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Exam 3 > Biliary disorders part 1: Gallbladder > Flashcards

Biliary disorders part 1: Gallbladder Flashcards

1
Q

amylase:

A

pancreatic enzyme; aids in the digestion of carbohydrates

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2
Q

cholecystectomy:

A

removal of the gallbladder

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3
Q

cholecystitis:

A

inflammation of the gallbladder which can be acute or chronic

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4
Q

cholecystokinin (CCK):

A

hormone; major stimulus for digestive enzyme secretion; stimulates contraction of the gallbladder

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5
Q

cholecystostomy:

A

surgical opening and drainage of the gallbladder

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6
Q

choledocholithiasis:

A

stones in the common bile duct

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7
Q

cholelithiasis:

A

calculi in the gallbladder

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8
Q

dissolution therapy:

A

the use of medications to break up/dissolve gallstones

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9
Q

endoscopic retrograde cholangiopancreatography (ERCP):

A

procedure using fiberoptic technology to visualize the biliary system

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10
Q

endoscopic ultrasound (EUS):

A

invasive procedure using an ultrasound probe at the end of an endoscope to detect cholelithiasis and to decompress the gallbladder in the setting of acute cholecystitis

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11
Q

exocrine:

A

secreting externally; hormonal secretion from excretory ducts

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12
Q

lipase:

A

pancreatic enzyme; aids in the digestion of fats

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13
Q

lithotripsy:

A

disintegration of gallstones by shock waves

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14
Q

pancreatitis:

A

inflammation of the pancreas; may be acute or chronic

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15
Q

secretin:

A

: hormone responsible for stimulating bicarbonate secretion from the pancreas; also used as an aid in diagnosing pancreatic exocrine disease

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16
Q

steatorrhea:

A

frothy, foul-smelling stools with a high fat content; results from impaired digestion of proteins and fats due to a lack of pancreatic juice in the intestine

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17
Q

trypsin:

A

pancreatic enzyme; aids in the digestion of proteins

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18
Q

describe the gallbladder and its location

A

The gallbladder, a pear-shaped, hollow, saclike organ, lies on the inferior surface of the liver

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19
Q

The gallbladder functions as

A

a storage depot for bile.

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20
Q

The capacity of the gallbladder

A

is 30 to 50 mL of bile

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21
Q

The pancreas is located

A

in the upper abdomen

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22
Q

The exocrine functions of the pancreas

A

secretion of pancreatic enzymes into the gastrointestinal (GI) tract through the pancreatic duct.

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23
Q

Pancreatic enzymes include

A

amylase,
trypsin,
and lipase,

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24
Q

the effect of glucagon is

A

(opposite to that of insulin) is to raise the blood glucose

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25
Q

calculi

A

stones

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26
Q

Duodenum is

A

the beginning portion of small intestines

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27
Q

Biliary system consists of

A

liver,
pancreas,
gallbladder

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28
Q

Pigment stones cannot be

A

dissolved and must be removed surgically

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29
Q

Those at high risk for cholelithiasis may be encouraged to

A
  1. maintain an optimal body weight

2. avoiding consumption of sugar and sweet foods, low-fiber foods, and fast foods

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30
Q

cholelithiasis (gallstones) manifestations

A

may be silent, producing no pain and only mild GI symptoms

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31
Q

cholecystitis manifestations

A
  1. epigastric distress
  2. radiating pain
  3. jaundice & itching
  4. dark urine & clay stool
  5. vitamin deficiency
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32
Q

what type of Epigastric distress experienced by cholelithiasis patients?

A

abdominal distention,

pain in the right upper quadrant

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33
Q

when might cholelithiasis patients experience epigastric distress?

A

This distress may follow a meal rich in fried or fatty foods

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34
Q

what vitamin deficiencies are associated with cholelithiasis?

A

Fat soluble vitamins: A, D, E, K (ADEK)

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35
Q

why is jaundice develops with cholelithiasis?

A

The bile, which is no longer carried to the duodenum, is absorbed by the blood and gives the skin yellowing

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36
Q

as a result of vitamin K decifiency, what might that cause the patient?

A

bleed, because vitamin K is necessary for normal blood clotting

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37
Q

what are the locations for radiating pain associated with biliary colic (obstruction)?

A

RUQ pain that radiates to the back or right shoulder

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38
Q

what happens if the gallstones/calculi obstruct a cystic duct?

A

the gallbladder becomes, inflamed, and eventually infected (acute cholecystitis).

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39
Q

what are manifestations of acute cholecystitis?

A
  1. fever
  2. severe pain
  3. palpable abdominal mass
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40
Q

what happens If the gallstone continues to obstruct the duct in the gallbladder?

A

abscess, necrosis, and perforation with generalized peritonitis may result.

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41
Q

peritonitis

A

(inflammation) of the tissue that lines your belly or abdomen.

