Gallbladder disease

Question 1

The following flashcards are going to be on gallbladder disease that is a recording posted on blackboard

Question 2

there are two types of gallbladder disease, which are?

Answer 2

Cholelithiasis
Cholecystisis

Question 3

what is cholelithiasis?

Answer 3

most common disorder of biliary system

• stones in the gallbladder

Question 4

what is cholecystitis?

Answer 4

inflammation of gallbladder
- usually associated with gallstones

Question 5

what are risk factors for those on gallbladder disease?

Answer 5

fertilize, 40 fat, female

Question 6

what is the pathophysiology with cholelithiasis ( gallstones ) ?

Answer 6

stones develop when balance that keeps cholesterol, bile salts, calcium changes.

Question 7

typically its the calcium in our body that will change and cause a disruption in our biliary system that ends up causing gallstones.

however this is not the only way, bile secreted by the liver can be supersaturated with ____(lithogenic) can cause it

Answer 7

cholesterol

Question 8

just something to note so I dont get confused when reviewing my flashcards

you either have biliary issues due to a gallstone, so like the physical change in the calcium, cholesterol, or bile

but you can also have biliary sludge, from the accumulation of the bile in a certain area in the body that remains stationary cause it isn’t flowing properly and it becomes thick.

Question 9

cholecystitis is an inflammation of the gallbladder that is often associated with ?

Answer 9

obstruction from stones or sludge

Question 10

what is acalculous cholecystitis ?

Answer 10

no obstruction
- just inflammation of the gallbladder

Question 11

typically patients who have acalculous cholecystitis, usually get this from what?

Answer 11

immobile, older adults, cancer, biliary statisis

Question 12

what are clinical manifestations of these two conditions?

Answer 12

vary from none at all to severe

( colicky pain - it comes and goes )
steady, excruciating, tachycardia, diaphoresis, prostration, residual tenderness in RUQ

Question 13

patients with gallstones typically have more severe pain when what is going on?(2)

Answer 13

the gallstones are moving
gallstones are obstructed

Question 14

which quadrant typically are patients with gallstones going to feel the pain in ?

Answer 14

right upper quadrant

Question 15

typically patients with these two conditions of the gallbladder will have pain that occurs from ___to___ after (2)

Answer 15

3-6 hours
after
high fat meal or lying down

Question 16

she mentions how in patients who have pancreasitis, also experience the same excruciating pain when they lay down just like gallbladder diseases. however to help differentiate between the two conditions, what are we going to ask a patient if we think its an gallbladder issue?

Answer 16

do you get pain after eating a high-fat meal 3-6hours later?

Question 17

if a total obstruction occurs what are some Clincal manifestions we will see?(5)

what color urine ?
what 2 stools ?
what are they feeling?
intolerance to what?
they are more likely to ?

Answer 17

dark amber urine
clay colored-steatorrhea
pruritus
intolerance to fatty foods
bleeding tendencies

Question 18

remember the gallbladder is hidden within the liver in the right upper quadrant, however patients with gallbladder diseases, typically the pain can radiate up to where?

Answer 18

right shoulder, scapula

Question 19

typically patients with gallstones, they are going to have severe inflammation due to the gallstones causing obstruction in the body, so we typically will see what in the CBC and on vital signs?

Answer 19

white blood cells
fever

Question 20

if a patient develops peritonitis with gallstones, we will see the abdomen be what?

why are we worried about this ?

Answer 20

rigid(firm)

peritontisits, because of lack of blood flow reaching there

Question 21

patients can have chronic cholecystitis, they have what 4 things?

Answer 21

fat intolenace
dyspepsia ( burping acid )
heart burn
flatulence

Question 22

how do we diagnose these conditions ? (2)

Answer 22

ERCP
- endoscope into the small intestine, use contrast and see it, and remove the stones or dilate strictures

percutaneous transhepatic cholangiography
- needle passed into the liver and remove bile

Question 23

what are the labs going to present ? (4)

Answer 23

increase WBC
increase Bilirubin
increase liver enzymes
increase serum amylase

Question 24

why are we going to see that dark amber color urine in patients with gallbladder disease?

Answer 24

because of the increase in urinary bilirubin levels from their lab work

Question 25

how do we treat cholelithiasis ?

Answer 25

typically treatment depends on the stage of disease we can use medication to dissolve gallstones we can just surgical remove the gallbladder and or we can do ERCP with spincterotomy and just remove the stones

Question 26

we can also use extracorporeal shock-wave lithotripsy (ESWL) which is just high energy shock will disintegrate the stones shaking it until its small enough to pass

Question 27

with cholecystitis, how are we going to help treat? (3)

Answer 27

antibiotic treatment choleycstotomy anticholinergics

Question 28

why do we give antibiotic treatment to help aid with cholecystitis? why do we do a cholecystotomy? why do we give anticholinergics ?

Answer 28

possible infection causing inflammation to just remove the problem all at once and then give opioids after to help with pain to help decrease gi secretions since we dont know the direct cause, but it can help aid the inflammation

Question 29

what are the 2 types of surgeries for gallbladder disease?

