Biliary disorders part 1: Gallbladder Flashcards
(109 cards)
1
Q
amylase:
A
pancreatic enzyme; aids in the digestion of carbohydrates
2
Q
cholecystectomy:
A
removal of the gallbladder
3
Q
cholecystitis:
A
inflammation of the gallbladder which can be acute or chronic
4
Q
cholecystokinin (CCK):
A
hormone; major stimulus for digestive enzyme secretion; stimulates contraction of the gallbladder
5
Q
cholecystostomy:
A
surgical opening and drainage of the gallbladder
6
Q
choledocholithiasis:
A
stones in the common bile duct
7
Q
cholelithiasis:
A
calculi in the gallbladder
8
Q
dissolution therapy:
A
the use of medications to break up/dissolve gallstones
9
Q
endoscopic retrograde cholangiopancreatography (ERCP):
A
procedure using fiberoptic technology to visualize the biliary system
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
11
Q
exocrine:
A
secreting externally; hormonal secretion from excretory ducts
12
Q
lipase:
A
pancreatic enzyme; aids in the digestion of fats
13
Q
lithotripsy:
A
disintegration of gallstones by shock waves
14
Q
pancreatitis:
A
inflammation of the pancreas; may be acute or chronic
15
Q
secretin:
A
: hormone responsible for stimulating bicarbonate secretion from the pancreas; also used as an aid in diagnosing pancreatic exocrine disease
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
17
Q
trypsin:
A
pancreatic enzyme; aids in the digestion of proteins
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
19
Q
The gallbladder functions as
A
a storage depot for bile.
20
Q
The capacity of the gallbladder
A
is 30 to 50 mL of bile
21
Q
The pancreas is located
A
in the upper abdomen
22
Q
The exocrine functions of the pancreas
A
secretion of pancreatic enzymes into the gastrointestinal (GI) tract through the pancreatic duct.
23
Q
Pancreatic enzymes include
A
amylase,
trypsin,
and lipase,
24
Q
the effect of glucagon is
A
(opposite to that of insulin) is to raise the blood glucose
25
calculi
stones
26
Duodenum is
the beginning portion of small intestines
27
Biliary system consists of
liver,
pancreas,
gallbladder
28
Pigment stones cannot be
dissolved and must be removed surgically
29
Those at high risk for cholelithiasis may be encouraged to
1. maintain an optimal body weight
| 2. avoiding consumption of sugar and sweet foods, low-fiber foods, and fast foods
30
cholelithiasis (gallstones) manifestations
may be silent, producing no pain and only mild GI symptoms
31
cholecystitis manifestations
1. epigastric distress
2. radiating pain
3. jaundice & itching
4. dark urine & clay stool
5. vitamin deficiency
32
what type of Epigastric distress experienced by cholelithiasis patients?
abdominal distention,
| pain in the right upper quadrant
33
when might cholelithiasis patients experience epigastric distress?
This distress may follow a meal rich in fried or fatty foods
34
what vitamin deficiencies are associated with cholelithiasis?
Fat soluble vitamins: A, D, E, K (ADEK)
35
why is jaundice develops with cholelithiasis?
The bile, which is no longer carried to the duodenum, is absorbed by the blood and gives the skin yellowing
36
as a result of vitamin K decifiency, what might that cause the patient?
bleed, because vitamin K is necessary for normal blood clotting
37
what are the locations for radiating pain associated with biliary colic (obstruction)?
RUQ pain that radiates to the back or right shoulder
38
what happens if the gallstones/calculi obstruct a cystic duct?
the gallbladder becomes, inflamed, and eventually infected (acute cholecystitis).
39
what are manifestations of acute cholecystitis?
1. fever
2. severe pain
3. palpable abdominal mass
40
what happens If the gallstone continues to obstruct the duct in the gallbladder?
abscess, necrosis, and perforation with generalized peritonitis may result.
41
peritonitis
(inflammation) of the tissue that lines your belly or abdomen.
42
what is the concern with use of opioids when caring for pain with cholelithiasis?
all opioids stimulate the sphincter of Oddi to some degree
43
bile consists of?
water
electrolytes, such as sodium, potassium, calcium, chloride and bicarb.
As well as fats, cholesterol, bilirubin, and salt
44
main purpose of of biliary system
Transports bile from the liver to the gallbladder to the duodenum
45
bile is made in the
liver
46
bile is store in
the gallbladder
47
sphincter of oddi is stimulated by
(CCK) cholecystokinin
48
Intrahepatic circulation is
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
Bilirubin is
Byproduct of broken down red blood cells.
50
Bilirubin usually goes through our
digestive system and gets excreted through our feces
51
If bilirubin gets attached to a protein,
its considered converted or unconjugated and its not excreted or blocked from the intestines making an increase in bilirubin levels which causes jaundice.
52
Conjugated
means water soluble
53
Cholelithiasis is more common in?
women
54
what are the 2 types of glasstones?
pigmented stones.
| cholesterol stones
55
what do you know about pigmented stones?
25% of cases
Unconjugated pigments in bile precipitate.
Increased in patients with cirrhosis, hemolysis, and infections of the biliary tract.
56
what do you know about cholesterol stones?
```
More common
75% of cases
Normal constitute of bile.
Decreased bile acid synthesis.
Increased cholesterol synthesis.
Produces inflammatory changes. (cholisistisis)
```
57
Problems in the liver will cause _______
problems in the gallbladder
58
Cirrhosis is
the scaring of the liver tissue.
59
what are the 2 types of gallbladder inflammation?
Calculous
| Acalculous
60
what do you know about calculous gallbladder inflammation?
