is super saturated with

A

Cholesterol

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9
Q

Disorders of the Biliary Tract
Etiology and pathophysiology
Cholelithiasis

Stasis of bile leads to progression of the supersaturation and changes in the chemical composition of the bile is known as

A

Biliary sludge

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10
Q

Disorders of the Biliary Tract
Etiology and pathophysiology
Cholelithiasis

What factors can decrease bile flow

A

Immobility, pregnancy, and inflammatory or obstructive lesions of the biliary system

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11
Q

Disorders of the Biliary Tract
Etiology and pathophysiology
Cholecystitis

Cholecystitis is most commonly associated with obstruction caused by

A

Gallstones or biliary sludge

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12
Q

Disorders of the Biliary Tract
Etiology and pathophysiology
Cholelithiasis

Cholecystitis in the absence of obstruction is known as

A

Acalculous cholecystitis

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13
Q

Disorders of the Biliary Tract
Etiology and pathophysiology
Cholelithiasis

Acalculous cholecystitis frequently occurs in older adults and in patients who are

A

Critically ill

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14
Q

Disorders of the Biliary Tract
Etiology and pathophysiology
Cholelithiasis

During an acute attack of cholecystitis, the gallbladder is edematous and hyperemic, and it may be distended with

A

Bile or Pus

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15
Q

Disorders of the Biliary Tract
Clinical Manifestations

What may result when a stone is lodged in the ducts and when stones are moving through the ducts

A

Spasms

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16
Q

Disorders of the Biliary Tract
Clinical Manifestations

When severe pain is produced by gallbladder spasms it is called

A

Biliary colic

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17
Q

Disorders of the Biliary Tract
Clinical Manifestations

The pain is often steady excruciating and accompanied by what manifestations

A

Tachycardia, diaphoresis, prostration

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18
Q

Disorders of the Biliary Tract
Clinical Manifestations

How long made the severe pain last

A

Up to an hour

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19
Q

Disorders of the Biliary Tract
Clinical Manifestations

When the severe pain subsides there is residual tenderness in the

A

RUQ

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20
Q

Disorders of the Biliary Tract
Clinical Manifestations

The attacks of pain frequently occur 3 to 6 hours after

A

High-fat meal or when the patient is lying down

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21
Q

Disorders of the Biliary Tract
Clinical Manifestations

The initial symptoms of acute cholecystitis include

A

Indigestion and pain and tenderness in the right upper quadrant

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22
Q

Disorders of the Biliary Tract
Clinical Manifestations

Right upper quadrant pain in a cute cholecystitis may be referred to what area

A

Right shoulder and scapula

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23
Q

Disorders of the Biliary Tract
Clinical Manifestations

What are the physical findings in acute cholecystitis

A

Right upper quadrant tenderness and abdominal rigidity

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24
Q

Disorders of the Biliary Tract
Clinical Manifestations

Manifestations of chronic cholecystitis

A

History of that intolerance, dyspepsia, heartburn, and flatulence

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25
Q

Disorders of the Biliary Tract
Diagnostic Studies

What is commonly used to diagnose gallstones

A

Ultrasonography

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26
Q

Disorders of the Biliary Tract
Clinical Manifestations

What is percutaneous transhepatic cholangiography

A

The insertion of a needle directly into the gallbladder duct followed by injection of contrast materials

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27
Q

Disorders of the Biliary Tract
Clinical Manifestations

What laboratory tests are elevated

A

White blood cell and bilirubin levels are elevated

28
Q

Disorders of the Biliary Tract
Collaborative Care

What’s gallstones become symptomatic what is usually indicated

A

Definitive surgical intervention with cholecystectomy

29
Q

Disorders of the Biliary Tract
Collaborative Care
Cholelithiasis

What are used to dissolve stones

A

Bile acids such as ursodiol and chenodiol

30
Q

Disorders of the Biliary Tract
Collaborative Care
Cholelithiasis

What are gallstones usually not treated with drugs

A

Because of the high use and success of laparoscopic cholecystectomy

31
Q

Disorders of the Biliary Tract
Collaborative Care
Cholelithiasis

What may be used for stone removal

A

ERCP with endoscopic sphincterotomy

32
Q

Disorders of the Biliary Tract
Collaborative Care
Cholelithiasis

What uses high-energy shockwaves to disintegrate gallstones

A

ESWL

33
Q

Disorders of the Biliary Tract
Collaborative Care
Cholelithiasis

How long does it usually take to disintegrate the stones with the ESWL procedure

A

1 to 2 hours

34
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

During an acute episode, treatment focuses on

A

Pain control, control of possible infection with antibiotics, and maintenance of fluid and electrolyte balance

