Gallbladder & Liver

Question 1

What is the main functin of the gallbladder?

Answer 1

Store & release bile in small intestine for fat emulsification

Question 2

Cholecystitis

Answer 2

Inflammation of the gallbladder

Question 3

Cholelithiasis

Answer 3

Gallstones

Question 4

Choledocholithiasis

Answer 4

Gallstones in the comon bile duct

Question 5

What damage can gallstones cause?

Answer 5

Block the duct

Injure the wall, which can lead to infection

Question 6

Four F’s in relation to gallbladder problems

Answer 6

Female
Fertile
Forty
Fat

Question 7

Risk factors for gallbladder problems

Answer 7

Obese women
Excessive cholesterol intake
Sedentary lifestyle
Age >45 
Diet change
Frequent pregnancies
Strenuous dieting or rapid weight loss
Diabetes
Use of birth control pills

Question 8

What is the cause of gallstones?

Answer 8

Unknown

Possibly may be due to abnormally thick bile

Question 9

What kind of base do some gallstones have?

Answer 9

Calcium

Question 10

Chronic gallbladder disease can damage what organ?

Answer 10

The liver

Question 11

S&S of cholecystits/cholelithiasis

Answer 11

Sudden onset of acute RUQ pain
Epigastric pain
Indigestion
Feeling of fullness after eating (especially after high fat meal)
Steatorrhea
N/V
Belching
Fever (usually low grade)
Jaundice
Malaise
Positive murphy sign
Rebound tenderness
Guarding
Referred pain
Anorexia
Flatulence
Increased HR and RR
Diaphoresis
Elevated WBC
Dark amber urine

Question 12

What is a positive murphy sign?

Answer 12

The abrupt cessation of inspiration because of pain when RUQ is palpated

Question 13

What kind of referred pain is experienced in relation to cholecystitis and cholelithiasis?

Answer 13

Pain radiates to the right shoulder or midline of scapulas

Question 14

Why is the urine dark amber in relation to cholecystitis and cholelithiasis?

Answer 14

Urine contains urobilonogen as the kidneys try to remove excess bilirubin from the blod stream

Question 15

Diagnositc tests r/t cholecystitis and cholelithiasis

Answer 15

ALP & AST
Ultrasound
X-ray
Cholecystogram
EGD
ERCP

Question 16

Medical management of cholecystitis and cholelithiasis

Mild attacks

Answer 16

Bed rest
NG tube to suction
NPO
IVFs
Antispasmodics/Analgesics
Antibiotics
Antiemetics
Avoid spicy food (when allowed PO intake)

Question 17

Treatment of cholecystitis and cholelithiasis

Answer 17

Diet change
Medications: chenix(chenodiol) and ursodiol (actigall)
Surgery: EWSL, cholecytostomy, cholecystectomy, choledocholithotomy

Question 18

Pre-op NIs for cholecystitis and cholelithiasis

Answer 18

Education

Question 19

Post-op NIs for cholecystitis and cholelithiasis

Answer 19

Nursing care similiar to other surgeries
Assess & monitor bile drainage
Turn, deep breath
IS
I&Os
Assess bowel sounds

Question 20

Common bile duct obstruction

Answer 20

bilary stones

Question 21

S&S of common bile duct obstruction

Answer 21

Severe abdominal pain
N/V
Fever
Jaundice
Elevated WBC
Elevated liver and pancreatic enzymes

Question 22

Cancer of the gallbladder

Answer 22

Very rare
Not easy to detect in early stage (often already end stage when it is found)
Often liver is invaded as well
Poor prognosis
More common in women than men

Question 23

Functions of the liver

Answer 23

Detoxification of blood
Formation of vitamin A
Synthesis of urea
Storage of fat-soluble vitamins
Secretion of bile
Breaking down fats
Storage of minerals

Question 24

Liver diagnositc tests

Answer 24

Serum bilirubin test
Liver enzyme test
AST, ALT
Serum protein test
Ultrasound
Needle liver biopsy
Serum ammonia test
CT scan

Question 25

What else is liver failure known as?

Answer 25

Hepatic coma

Question 26

Causes of liver failure

Answer 26

Massive GI hemorrhage Massive infection Alcoholic liver disease

Question 27

S&S of liver failure | Initial

Answer 27

Fatigue Gi upset Diarrhea

Question 28

S&S of liver failue | Those that follow initial

Answer 28

Jaundice Bleeding Ascites/Abdominal distention Edema

Question 29

S&S of liver failue | End stage

Answer 29

``` Tremors Mental change Confusion Clotting disorder- coagulopathy Shrinking liver ```

Question 30

Diagnostic tests r/t liver failure

Answer 30

Liver function tests | Blood ammonia levels (because ammonia cannot convert to urea)

Question 31

Treatment of liver failure

Answer 31

``` Bed rest All drugs are discontinued Control bleeding (if present) High calorie, Low sodium, Low protein diet Management of F&E balance Antibiotics may be used ```

Question 32

Nursing considerations for patients with liver failure

Answer 32

Starch baths, calamine lotions and tepid sponging for relief of itching If Ascites place in high or semi-fowlers Assess for signs of bleeding (stool or urine) Look for bruises Provide support Explain jaundice

Question 33

S&S of liver abcess

Answer 33

``` Chills Intermittent fever Extreme weight loss N/V Abdominal distention/pain tenderness Right side abdomen pain and shoulder/ (pain over liver is a later symptom) Jaundice ```

Question 34

Extensive trauma/damage to the liver can be ____?

Answer 34

Fatal

Question 35

S&S of liver trauma

Answer 35

Orthostatic Hypertension Hypotension Tachycardia Shock

Question 36

Treatment of liver trauma

Answer 36

Surgery

Question 37

Liver cancer

Answer 37

Rarely site of primary cancer | Usually metastatic

Question 38

Risk factors for liver cancer

Answer 38

Chronic Hep B or Hep C Heavy alcohol abuse Smoking

Question 39

S&S of liver cancer

Answer 39

Encephalopathy Abnormal breathing Jaundice Ascites

Question 40

Treatment of liver cancer

Answer 40

Surger (rare) | Chemotherapy

Question 41

Liver transplantation

Answer 41

Used in end-stage liver disese | Can be total or a segment of a liver

Question 42

What is the medication involved with liver transplantation?

Answer 42

Clyclosporine