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42
Q

what is the concern with use of opioids when caring for pain with cholelithiasis?

A

all opioids stimulate the sphincter of Oddi to some degree

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43
Q

bile consists of?

A

water
electrolytes, such as sodium, potassium, calcium, chloride and bicarb.
As well as fats, cholesterol, bilirubin, and salt

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44
Q

main purpose of of biliary system

A

Transports bile from the liver to the gallbladder to the duodenum

45
Q

bile is made in the

A

liver

46
Q

bile is store in

A

the gallbladder

47
Q

sphincter of oddi is stimulated by

A

(CCK) cholecystokinin

48
Q

Intrahepatic circulation is

A

basically just that pathway of the bile that’s

moving from the liver to the gallbladder to the intestines back up to the liver

49
Q

Bilirubin is

A

Byproduct of broken down red blood cells.

50
Q

Bilirubin usually goes through our

A

digestive system and gets excreted through our feces

51
Q

If bilirubin gets attached to a protein,

A

its considered converted or unconjugated and its not excreted or blocked from the intestines making an increase in bilirubin levels which causes jaundice.

52
Q

Conjugated

A

means water soluble

53
Q

Cholelithiasis is more common in?

A

women

54
Q

what are the 2 types of glasstones?

A

pigmented stones.

cholesterol stones

55
Q

what do you know about pigmented stones?

A

25% of cases
Unconjugated pigments in bile precipitate.
Increased in patients with cirrhosis, hemolysis, and infections of the biliary tract.

56
Q

what do you know about cholesterol stones?

A 
More common
75% of cases
Normal constitute of bile.
Decreased bile acid synthesis.
Increased cholesterol synthesis.
Produces inflammatory changes. (cholisistisis)
57
Q

Problems in the liver will cause _______

A

problems in the gallbladder

58
Q

Cirrhosis is

A

the scaring of the liver tissue.

59
Q

what are the 2 types of gallbladder inflammation?

A

Calculous

Acalculous

60
Q

what do you know about calculous gallbladder inflammation?

A

90% of acute cases.
Gallbladder stone obstructs bile outflow.
Vascular supply is compromised. Because if there is an issue with the flow we will have things excreted back into kidneys which in turn causes vascular issues.

61
Q

what do you know about acalculous gallbladder inflammation?

A

Absence of obstruction of stone. Inflammation without stones!
Occurs after surgery, orthopedic procedures, trauma, burns.
Can come from bacterial infections.
Bile stasis (lack of bile contraction)
Increased viscosity of bile. Because of stasis, becomes thick and sticky.

62
Q

what are the “5 F’s” risk factors for cholelithiasis?

A
  1. Fair skin (Caucasian)
  2. Fat (cholesterol)
  3. Female
  4. Fertile (multiple births)
  5. Forty (40+ yo)
63
Q

cyctic fibrosis, ileostomy bag, or pts with hormonal changes or estrogen.

A

are also Other risk factors for cholelithiasis

64
Q

pruritus means

A

itching

65
Q

Murphy’s Sign

A

you want to place your hands on their right upper quadrant.
When you put your hands on the right upper quadrant, you ask the patient to breathe out when they exhale.
then ask them to inhale while your hand is
on that right upper quadrant.
If the patient is not able to inhale or they
are experiencing extreme pain when they inhale, you can indicate that as a positive Murphy sign

66
Q

positive Murphy sign indicates

A

an issue with the gallbladder

67
Q

what are the 2 goals of medical treatment for choleithiasis?

A
  1. If acute: Reduce the incidence of acute episodes of gallbladder pain and cholecystitis by supportive and dietary management
  2. If chronic: Remove the cause of cholecystitis
68
Q

what are ways to remove the cause of cholecystitis?

A

by pharmacologic therapy,
endoscopic procedures,
or surgical intervention.

69
Q

what is Endoscopic retrograde cholangiopancreatography (ERCP)?

A

a way to visualize the structures and treat confirmed stones in the Common Bile Duct (CBD), before or during laparoscopic cholecystectomy

70
Q

nursing implications for patient scheduled for ERCP?

A
  1. NPO hours before procedure

2. IV sedation and anesthesia

71
Q

Cholecystectomy (removal of the gallbladder) through traditional surgical approaches has largely been replaced _________

A

by laparoscopic cholecystectomy (removal of the gallbladder through a small incision through the umbilicus)

72
Q

how do most patients with acute gallbladder inflammation achieve remission?

A

with rest, IV fluids, nasogastric suction, analgesia, and antibiotic agents

73
Q

What type of diet is recommended follow cholecystectomy?

A
  1. low-fat liquids, powdered high protein and carb supplements stirred into skim milk
  2. cooked fruits, rice, lean meats, mashed potatoes
  3. AVOID gas-forming vegetables like Cauliflower, broccoli.
  4. AVOID eggs, cream, cheese, pork, fried foods, and of course ALCOHOL.
74
Q

examples of pharmacologic therapy for cholelithiasis

A
  1. Ursodeoxycholic acid (UDCA) (brand name: Ursodil)

2. Chenodeoxycholic acid (CDCA)

75
Q

what is the functions of UDCA, CDCA?

