Cholecystitis and Cholelithiasis Gail L Lupica Ph D

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Cholecystitis and Cholelithiasis Gail L Lupica Ph. D, RN, CNE

Cholecystitis and Cholelithiasis Gail L Lupica Ph. D, RN, CNE

Quick A&P Review

Quick A&P Review

The gallbladder is a muscular sac located under the liver. It stores and

The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver. Quick A&P Review

Cholecystitis ◦ Inflammation of the gallbladder, usually associated with cholelithiasis ◦ May be

Cholecystitis ◦ Inflammation of the gallbladder, usually associated with cholelithiasis ◦ May be acute or chronic Cholelithiasis ◦ Gallstones Definitions

Stones may remain in the gallbladder or migrate to the cystic duct or

Stones may remain in the gallbladder or migrate to the cystic duct or common bile duct causing pain. Stones may lodge in the ducts resulting in obstruction Etiology and Pathophysiology

Indigestion Fever Jaundice Pain in the RUQ, which may be referred to the

Indigestion Fever Jaundice Pain in the RUQ, which may be referred to the right shoulder or scapula Nausea/vomiting Diaphoresis Leukocytosis (increased WBC’s) Clinical Manifestations

Obstructivejaundice Dark, frothy, amber Clay-colored stools Pruritis Intolerance urine for fatty foods (nausea,

Obstructivejaundice Dark, frothy, amber Clay-colored stools Pruritis Intolerance urine for fatty foods (nausea, “fullness”, anorexia) Bleeding tendencies No bile flow into duodenum Soluble bilirubin in urine No bilirubin in small intestine to be converted into urobilinogen Deposition of bile salts in skin No bile in intestine to digest fats Decreased absorption of Vit K, leading to decreased production of prothrombin Clinical Manifestations: No bile salts in duodenum preventing fat emulsion and Obstructed Bile Flow digestion Steatorrhea

Ultrasound CBC Serum bilirubin (will be elevated) ERCP alkaline phos, ALT, AST, and

Ultrasound CBC Serum bilirubin (will be elevated) ERCP alkaline phos, ALT, AST, and amylase if the pancreas is involved Elevated Diagnostic Studies

Minimally invasive Outpt. CO 2 is insufflated into abdomen and gall bladder is

Minimally invasive Outpt. CO 2 is insufflated into abdomen and gall bladder is removed through umbilical incision What complications do you think could occur? What pt manifestation would you see if they occurred? Surgical –lap choley

More pain and more recovery time Penrose drain. T-tube for pts with stones

More pain and more recovery time Penrose drain. T-tube for pts with stones in the common bile duct. Ensures patency of common bile duct until edema subsides. Some bile flows into duodenum and some flows into drainage collection system. Fasten securely to pt dressing. Surgery- open choley

Pain Control NGT Anticholinergics (to decrease secretions and calm smooth muscle spasms) NPO

Pain Control NGT Anticholinergics (to decrease secretions and calm smooth muscle spasms) NPO Care Plan

Low-fat Eat diet smaller, frequent meals Nutritional Therapy

Low-fat Eat diet smaller, frequent meals Nutritional Therapy

Are there specific lab tests done to confirm the diagnosis of choleycystitis? Critical

Are there specific lab tests done to confirm the diagnosis of choleycystitis? Critical thinking

For am open choley, a t-tube may be inserted to ensure the patency

For am open choley, a t-tube may be inserted to ensure the patency of the common bile duct. What color would you expect the output to be in the first 24 hours? Thereafter? What condition would prompt the nurse to notify the surgeon Critical thinking

Gall Stones Cholelithiasis Cholelithiasis Definition Most common biliaryGall Stones Cholelithiasis Cholelithiasis Definition Most common biliary
Gallbladder Disorders A Cholelithiasis and Cholecystitis Definitions aGallbladder Disorders A Cholelithiasis and Cholecystitis Definitions a
Gallbladder Disorders A Cholelithiasis and Cholecystitis Definitions aGallbladder Disorders A Cholelithiasis and Cholecystitis Definitions a
Cholecystitis Cholelithiasis by Gari Glaser What is itCholecystitis Cholelithiasis by Gari Glaser What is it
Gallbladder and pancreas Underlying Cause of Cholecystitis CholecystitisGallbladder and pancreas Underlying Cause of Cholecystitis Cholecystitis
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