biliary

Question 1

coalathiatis - and symptoms or no?

Answer 1

stones in gallbladder. usually asymptomatic.

Question 2

how to detect coalathiatis (koalas need ultrasound)

Answer 2

ultrasound, and need to fast for about 6 hours.

Question 3

The primary function of the gallbladder is

Answer 3

to store and concentrate bile.

Question 4

Bile is comprised of

Answer 4

bile salts, bilirubin, phospholipids, cholesterol, bicarbonate and water.

Question 5

Bile salts mix with ingested fats to

Answer 5

promote absorption of fats from the gastrointestinal tract.

Question 6

Bicarbonate and water are needed in the gastrointestinal tract to (bi is the great neutralizer)

Answer 6

help neutralize stomach acid, as digestion and absorption require an alkaline environment.

Question 7

After it’s formation in the liver, bile flows into

Answer 7

After it’s formation in the liver, bile flows into the hepatic duct.

Question 8

The sphincter of Oddi surrounds the ampulla of Vater. (oddi and vader)

Answer 8

needs to relax to let bile out.

Question 9

Cholelithiasis formation

Answer 9

Stones d/t precipitation➔ bile ➔ obstruction ➔Sx

Question 10

Cholecystitis (think itis)

Answer 10

Inflammation of the gall bladder ➔obstruction ➔Sx.

Question 11

Cholangitis (chang in the ducts is an emergency)

Answer 11

Inflammation of the bile ducts ➔obstruction ➔Sx. this is an emergency.

Question 12

Cholecystectomy

Answer 12

Removal of gall bladder (open, laparoscopic, T-tube care)

Question 13

Cholecystitis - s/sx - hurts before or after eating?

Answer 13

Food stimulation moves stone to block duct
Pain after meals (high fat)
Nausea, belching, flatulence, indigestion

Question 14

Cholecystitis - s/sx - pain, bowel sounds (itis in my right-is)

Answer 14

Epigastric pain, decreased or absent bowel sounds. right upper quadrant and chest pain.

Question 15

cholecystitis - skin

Answer 15

Bile flow blocked leads to bile salts on skin, pruritus
Mild jaundice (bile is obstructed form liver)
Clay colored stools, dark foamy urine, steatorrhea (fatty stools)
Strictures

Question 16

Cholecystitis-Kehr’s sign (Chole says Kerry on, right?)

Answer 16

Pain radiates to right shoulder with breathing

Question 17

Cholecystitis- Murphy’s sign (murphy inspired the upper right)

Answer 17

Pain on deep inspiration with RUQ palpation

Question 18

Cholecystitis - diagnostics and what blood tests? (Chole is a cutie)

Answer 18

Amylase, lipase, CBC (WBC), LFT’s
Abdominal ultrasound, CT

Question 19

Cholecystitis - treatment

Answer 19

NPO, IV hydration
NGT suction with N/V
T-Tube insertion if no resolution or worsening Sx
Cholecystectomy if tolerated
low fat diet

Question 20

Cholecystitis - meds (Cole and the 4 As)

Answer 20

Antibiotics
Analgesics (opiate –demerol versus morphine)
Anticholinergic (decrease motility and acid)
Antispasmotics (decrease GI spasms and therefore pain)

Question 21

Cholecystitis - complications

Answer 21

Gall bladder perforation
Peritonitis (secondary)
Pericholecystic abscess (15% mortality)
Empyema
Suppurative cholecystitis ➔sepsis/shock

Question 22

gallstones

Answer 22

Super saturated bile stasis, precipitates
Cholesterol orcalcium bilirubinate (pigment) gallstones

Question 23

gallstones - who gets them

Answer 23

More prevalent in women than men, obesity, rapid weight loss post pregnancy/multiple pregnancy, use of estrogens, rich/fatty foods, Mexican American or American Indian

Question 24

gallstones - causes (hard livin gal)

Answer 24

High fat/low fiber diet, heavy drinking, infection, CAD, intestinal disorders, smoking

Question 25

smoking and coffee - (friends with gale)

Answer 25

decrease risk of gallstones

Question 26

gallstones - s/sx - and if symptoms, when do they start?

