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NUR122 gallbaldder


stores and secretes bile Gallbladder
digests fats in the ileum Bile
If bile flow is impeded by stones, _______increases in the blood stream bilirubin
Liver and gallbladder share a “common bile duct” that empties into the intestines through the sphincter of Oddi
The pancreas secretes enzymes into the intestine through the pancreatic duct and common bile duct. Pancreas (endocrine function)
Pancreas (exocrine function) Amylase,Trypsin,Lipase
enzymes that lowers blood sugar Insulin and somatostatin
enzyme that raises blood sugar Glucagon
enzyme that digests carbs Amylase
enzyme that digests proteins Trypsin
enzyme that digests fats Lipase
Located in the RUQ of the abdomen behind the liver gallbladder
__________ pain can be experienced during cholecystitis episodes shoulder
S/S that may develop due to blockage of the common bile duct Jaundice,itching and clay-colored stools
Cholelithiasis Symptoms in the Elderly: Oliguria (<16ml/hr), Hypotension, Change in mental status, Tachycardia, Tachypnea
Stones form when there is a decrease in _____ _______and increase in ___________from the liver and results in bile saturated with cholesterol. bile acids, cholesterol
an acute inflammation of the gallbladder Cholecystitis
Patient becomes symptomatic when stones get caught in the common duct
the cause of 90% of cholecystitis Stones
Cholecystitis S/S Pain in RUQ with radiation to back; Nausea and vomiting
Risk Factors for Cholelithiasis Female, fat, & fifty: Obesity,Female,Rapid weight loss,High dose estrogen,Ileal resection or disease,Cystic fibrosis,Diabetes mellitus
Ultrasound (U/S) -> Sound waves show gallstones 95% of the time
Abdominal X-ray -> Shows calcified gallstones 20% of the time
HIDA scan -> Radioactive dye shows gallbladder function
ERCP -> Endoscopic visualization of hepatobiliary system, visualizes ducts and stones
ERCP= (Endoscopic Retrograde Cholangiopancreatography) An important S/P Sx assessment is note return of gag and cough reflexes
Fast prior to U/S so that gallbladder is distended. Remember gallbladder contracts when stimulated by food.
Used to distinguish jaundice caused by liver disease or from gallstones and to diagnose cancer. PTC= Percutaneous Transhepatic Cholangiography
Serum Tests Used to Diagnose Gallbladder Problems Increased Liver Function Tests (LFTs);Increased Serum amylase or lipase;Increased WBCs in the Complete Blood Count (CBC);Decreased Calcium levels
In gallbladder disease calcium levels decreased due to hypoalbumin/protein unable to bind with calcium and release of glucagon decreases PTH from releasing calcium
S/S of hypocalcemia + Chvostek’s sign (tap facial nerve anterior to earlobe); +Trousseau’s (carpal spasm); seizures
80% of patient with cholecystitis achieve remission with rest, IV fluids, NG suction, analgesics, and antibiotics
For medical management of cholelithiasis take antacids when? after meals and at bedtime
How long does it take the medications for cholecystitis to dissolve small stones, reduce the size of existing stones, and prevent new stones from forming? 6-12 months
Nonsurgical removal of gallstones for poor surgical candidates Lithotripsy
Standard therapy for symptomatic gallstones Laparoscopic Cholecystectomy. Used in outpatient or discharged in 48 hrs. Resumes full activity in one week. No risk of paralytic ileus.
Laparoscopic Cholecystectomy Patient Teaching: Abdominal complications to report N/V abdominal distention, and increased temperature
After cholecystectomy, right shoulder pain is due to CO2 migrating from abdominal cavity during the procedure.
Requires an incision to remove stones only. T tube is placed in duct until edema subsides. Choledochostomy
Gastrointestinal symptoms to assess for, after laparoscopic surgery loss of appetite, vomiting, pain, distention, fever—potential infection or disruption of GI tract
If undergoing surgery for gallbladder disease teach that medications to avoid are ASA or St. John’s Wart (interfere with coagulation)
For the Patient Undergoing Surgery for Gallbladder Disease Assess Nutritional status by what labs? Note albumin and protein levels
An important intervention for the Patient S/P Surgery for Gallbladder Disease Pain relief so that patient can TCDB every hour, use of splinting
Obstruction of common bile duct may interfere with the absorption of fat-soluble vitamins A,D,E,K
Epigastric distress = fullness, abdominal distention, vague upper right quadrant pain. Distress may occur after eating a fatty meal
Cholelithiasis acute symptoms that occur with obstruction and inflammation or infection fever, palpable abdominal mass, severe right abdominal pain that radiates to the back or right shoulder, nausea and vomiting
Biliary colic is episodes of severe pain usually associated with nausea and vomiting, which usually occur several hours after a heavy meal
What S/S may develop due to blockage of the common bile duct? Jaundice,itching and clay-colored stools
Patient should _______ prior to U/S so that gallbladder is distended. Fast. Remember gallbladder contracts when stimulated by food.
Dietary management of Cholelithiasis low fat liquids, high carb, high protein (1175). Avoid eggs, cream, pork, fried foods, cheeses.
How does Actigall and Chenix work to manage Cholelithiasis? By dissolving small stones, reducing the size of existing stones, and preventing new stones from forming. They also inhibit the secretion and synthesis of cholesterol. They take 6-12 months to work.
Cholecystectomy requires an incision.
To maintain skin integrity, Penrose drains require freq. drsg. changes, as bile is corrosive to skin.
Nutrition post-op cholecystectomy should include Low fat, high carbs, and high proteins. Fat restriction is stopped after 4-6 weeks
What kind of injections might patient need after a cholecystectomy? Vitamin K injections to help blood to clot.
For a cholecystectomy an important assessment in preventing post-operative complications is respiratory status (adventitious breath sounds?), and risk factors for respiratory complications such as might occur if history of COPD, emphysema, asthma
Classic sign of internal hemorrhage after abdominal surgery boardlike rigidity of the abdomen
What position should patient be in after cholecystectomy? low fowlers
What is an important post-operative care intervention that can be done 24 hrs after cholecystectomy? encourage early ambulation
Name two things that can assist patients to TCDB every hour splint with pillow, and pain control
S/P cholecystectomy, what helps to enhance gas exchange? Turn, cough, deep breath, use of IS every hour, early ambulation
After gallbladder surgery a drain is inserted to prevent what during the first 24 hours? accumulation of bile
S/P cholecystectomy discharge teaching should include activity restrictions of Avoid heavy lifting for 1 week
S/P cholecystectomy discharge teaching should include Instruct patient and family to report signs of gastrointestinal complications, changes in color of stool or urine, fever, unrelieved or increased pain, nausea, vomiting, and redness/edema/signs of infection at incision site
After gallbladder removal, the bile will be released from the Ampulla of Vater.
When patient eats fats again, the bile will be released in the GI tract to emulsify fats as a part of digestion.
With cholelithiasis patient becomes symptomatic when stones get caught in the Common duct. Patients will have symptoms of both cholecystitis and pancreatitis.
Liver and gallbladder share a “common bile duct” that empties into the intestines through the sphincter of Oddi
Bile digests fats in the ileum
If bile flow is impeded by stones, what increases in the blood stream? Bilirubin. This produces many of the s/s of gallbladder disorders.
Patient Teaching at Discharge S/P cholecystectomy should include the use of which OTC medication? multi-vitamins
Created by: husseyj