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Appendectomy/Cholecystectomy Flashcards

1
Q

Two major types of gallstones

A

pigment & cholesterol stones

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2
Q

Pigment stones

A

bilirubin salt, calcium bilirubinate & associated with bacteria in the bile. Can only be removed surgically

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3
Q

Cholesterol Stones

A

more common. contain calcium salts & bile pigments

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4
Q

Cholecystitis

A

inflammation of the gallbladder. Can be acute or chronic

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5
Q

How does Acute Cholecystits develop?

A

Usually in association with cholelithiasis (gallstones) & high fat meal

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6
Q

Cholelithiasis

A

formation of gallstones

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7
Q

Symptoms of Acute cholecystitis

A

Severe pain radiating from RUQ abdomen to midline & posterior scapular region described as “colicky”, N/V, low grade fever, possible jaundice

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8
Q

What happens if a gallstone obstructs the cystic duct?

A

gallbladder becomes distended, inflamed & eventually infected (acute cholecystits)

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9
Q

Biliary colic

A

RUQ pain due to obstruction of a bile duct by a gallstone

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10
Q

Key sign for Cholecystitis

A

Patient is restless for 30min-6hrs after eating a meal

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11
Q

Cholecystitis makes stool what color & why?

A

white because gallbladder cant secrete any bile. Bile makes stool brown

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12
Q

What will urine look like with cholecystitis and why?

A

Urine may be dark & foamy b/c bilirubin increases which causes kidneys to try & filture out the bilirubin

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13
Q

A patient with cholecystitis will have an __________ WBC count

A

Incresed

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14
Q

Cholecystiits medical objectives

A

supportive and dietary management to reduce the incidence of acute episodes of gallbladder pain & to remove the cause of cholecystitis by pharmacologic therapy, endoscopic procedures or surgical interventions

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15
Q

Ursodiol (URSO)

A

a bile acid that dissolves gallstones and decreases biliary cholesterol formation. Used to treat asymptomatic cholecystitis

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16
Q

Who is at risk for cholecystitis?

A

3 F’s: Female, FAT, Forties. Chances increases with age, increased with pregnancy

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17
Q

Why does cholecystitis increase with pregnancy?

A

because baby can smush gallbladder (that’s what Marty said) online says its because when youre pregnant you produce lots of estrogen which produces cholesterol (hence cholesterol stones)

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18
Q

Symptoms of chronic cholecystitis

A

not as severe as acute, more vague. Long-term intolerance of fatty foods, vague gastric symptoms, increased flatulence

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19
Q

Cholecystitis diagnostics

A

Cholangiogram (Radiography of the bile ducts), endoscopic, IV, transhepatic, operative, oral cholecystograpy, CT scan

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20
Q

Cholecystitis surgical management

A

Laparoscopy cholecystectomy

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21
Q

Cholecystectomy

A

removal of gallbladder

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22
Q

Laparoscopic cholecystectomy

A

removal of the gallbladder through a small incision thru the umbilicus

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23
Q

advantages of laparoscopic cholecystectomy

A 
Decreased:
 surgical risks,
 length of hospital stays, 
recovery periods & 
postoperative pain
Patient does not experience paralytic ileus that occurs with open abdominal surgery
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24
Q

How many incisions for a Laparoscopic cholecystectomy ?

