L5 Flashcards
(23 cards)
Risk factors of cholelithiasis
Female, Fertile (pregnancy), Forty (age), Family history, Fat (obesity and hyperlipidemia)
Use of oral contraceptive or estrogen therapy
Rapid weight loss
Biliary stasis (Fasting / On long-term parenteral feeding)
Diabetes Mellitus
Clinical manifestations of cholethiasis
Can be asymptomatic
- Biliary colic
- Jaundice if choledocholithiasis
- Nausea and vomiting
Biliary colic
Right Upper Quadrant (RUQ) abdominal pain radiates to the upper mid back
Occurs 30 mins to several hours after ingesting fatty meal
Complications caused by choledocholithiasis
Obstructive jaundice and possible liver damage
Pancreatitis
Treatments of choledocholithiasis
- Endoscopic Retrograde Cholangiopancreatography with papillotomy/sphincterotomy
- Extracorporeal shock-wave lithotripsy
- Percutaneous transhepatic biliary catheter
- Surgery
Complications of ERCP
- Bleeding (Sphincterotomy related)
S/s: hypotension, dissiness - Pancreatitis
S/s: abdominal pain, fever, chills - Allergy (Contrast related)
S/s: SOB, rash, hypotension
PTBD preparation
Keep NPO 4-6 hours
Premedication: Prophylatic antibiotics;
Steroid for allergy
PTBD complications
Cholangitis (infection of bile ducts); Wound infection
Bile leakage into the peritoneal cavity; Haemobilia (bleeding from or into the biliary tract)
Obstruction of drainage; Cathether dislodgement
Sepsis; Injury to other organ; Pneumothorax; Perforation of duodenum diverticulum
Pathophysiology of cholecystitis
Obstruction caused by gallstone in the cystic duct —> Gallbladder distended and inflamed due to bacterial infection —> Pressure against the distended gallbladder wall decrease blood flow —> ischemia, necrosis and perforation
Clinical manifestations of acute cholecystitis
Fever, chills
Anorexia, nausea and vomiting
RUQ pain radiates to the right scapula and shoulder
(Aggravated by movement and breathing)
Jaundice if CBD obstruction
Positive Murphy’s sign
Pruritus (itchy)
Abdominal muscle guarding and tenderness
Tea colour urine; yellow skin discoloration
Murphy’s sign
Press the lower region of the right rib and feel painful during inhalation
Complications of acute cholecystitis
Gangrenous gallbladder
Abscess (pus/empyema) formation in gallbladder —> fistula forms in adjacent organs (small intestine) while trying to get rid of pus —> gallbladder ileus (bowel obstruction)
Rupture of gallbladder —> bile peritonitis
Diagnostic test for cholecystitis
USG, CT scan, Blood test (elevated WBC and deranged LFT)
Medical treatment for mild symptoms in acute cholecystitis
Bed rest
Keep NPO or NG insertion for decompression
—> prevent further stimulation of gallbladder
Administer medication:
I) Antibiotic —> for inflammation
II) Anticholinergic or analgesic —> for pain relief
III) Ursodeoxycholic acid / Chenodeoxycholic acid —> for dissolving small gallstones
ERCP with papillotomy —> extract gallstone
Transhepatic biliary catheter
Surgical treatment for severe symptoms of acute cholecystitis
Open or Laparaoscopic cholecystectomy
Anti-emetics
Stop vomiting
Post-op nursing care of cholecystitis
Semi-Flower position; Encourage deep breathing and coughing exercise; Encourage incentive spirometry exercise
Monitor blood test results of WBC, bilirubin and LFT
Administer prophylactic antibiotics as prescribed
Normal amount of T-tube drainage after cholecystectomy
300-500 mL in the first 24 hours;
200 mL in 2-3 days
Pathophysiology of obstruction-related acute pancreatitis
Pancreatic duct obstruction —> increase pressure —> ductal rupture —> production and secretion of pancreatic enzyme (Trypsin) —> activate other enzymes —> Auto digestion of pancreatic tissue —> inflammation —> vascular damage, coagulation necrosis, fat necrosis, formation of pseudocysts —> edema within the pancreatic capsule —> ischemia —> necrosis
Pathophysiology of alcohol-related acute pancreatitis
Pancreatic acinar cells metabolise ethanol —> generate toxic metabolites —> injury acinar cells —> release activated enzymes
Chronic alcohol consumption —> formation of protein plugs in pancreatic duct and spasm of the Oddi sphincter —> obstruction —> autodigestion —> inflammation —> pancreatitis
Clinical manifestation of acute pancreatitis
LUQ pain radiates to the back
Fever, leukocytosis (increase WBC)
Nausea and vomiting
Hypotension and tachycardia
Tachypnea and hypoxia
Transient hyperglycemia
Abdominal distension
Jaundice
Severe can lead to multi-organ failure
Complications of acute pancreatitis
Necrosis pancreatitis
Septic shock; hypovolemic shock
Acute renal failure; type 2 DM
Pleural effusion; acute respiratory distress syndrome; atelectasis (collapses of a part or a lung), pneumonia
Multi-organ failure
Diagnostic test for acute pancreatitis
1) Imaging: USG, CT scan, MRI, MRCP
2) Endoscopic: ERCP
3) Blood test:
increase lipase/amylase, WBC, bilirubin, LDL, glucose