35
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

What may be used if nausea and vomiting are severe

A

NG tube insertion and gastric decompression

36
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

What are given for pain management

A

NSAIDs

37
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

What may be administered to decreased secretion and counteract smooth muscle spasms

A

Anticholinergics

38
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

What is the treatment of choice for symptomatic cholecystitis

A

Laparoscopic cholecystectomy

39
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

How many punctures are made in the abdomen in a laparoscopic cholecystectomy

A

1 to 4 small punctures

40
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

How long after a laparoscopic Cholecystectomy is the patient usually discharged

A

The day of the surgery or the day after

41
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

How long after surgery is the patient usually able to resume normal activities and return to work

A

One week

42
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

What may be inserted into the common bile duct during surgery when a common bile duct exploration is part of the surgical procedure

A

T tube

43
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

What is used when endoscopic drainage has been unsuccessful

A

Transhepatic biliary catheter

44
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

How often is the skin around the catheter insertion site clean with an antiseptic

A

Daily

45
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

Can the patient be discharged with a transhepatic biliary catheter

A

The patient may be discharged with the catheter in place

46
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

When they morphine be used for pain management

A

Initially

47
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

What are the most common drugs used to treat gallbladder disease

A

Analgesics, anticholinergics, fat soluble vitamins, and bile salts

48
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

In chronic gallbladder disease or any biliary tract obstruction, what fat-soluble vitamins may need to be given

A

A, D, E, and K

49
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

Cholestyramine may provide relief for

A

Pruritus

50
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

How is cholestyramine administered

A

Powder form mixed with milk or juice

51
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

People with fewer problems can eat smaller, more frequent meals with some fat at each meal to promote

A

Gallbladder emptying

52
Q

Disorders of the Biliary Tract
Collaborative Care
Cholecystitis

What do you want to teach the patient about dietary changes after laparoscopic cholecystectomy

A

Liquids for the rest of the day and eat light meals for a few days

53
Q

Disorders of the Biliary Tract
Nursing Implementation

Patients with chronic cholecystitis may not have acute symptoms and may not seek help and to what occurs

A

Jaundice or biliary obstruction

54
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

What nursing comfort measures are appropriate

A

Clean bed, comfortable positioning, oral care, care of nares

55
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

NG tube insertion is used for severe nausea and vomiting but what is adequate for patients with less severe nausea and vomiting

A

Antiemetics

56
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

What are signs of obstruction of the ducts by stones

A

Jaundice, clay colored stool, it’s dark and foamy urine, steatorrhea, fever, increased WBC count

57
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

Due to bleeding, what do you need to know and use as a guide in the assessment process

A

Prothrombin time

58
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

What do you want to assess for after ERCP with papillotomy

A

Pancreatitis, perforation, infection, and bleeding

59
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

After an ERCP with papillotomy, The patient should be on bed rest for several hours and should be NPO for how long

A

Until gag reflex returns

60
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

Because of carbon dioxide that is used to inflate the abdominal cavity during surgery, what is a common postoperative problem after a laparoscopic cholecystectomy

A

Referred pain to the shoulder

61
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

Carbon dioxide can irritate the phrenic nerve and the diaphragm causing

A

Difficulty breathing

62
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

What position helps move the gas pocket away from the diaphragm

A

Sims position

63
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

What is Sim’s position

A

On left side with right knee flexed

64
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

Postoperative nursing care for incisional cholecystectomy focuses on

A

Adequate ventilation and prevention of respiratory complications

65
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

After an incisional cholecystectomy, the patient is usually discharge in how many days

A

Two or three days

66
Q

Disorders of the Biliary Tract
Nursing Implementation
Cholecystitis and Cholecystitis

How long do you instructed patient to avoid heavy lifting and after an incisional cholecystectomy

A

4 to 6 weeks

67
Q

Disorders of the Biliary Tract
Gallbladder Cancer

The majority of gallbladder cancers are what type of carcinomas

A

Adenocarcinomas

68
Q

Disorders of the Biliary Tract
Gallbladder Cancer

Nursing management for gallbladder cancer

A

Palliative care with special attention to nutrition, hydration, skincare, and pain relief

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