gallbladder disorders

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  1. Cholelithiasis
    • stones in the gallbladder
    • actual cause is unknown
    • - disturbance in balance and precipate forms
    • - supersaturation in gallbladder
    • infection, changes in cholesterol metabolism. bile statis, impaired gallbladder motility (contractility)
    • bile salts, bilirubin, calcium, protein, ***cholesterol***
    • bile salts/lecithinin- inc choles- inc risk for stone formation
  2. Cholelithiasis
    risk factor
    • most formed in the gall bladder
    • may also form in the CBD (choledecholithiasis)
    • risk factor:
    • FAIR- white complexion
    • FAT- diet inc in choles and truncal obesity
    • FEMALE- higher estrogen
    • FORTY- pre menuopausal
    • FERTILE
    • bad fats, genetics
  3. other factors
    cholelithiasis
    • Diet:
    • - fatty meals, high fat diet
    • - fast food test (not actual test but if pt goes to fast food place and then a few hours experience pain)
    • Genetics:
    • - American indians- highest in US
    • Diabetes:
    • - incr in trig can chx composition in bile
    • Rapid weight loss, yo yo diet
    • - changes bile makeup and may decr GB contractions
    • - gastric bypass pt are at high risk for this
  4. Cholelithiasis
    decrease risk by
    • maintaining a healthy body weight
    • avoiding crash diets esp < 800 cal
    • excerising regularly
    • low fat, high fiber diet- dec animal fat, butter, margarine, mayo, fried food
    • dec alcohol
  5. Cholecystitis
    • Inflammation of the gallbladder
    • usually caused by obstruction of bile by gallstones or billary sludge (sticky mud in ducts)
    • acute or chronic
    • confined in mucous lining or entire GB wall
    • distended and congested during acute attack
    • scarring with attack my reduce function
  6. Manifestations
    • silent cholelithiasis- 1%
    • mild pain to severe unrelenting pain
    • similar to agina, heart attack (r/o cardiac), peptic ulcer disease, hepatitis, appendicitis
    • vary from indigestion to pain, fever, jaundice
    • severity depends on where the stones are, are they moving, obstruction, GB colic, spasm
    • pain moves cause the stone is moving
  7. Acute Cholecystitis
    • RUQ pain that incr with deep breath (Murphy's sign), may radiate to right shoulder or scapula
    • May be colicky (passing thru the ducts, come and go)
    • - can be described as excruciating
    • - tachycardia, diaphoresis, restless
    • - nausea, and vomiting
    • - last up to an hour
    • - residual tenderness
    • - usually occurs 3-6 hours after meal, lying down
    • RUQ tenderness and abd rigidity
    • - slight fever, elevated WBC
    • - Jaundice only if CBD obstructed (clay stools ect)
  8. chronic cholecystitis
    • dyspepsia
    • heartburn
    • flatulence
    • intolerance for fatty foods
    • - nausea, fullness
    • steatorrhea- no bile
    • vitamin def
    • -fat soluble vitamins ADEK
    • recurring attacks, scar tissue
  9. Cholecystitis
    accurate physical exam
    • nature of pain
    • US
    • ERCP- tx and dx
    • CT
    • MRI
    • cholangiography
  10. Cholecystitis
    labs
    • elev WBC- inflammation
    • incr bili- if obstruction
    • LFT's elev- if obstruction
    • amylase-if pancreas
  11. Cholecystitis
    complications- usually delay in seeking care
    • subphrenic abscess
    • pancreatitis
    • cholangitis
    • fistulas
    • GB ileus
    • GB rupture
    • peritonitis
  12. Cholecystitis
    treatment
    • acute attack: alleviate symptoms (morphine, toradol)
    • - analgesics, antiemetics (zofran), anticholinergics (spasm of sphrincter, s/e dry mouth, confusion, blurred vision, urine retention), NGT (get rid of secretion)
    • preventing/controlling infections
    • - antibiotics
    • maintaining fluid and electrolytes balance
    • - NPO, IVF
    • 80% of supportive care
  13. Cholecystitis
    non surgical
    • ERCP- 90% effective
    • - stents, papillotomy, lithotripsy
    • Medication- for poor surgical canididates
    • - 6m to 2 yrs
    • - antigal and chenix (change synthesis of chol s/e GI hepatoxity)
    • ESWL- shock waves crush stones
    • - 1-2 hrs under conscious sedation
    • - out pt multi session
  14. Cholecystitis
    laparascopic cholecystectomy
    • tx of choice whenever possible
    • 4 small incisions
    • *** CBD stones or GB is perforiated is contraindicated
    • minimal pain, d/c within 24 hours
    • resume normal activities, return to work in a wk
    • pain referred to right shoulder or difficulty breathing is common post op problem- due to CO2
    • - sims position- left side knees flexed
    • b/c gases rise
  15. Open cholecystectomy
    • larger incision, more involved surgery
    • increased postop pain, longer hospital stay (up to 1 wk) longer rehab several weeks
    • may NG tube
    • T tube if CBD explored
    • - ensure patency of CBD
    • - drain bile each day it should go down. it should be green/yellow not bleedins
    • remember things to worry about after surgery- infection, DVT, respiration (pnuemonia), constipation
  16. cholecystectomy
    post op care
    • pain control
    • respiratory assessment
    • maintain skin integrity
    • promoting self care and activity
    • diet management
    • next slide
    • assessment post op c/o
    • follow up care
  17. cholecystectomy
    diet
    • lap- liquid until next day, the "light for a few days
    • open- liquids to bland when bowel sounds return
    • both- amt of fat depends on tolerance
    • - usually low fat, high CHO and proteins in early post op period
    • - fat restriction for 4-6 weeks by some MD's
    • takea body time to adjust to fat in diet

Card Set Information

Author:
Prittyrick
ID:
315632
Filename:
gallbladder disorders
Updated:
2016-02-10 00:51:34
Tags:
gallbladder
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Description:
gallbladder
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