A

used to dissolve small gallstones composed primarily of cholesterol

76
Q

how long is the treatment of UDCA, CDCA?

A

Six to 12 months of therapy is required in many patients to dissolve stone

77
Q

which patients are not candidates for pharmacologic therapy of cholelithiasis?

A

Patients with frequent symptoms, cystic duct occlusion, or pigment stones

78
Q

what type of treatment is more appropriate for symptomatic patients?

A

Laparoscopic or open cholecystectomy

79
Q

what is a nonsurgical technique for removing stones in the CBD?

A

ERCP / or more specifically: a catheter with a basket are threaded through the t-tube tract

80
Q

what is intracorporeal lithotripsy?

A

using laser pulse to fragment stones in the gallbladder or CBD

81
Q

what is Extracorporeal Shock ?

A

uses repeated shock waves directed at the gallstones in the gallbladder or CBD to fragment the stones.

82
Q

what are preoperative measures appropriate for surgical management of cholelithiasis?

A
  1. x-ray, ekg
  2. administration of vitamin K & protein supplement
  3. IV glucose
83
Q

laparoscopic cholecystectomy is

A

is the standard of therapy for symptomatic gallstones through small incisions and instruments to remove the gallbladder, and small stones are suctioned.

84
Q

what type of anesthesia is given during laparoscopic cholecystectomy?

A

general anesthesia

85
Q

how soon is the patient discharged after laparoscopic cholecystectomy?

A

same day

86
Q

when would a laparoscopic cholecystectomy be converted to an open procedure?

A

if there is inflammation in or around the gallbladder

87
Q

The most serious complication after laparoscopic cholecystectomy is

A

a bile duct injury

88
Q

Patients with a postoperative bile leak may not develop symptoms until

A

several days after the procedure

89
Q

a bile leak could cause a rare complication that results in serious illness or death called?

A

bile peritonitis

90
Q

post laparoscopic procedures, patients are instructed to report signs such as?

A

loss of appetite, vomiting, pain, distention of the abdomen, and temperature elevation

91
Q

if a post laparoscopic procedure patient complains of pain in the right shoulder or scapular area, what might the nurse recommend?

A

a heating pad for 15 to 20 minutes hourly.

92
Q

cholecystectomy is indicated for which patients?

A

for acute and chronic cholecystitis

93
Q

why is T-tube drainage inserted into the CBD during cholecystectomy?

A

to drain excess bile leak during and post surgery for recovery

94
Q

what amount of drainage is normal to be seen in the T-tube drain?

A

Usually, only a small amount of serosanguineous fluid drains in the initial 24 hours after surgery

95
Q

what amount of fluid in T-tube drainage should immediately be reported to the doctor?

A

over 500 ml!

96
Q

what are post-op nursing interventions for gallbladder surgery patients?

A
  1. place pt in low fowler position
  2. fluids administered via IV
  3. Water may be given few hours after procedure
  4. a soft diet is started after bowel sound return
  5. incentive spirometer
  6. ambulation
97
Q

when is it expected for bowel sounds to return after laparoscopic procedure?

A

next day

98
Q

what is a post-op priority for patients who underwent cholecystostomy?

A

drainage must be connected immediately to a drainage receptable

99
Q

what is a cause for bile not draining properly?

A

an obstruction causing bile to be forced back into the liver and bloodstream

100
Q

post-op from gallbladder surgery, the nurse must report which signs and symptoms?

A
  1. RUQ pain
  2. nausea and vomiting
  3. bile drainage around tubes
  4. clay stool
  5. change in vital signs
101
Q

what might the surgeon instruct the nurse to do with the T-tube drain to prevent total loss of bile?

A

elevate drain receptacle above level of abdomen

102
Q

how often is T-tube drainage measure and collected?

A

every 24 hours

103
Q

what might the nurse do to the T-tube drain to help with digestion, several days after surgery?

A

clamp the T-tube 1 hour before, and 1 hour after meals.

104
Q

how soon is the T-tube drain removed?

A

1 to 3 weeks

105
Q

post-op gallbladder diet recommendations for pts

A
  1. low fat, high carb, high protein

2. avoid excessive fats

106
Q

when might the fat restriction lift, after gallbladder surgery?

A

4-6 weeks later

107
Q

what is a concern with giving narcotics to manage pain postop?

A

respiratory depression

108
Q

why is bile leak dangerous to pt skin and internal organs?

A

it is very acidic, will damage tissue

109
Q

post-op, nurse determines the pt is experiencing increased tenderness and rigidity of the abdomen, what is priority intervention?

A

report to doctor

Exam 3 (6 decks)

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