Answer 26

can be asymptomatic OR Abrupt, episodic pain epigastric/RUQ Pain beginning in the abdomen and radiating to the chest, back and shoulders N/V, tachycardia, diaphoresis Attacks start after meals and usually at night

Question 27

gallstones - diagnostics (Erp is a good gal)

Answer 27

Ultrasound, oral cholecystogram, endoscopy, ERCP

Question 28

gallstones - treatment (gals like hot water)

Answer 28

Heat, sips of water, analgesics, non-surgical or surgery (ERCP, cholecystectomy) Complications: empyema, peritonitis, duct or liver injury/damage

Question 29

gallstones - prevention

Answer 29

Exercise, diet, avoid modifiable risks

Question 30

ERCP

Answer 30

throat is numbed bc tube goes down throat. pt is under conscious sedation. bed rest for 4 hours after procedure. NPO until gag. 30-45 degrees.

Question 31

T-tube

Answer 31

T-tubes are colonized after 24 hrs so there is a high rate of infection.

Question 32

T-tube nursing - how often to change dressing?

Answer 32

Assess and measure drainage Change dressing daily Assess skin Assess for peritonitis Assess for leaks

Question 33

Cholangitis (chang is bacteria in my ducts)

Answer 33

very serious. Bacterial inflammation of bile ducts Associated with stones Predisposition with stagnant bile flow; pancreatic CA; procedures (ERCP, contrast injections), T tube infections (90% are colonized within one week)

Question 34

Cholangitis - s/sx (Chang loves charlotte P, the FJ)

Answer 34

Charcot’s triad (abdominal pain, fever, and jaundice) Intermittent chills & fever Abdominal pain Jaundice (sudden onset) RUQ tenderness Elevated WBC, bilirubin, AST, ALT

Question 35

Cholangitis - treatment

Answer 35

IV antibiotics EMERGENCY GB decompression ERCP PTC (percutaneous transhepatic cholangiography) Surgery NOT done (20-60% mortality

Question 36

Cholangitis - complications (Chang has an abscess)

Answer 36

Hepatic abscess (15%) empyema

Question 37

Primary Sclerosing Cholangitis (think sclerosis)

Answer 37

Narrowing and hardening of the bile ducts which leads to a back up pressure and obstruction of the bile ducts. Increased pressure leads to liver inflammation, fibrosis and cirrhosis of the liver

Question 38

Primary Sclerosing Cholangitis (inflammed bile duct) linked with (Chang is primarily friends with UC students)

Answer 38

ulcerative coalitis - 70%

Question 39

Primary Sclerosing (bile ducts inside and outside liver become scarred) - risk factors - gender and age only?

Answer 39

Risk factors: Ulcerative colitis (UC), male 30-40 years and family history, microbiome issues, genetics, environmental

Question 40

Primary Sclerosing - s/sx (same)

Answer 40

RUQ pain, jaundice, fatigue, pruritis, cirrhosis, LFT changes (alk phos elevates first, then bilirubin, and finally ALT, AST

Question 41

Cholecystectomy - Laparotomy

Answer 41

Hospitalized Prevent/minimize pulmonary complications ICS, TCDB, splinting, ambulate Proactive pain management with PCA opioids, splinting NPO, NGT, antiemetics T tube or C tube, wound drain, incision care Patient discharge education Pain, wound, tubes, diet, activity restrictions

Question 42

Cholecystectomy - Laproscopic “lap choley” - when can I lift stuff and drink alcohol?

Answer 42

Ambulatory surgery Multiple stab wounds, insuffation with CO2, cameras, laser, “bagged” and removed Fever pulmonary complications Pain management Less trauma, less pain Free air in abdomen, absorbs, ambulate Patient discharge education Pain management, wounds, tubes, diet (low fat) , activity resumption No lifting > 20 pounds for 10 days No alcohol for 2 months Report signs of obstruction or infection

Question 43

Foods to Avoid Cholecystitis or Cholelithiasis - high in cholesterol (and what else)

Answer 43

Dairy Whole milk, ice cream, butter, cheese, cream Fried, fatty foods Rich pastries Gravies Nuts and chocolate Egg yolks and avocado

Question 44

foods to avoid - gas forming veggies

Answer 44

Gas Forming Vegetables Onions Broccoli Cauliflower Sauerkraut Radishes Cucumbers Beans

Question 45

cholysystitis - what type of pain? (Chole's shoulder hurts)

Answer 45

pain radiates to shoulder. can have this without obstruction

Question 46

who usually gets cholycyitis? (Chole is really old)

Answer 46

usually really old or sick. immobile. it's not very common. sludgy bile. could be cancer, opioids. can be from infection as well. worry is rupture and periotonitis.