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
what do you know about acalculous gallbladder inflammation?
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
what are the "5 F's" risk factors for cholelithiasis?
1. Fair skin (Caucasian)
2. Fat (cholesterol)
3. Female
4. Fertile (multiple births)
5. Forty (40+ yo)
63
cyctic fibrosis, ileostomy bag, or pts with hormonal changes or estrogen.
are also Other risk factors for cholelithiasis
64
pruritus means
itching
65
Murphy’s Sign
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
positive Murphy sign indicates
an issue with the gallbladder
67
what are the 2 goals of medical treatment for choleithiasis?
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
what are ways to remove the cause of cholecystitis?
by pharmacologic therapy,
endoscopic procedures,
or surgical intervention.
69
what is Endoscopic retrograde cholangiopancreatography (ERCP)?
a way to visualize the structures and treat confirmed stones in the Common Bile Duct (CBD), before or during laparoscopic cholecystectomy
70
nursing implications for patient scheduled for ERCP?
1. NPO hours before procedure
| 2. IV sedation and anesthesia
71
Cholecystectomy (removal of the gallbladder) through traditional surgical approaches has largely been replaced _________
by laparoscopic cholecystectomy (removal of the gallbladder through a small incision through the umbilicus)
72
how do most patients with acute gallbladder inflammation achieve remission?
with rest, IV fluids, nasogastric suction, analgesia, and antibiotic agents
73
What type of diet is recommended follow cholecystectomy?
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
examples of pharmacologic therapy for cholelithiasis
1. Ursodeoxycholic acid (UDCA) (brand name: Ursodil)
| 2. Chenodeoxycholic acid (CDCA)
75
what is the functions of UDCA, CDCA?
used to dissolve small gallstones composed primarily of cholesterol
76
how long is the treatment of UDCA, CDCA?
Six to 12 months of therapy is required in many patients to dissolve stone
77
which patients are not candidates for pharmacologic therapy of cholelithiasis?
Patients with frequent symptoms, cystic duct occlusion, or pigment stones
78
what type of treatment is more appropriate for symptomatic patients?
Laparoscopic or open cholecystectomy
79
what is a nonsurgical technique for removing stones in the CBD?
ERCP / or more specifically: a catheter with a basket are threaded through the t-tube tract
80
what is intracorporeal lithotripsy?
using laser pulse to fragment stones in the gallbladder or CBD
81
what is Extracorporeal Shock ?
uses repeated shock waves directed at the gallstones in the gallbladder or CBD to fragment the stones.
82
what are preoperative measures appropriate for surgical management of cholelithiasis?
1. x-ray, ekg
2. administration of vitamin K & protein supplement
3. IV glucose
83
laparoscopic cholecystectomy is
is the standard of therapy for symptomatic gallstones through small incisions and instruments to remove the gallbladder, and small stones are suctioned.
84
what type of anesthesia is given during laparoscopic cholecystectomy?
general anesthesia
85
how soon is the patient discharged after laparoscopic cholecystectomy?
same day
86
when would a laparoscopic cholecystectomy be converted to an open procedure?
if there is inflammation in or around the gallbladder
87
The most serious complication after laparoscopic cholecystectomy is
a bile duct injury
88
Patients with a postoperative bile leak may not develop symptoms until
several days after the procedure
89
a bile leak could cause a rare complication that results in serious illness or death called?
bile peritonitis
90
post laparoscopic procedures, patients are instructed to report signs such as?
loss of appetite, vomiting, pain, distention of the abdomen, and temperature elevation
91
if a post laparoscopic procedure patient complains of pain in the right shoulder or scapular area, what might the nurse recommend?
a heating pad for 15 to 20 minutes hourly.
92
cholecystectomy is indicated for which patients?
for acute and chronic cholecystitis
93
why is T-tube drainage inserted into the CBD during cholecystectomy?
to drain excess bile leak during and post surgery for recovery
94
what amount of drainage is normal to be seen in the T-tube drain?
Usually, only a small amount of serosanguineous fluid drains in the initial 24 hours after surgery
95
what amount of fluid in T-tube drainage should immediately be reported to the doctor?
over 500 ml!
96
what are post-op nursing interventions for gallbladder surgery patients?
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
when is it expected for bowel sounds to return after laparoscopic procedure?
next day
98
what is a post-op priority for patients who underwent cholecystostomy?
drainage must be connected immediately to a drainage receptable
99
what is a cause for bile not draining properly?
an obstruction causing bile to be forced back into the liver and bloodstream
100
post-op from gallbladder surgery, the nurse must report which signs and symptoms?
1. RUQ pain
2. nausea and vomiting
3. bile drainage around tubes
4. clay stool
5. change in vital signs
101
what might the surgeon instruct the nurse to do with the T-tube drain to prevent total loss of bile?
elevate drain receptacle above level of abdomen
102
how often is T-tube drainage measure and collected?
every 24 hours
103
what might the nurse do to the T-tube drain to help with digestion, several days after surgery?
clamp the T-tube 1 hour before, and 1 hour after meals.
104
how soon is the T-tube drain removed?
1 to 3 weeks
105
post-op gallbladder diet recommendations for pts
1. low fat, high carb, high protein
| 2. avoid excessive fats
106
when might the fat restriction lift, after gallbladder surgery?
4-6 weeks later
107
what is a concern with giving narcotics to manage pain postop?
respiratory depression
108
why is bile leak dangerous to pt skin and internal organs?
it is very acidic, will damage tissue
109
post-op, nurse determines the pt is experiencing increased tenderness and rigidity of the abdomen, what is priority intervention?
report to doctor
