Gallbladder diseases Flashcards
(40 cards)
1
Q
Gallbladder
A
- pear shaped muscular sac
- stores bile from liver and concentrates it
- essential for emulsification (breakdown) of fats
- powerful antioxidant
2
Q
Bile
A
- bitter, yellow fluid
- bile salts
- cholesterol
- calcium
- acids
- produces gallstones
- liver manufactures 1.1.5 quarts a day
3
Q
Cholelithiasis
A
gallstone formation
4
Q
Cholecystitis
A
inflammation of the gallbladder of cystic duct
5
Q
Obstruction
A
caused by gallstones
6
Q
Gallstones
A
- solid crystalline precipitates
- major component is cholesterol
- some are from calcium salts
- sand-like
- usually form in gallbladder or bile duct
- can cause life threatening infection of liver, bile duct and pancreas
7
Q
What causes gallstones?
A
- stasis/stagnation of bile
- incomplete emptying of the GB
- pure cholesterol stones
8
Q
Incomplete emptying of the GB
A
- bile coagulates and clumps together
- imbalance of cholesterol and bile salts
9
Q
Pure Cholesterol Stones
A
- white diet: sugar, white bread, pasta, pastries
- soda and lots of meat
- not enough veges
10
Q
Cholecystitis
A
inflammation of the gallbladder and/or cystic duct
acute versus chronic
11
Q
Etiology of Cholecystitis
A
- gallstones usually
- bacterial infection
- tumor of pancreas or liver
- decreased blood supply to gallbladder
- gallbladder sludge
12
Q
Symptoms of Cholecystitis
A
- may be asymptomatic
- attack lasts 2-3 days
- intense, sudden pain RUQ
- pain, may radiate up to right shoulder
- recurrent attacks several hours after meals
- N/V/indigestion
- rigid abdominal muscles or bloating
- slight fever/chills/leukocytes
- loose, light colored stools
13
Q
Complications of Cholecystitis
A
- abscess
- pancreatitis
- biliary cirrhosis
- fistulas
- rupture of the gallbladder
- inflammation of biliary ducts
- bile peritonitis
- empyema
14
Q
Gallstone formation
A
- bile stagnation
- solid crystalline
- changes in chemical composition
- decrease bile flow
- immobility
- pregnancy
- inflammation
- obstructive lesions
15
Q
Symptoms of Cholelithiasis
A
- may be silent cholelithiasis
- dependent upon if stone are stationary or mobile
- biliary colic
16
Q
if obstruction is present…
A
- amber (tea) colored urine
- clay colored stools
- jaundice
- pruritus
- steatorrhea
- bleeding tendencies
17
Q
steatorrhea
A
the excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine.
18
Q
Biliary Colic
A
- severe steady pain due to spasm
- accompanied by tachycardia, diaphoresis and prostration
- pain may last as long as 1 hour with residual RUQ tenderness
- occurs 3-6 hours after heavy meal
19
Q
Complications of Cholelithiasis
A
- inflammation of biliary ducts
- biliary cirrhosis
- carcinoma
- obstruction
- peritonitis
20
Q
Cholecystogram
A
- gall bladder series
- oral contrast, pills
- abdominal xrays
21
Q
Cholangiogram
A
- IV contrast
- series of xrays
22
Q
ERCP
A
Endoscopic Retrograde Cholangio Pancreatography
- use of endoscope
- injection of dye
- series of xrays
23
Q
CT Scan
A
- with or without contrast
- 2 dimensional image
24
Q
LFTs
A
Looks for obstruction
-direct and indirect bilirubin
25
Serum enzymes
may be elevated
| AST, alkaline phosphastase
26
CBC
elevated WBC
27
Serum Amylase
pancreas involvment
28
Prothrombin Time
prolonged clotting due to lack of vitamin K absorption
29
Medications
- antibiotics
- correct/maintain balance
- pain control
30
Narcotics
- dilaudid, morphine
| - can increase biliary colic
31
Antispasmotics
-anticholinergics (Atropine)
32
Antiemetrics
Phenergan, Zofran
33
Give fat soluble vitamins...
for chronic GB disease
-any type of obstruction
34
Urso
(Ursodiol)
- naturally occurring bile acid
- small quantities in humans
- large quantities in BEARS
- Action: replace/displace toxic bile acids, cytoprotection of injured bile duct epithelial cells, assists to shrink gall stones
35
Lithotripsy
(ESWL)
- extracorporeal shock wave lithotripsy
- pulverizes stones
- passes into duodenum
- passed in stool
36
Laproscopic Cholesystecomy
- less invasive
- 3 to 4 small incisions
- same day surgery (90 percent) or overnight
- return to normal ADL's in 2-3 days
37
Incisional/open CHOLEYCYCTECTOMY
- invasive with skin incision
- hospital stay 4-7 days
- may require T-tube insertion
38
T-tube
- used if common bile duct is explored
- used pre-op for biliary obstruction
- attached to closed drainage system
39
Open Choleycyctectomy
- bleeding
- common duct injury
- infection
Post op:
- monitor bleeding/complications
- difficulty breathing
- pain control
- monitor I and Os, NG drainage
- IV therapy
40
The primary substance in bile
bile salts