A

4

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25
How many incisions for a Laparoscopic Appendectomy?
3
26
Preferred treatment for acute cholecystitis?
Early Laparoscopic cholecystectomy (within 24-48 hrs of symptoms)
27
paralytic ileus
paralyzed intestines. Not able to pass stool or gas. happens often with abdominal surgery
28
If a patient has paralytic ileus why don't you want to give them a laxative?
Because stool will just build up and could bust appendix
29
Steps in Laparoscopic cholecystectomy
1. ) Anesthesia is administered 2. ) A small incision is made thru the abdominal wall at the umbilicus. 3. )Abdominal wall is filled with carbon dioxide 4. )The fiberoptic scope is inserted thru umbilicus 5. ) other instruments make small incisions
30
Why is abdominal wall filled with carbon dioxide during a laparoscopic cholecystectomy?
to assist in inserting the laparoscope & to aid in visualizing the abdominal structures
31
Discharge instructions for a patient that had a laparoscopic cholecystectomy
written and verbal instructions about managing postoperative pain & reporting s/s of intra-abdominal complications
32
Common s/s AFTER a laparoscopic cholecystectomy
pain or discomfort in right shoulder due to gas used to inflate abdominal area, may be drowsy afterward
33
Abnormal s/s a patient that has had a laparoscopic cholecystectomy should report when home
redness, tenderness, swelling, heat, or drainage around incision site. Loss of appetite, vomiting, pain, distention of abdomen and temp elevation
34
When should a patient who has had a laparoscopic cholecystectomy shower or take a bath?
after 1 or 2 days
35
When should a patient who has had a laparoscopic cholecystectomy drive a car?
after 3 or 4 days
36
How should a patient who has had a laparoscopic cholecystectomy care for wound?
check puncture site daily, wash with mild soap and water, allow special adhesive strips on site to fall of. DO NOT peel them off.
37
Lithotripsy
sound waves that break up gallstones
38
Appendicitis is most common in what age groups
10-30
39
Where is the appendix located?
RLQ (usually) attached to the cecum just below the ileocecal valve
40
Function of appendix
regularly fills with food & empties into cecum.
41
Average length of appendix
3-6 inches
42
peritonitis
inflamation of the serous membrane that lines the abdominal cavity
43
what causes peritonitis
Rupture/perforation of appendix
44
Appendicitis is most common in countries with...
diet low in fiber & high in refined carbs
45
Key sign of appendicitis
Pain that moves from umbilicus to RLQ
46
McBurney's point
rebound pain. (when you push down on abdomin and pain starts when you lift off)
47
where could the appendix be located if not in the RLQ?
lumbar region, pelvis, by kidney,
48
Rovsing's sign?
pain is felt when reverse side is palpated
49
Fecalith
harden mass of stool
50
pathophysiology of appendicitis
inflamation occurs --> decrease in blood supply -->infection -->fluid secretion --> increase in pressure & once it exceeds venous pressure then blood flow is restricted --> further infection with more swelling -->gangrene from hypoxia or reputure can occur in 24-36 hrs
51
obstruction of appendix can be caused by..
kinking, occlusion, adhesions, fecalith, tumor, intestinal worms, foreign material, viral infections causing enlarged lymphoid follicles
52
What happens to abdomen once appendix is ruptured/perforated?
abdominal distention, abdomen may become ridgid, pain may become more diffused or it may subside b/c of a decrease in pressure
53
MANTRELS score
Migration of pain, Anorexia, N/V,Tenderness, Rebound pain, Elevated temp, Leukocytosis, Shift to the left
54
what MANTRELS signs are worth 2 points?
Tenderness * Leukocytosis. All others are 1 point
55
simple appendicitis
appendix is inflamed & intact
56
Gangrenous appendicitis
appendix has area of tissue necrosis & microscopic perforations present
57
Perforated appendix
evidence of gross perforation & contamination of the peritoneal cavity
58
what kind of anesthesia is used for a appendectomy?
general or spinal
59
What sugical prodecures are prefored in the treatment of appendicitis with perforation
Laparotomy or laparoscopy. Lapaproscopy has a quicker recovery period
60
Why cant you give a laxative or emea to a patient with appendicitis?
Because they have pain which doesnt allow them to poop. Giving a laxitive will just make it worse. They will have an increase in pressure and it may cause the appendix to burst
61
When can you give a laxative to a patient with appendicitis?
AFTER surgery. It helps the patient decrease staining
62
What may form due to perforation of the appendix
abscess
63
What will the surgen do to help with an abscess
before surgery they will be put on antibiotics & during surgery, a drain will be placed in the abscess
64
Heel-jar test
stand on tiptoe & suddenly drop both heels to the floor =RLQ pain=+ sign
65
Hop Test
hop on one foot = RLQ pain = + sign
66
what other tests can you do for appendicitis?
Cough test * if patient is too ill to stand, tap heel while pt is supine & fully extended=RLQ pain =+ sign
67
lliopsoas muscle test
lie on left sign while right hip & legs are passively extended - a retroperitoneal appendix will have contact with muscle & elicit RLQ pain
68
Obturator muscle test
lie supine with right hip flexed & passively rotated inward =+ sign
69
Cutaneus hyperesthesia test
gently lifts fold of skin between thumb & index fingers without pinching at a series of points on abdomen, moving from UQ to LQ esp over McBurney's point= + sign
70
5-6 points on MANTRELS score
possible appendicitis
71
7-8 points on MANTRELS score
probable appendicitis
72
9-10 points on MANTRELS score
very probable
73
If ithere is a possibility of peritonitis after surgery, what will the surgeon do?
A drain will be left in place at the area of the incision.

Nursing II (16 decks)

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