Answer 29

laparoscopic cholecystectomy open(incisional) cholecystectomy

Question 30

what is laparoscopic cholecystectomy ? BETTER TREATMENT^

Answer 30

removal of the gallbladder through 1 to 4 puncture holes

Question 31

what is open(incisional) cholecystectomy?

Answer 31

removal of the gallbladder through right subcostal incision

Question 32

we can also do something called transhepatic biliary catheter, which is what? typically we only do this under what 2 conditions?

Answer 32

a catheter that is inserted through the skin to help drain out all the extra bile out in the drainage bag if the patient has cancer, so taking the gallbladder out isn't going to change their outcome or if the patient has so much swelling and inflammation of bile before surgery, so its a much safer and easier surgery to perform after the drainage of fluid

Question 33

what are our 2 main concerns when it comes to having patients with transhepatic biliary catheter?

Answer 33

fluid and electrolyte - remember we are draining out all this fluid from them skin care - it is another catheter that is inserted through the skin, so we must be mindful of inflammation, infection, redness, and irritation

Question 34

gallbladder disease is super painful, what are some medications we are going to give? (2)

Answer 34

morphine (analgesics) atropine ( anticholinergic )

Question 35

we also need to be worried about vitamin deficiency in these patients with gallbladder disease, so what might we give them? (4)

Answer 35

A,D,E,K

Question 36

remember these patients are going to feel a lot of itching, so what medication might we give them ? how do we give it?

Answer 36

cholestyramine it comes as a powder, and you mix it with milk or juice

Question 37

cholestyramine is the medication of choice to help aid patients with gallbladder disease for their pruirtus, but we have to be mindful for side effects so what are some that we should look out for or education our patient on?

Answer 37

nausea/vomiting diarrhea constipation skin reactions

Question 38

cholestyramine is famous for having drug on drug interaction, so we have to do what to prevent this ?

Answer 38

2 hours before or 4 hours after any other medication the patient may be on

Question 39

what is going to be nutritional therapy for these patients with gallbladder disease? (4)

Answer 39

small, frequent meals high in fiber reduce calories low fat

Question 40

nursing assessment notes Subjective data Assess for risk factors Ask about family history Assess for medications that increase risk Previous abdominal surgeries Assess for clinical manifestations Objective data Fever Restlessness Jaundice, icteric sclera Diaphoresis Tachypnea Splinting Tachycardia Palpable gallbladder Abdominal guarding and distention Abnormal labs or studies

Question 41

nursing diagnosis notes Acute pain Knowledge deficit nursing health promotion Screen for predisposing factors Teaching for at-risk ethnic groups Early detection of chronic cholecystitis Manage with low-fat diet

Question 42

pain management notes Give drugs as needed before pain becomes severe Observe for side effects Comfort measures Clean bed Positioning Oral care nausea and vomiting NG tube, gastric decompression Oral hygiene, care of nares Accurate intake and output Maintaining suction Antiemetics

Question 43

nursing implementation pruritus relief notes Pruritus relief measures Antihistamines Baking soda or Alpha Keri baths Lotions Soft linen Control of temperature Short, clean nails Scratch with knuckles rather than nails

Question 44

nursing implementation : complications notes Acute care Monitor for complications Obstruction Bleeding Infection Post-ERCP care Assessment for complications Vital signs, pain Bed rest NPO until return of gag reflex Patient teaching postoperative care Laparoscopic cholecystectomy Monitor for complications Patient comfort Referred pain to shoulder pain from CO2 Sims’ position (left side, right knee flexed) Deep breathing, ambulation, analgesia Clear liquids Discharged same day

Question 45

after a surgery of the removal of gallbladder, we put them in a sims position which is?

Answer 45

left side, right knee flexed

Question 46

notes Postoperative care Incisional cholecystectomy Maintain adequate ventilation Prevent respiratory complications General postoperative nursing care Maintain drainage tubes (T-tube, Penrose tube, or Jackson-Pratt tube), if present Replace lost fluids and electrolytes

Question 47

Ambulatory care Laparoscopic cholecystectomy Remove bandages day after surgery and then can shower Report signs of infection Gradually resume activities Return to work in 1 week May need low-fat diet for several weeks

Question 48

Ambulatory care Open-incision cholecystectomy No heavy lifting for 4 to 6 weeks Usual activities when feeling ready May need low-fat diet for 4 to 6 weeks

Question 49

Expected outcomes Appear comfortable and has pain relief State knowledge of activity level and dietary restrictions

Question 50

in the study guide prep thing we need to understand pre and post up from the surgery just remember laparoscopic cholecystectomy - minimal - 1-4 holes - can go back to work within a week - few complications - sims position - clear liquids day 1 then normal - low fat 1 week open - removal with 8inch incision - t use can be used - drainage tubes - prevent repsiraoty complications due to needing 8 days of resting - no heavy lift for 4-6 weeks - low fat 4-6 weeks