Disorders of the gallbladder
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| Gallstones form in approximately what percentage of the U.S. population get gallstones? | 10%
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| How many people each year are hospitalized by gallbladder disorders each year? | >1/2 million
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| Where is the gallbladder located? | right inferior surface of the liver
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| How large is the gallbladder? | 3-4 inches long
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| What connects the gallbladder to the duodenum? | Cystic and common bile ducts
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| What makes up the billiary system? | Gallbladder and bile ducs
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| Define Cholecystectomy: | Surgical removal of the gall bladder
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| Define cholelithiasis: | Formation of stones in the gallbladder (gallstones). These stones may be as small as a grain of sand, and may become as large as an inch in diameter.
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| Who do cholelithiasis occur most in? | American Indians, whites, middle aged women and pregnant women
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| What percentage of cholecystitis is caused by gallstones? | 90%
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| What is thought to be the cause of gallstones? | Thought to be related to altered lipid metabolism and female sex hormones
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| When do problems occur with gallstones? | When they block the ducts
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| What is billiary colic? | Pain from spasms of the billiary ducts as they try to dislodge gallstones
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| What causes cholecystitis? | Gallstone blocking billiary duct resulting in inflammation.
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| within how long does a typical inflammatory response occur with a gallstone blocking a bile duct? | within 3-4 days
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| How does cholecystitis affect the gall bladder? | Bile stasis along with vascular occlusion causes the mucosal lining of gallbladder to become necrotic
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| The ischemia caused by cholecystis leads to what within a few days? | Bacterial growth. Bile is normally sterile.
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| What is released by the small intestine each time a person eats fatty food? | Cholecystokinin (a hormone)
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| What effect does cholecystokinin have? | Stimulates gallbladder to send bile and can cause it to contract forcefully.
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| What can happen if the swelling and distended volume of the gallbladder is not relieved? | Bladder wall can become gangrenous or rupture causing peritonitis
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| What are S/Sx of acute cholecystitis? | *Nausea *Vomiting *Severe, colicky RUQ pain
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| Intolerance to fat is found in acute or chronic cholecystitis? | Chronic
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| True or False: Many patients with Cholecystitis are asymptomatic. | True. Many times choledocholithiasis is discovered only during exam for another problem
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| Define choledocholithiasis | the presence of a gallstone in the common bile duct
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| list 3 subjective symptoms of Cholecystitis? | *Indigestion after eating high fatty foods *Pain localized in the RUQ epigastric region *Anorexia, nausea, vomiting *Possibly tachycardia and tachypnea with diaphoresis similar to MI *Mild jaundice *Steatorrhea
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| What is an x-ray of the gall bladder before it releases bile? | Cholecystogram
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| What is the procedure where common bile duct is directly injected with radiopaque dye? | Cholangiography
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| What is the medical management of mild cholelithiasis? | *Bedrest *NG tube to low suction *NPO-allows GI tract and gallbladder to rest *IV fluids to maintain hydration and replace NG drainage
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| What is the pain control drug of choice for Cholelithiasis and why? | Demerol (Meperidine), because of decreased incidence of spasms to sphincter of Oddi
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| What is extracorporeal shock wave lithotripsy (ESWL)? | Machine discharges a series of shockwaves through water or a cushion that breaks gallstones into fragments
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| What is an EWSL indicated for? | Patients who have mild or moderate symptoms caused by few gallstones
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| What is an Endoscopic Sphincterotomy? | For stones in the common bile duct. A flexible endoscope is advanced through the mouth and stomach until its tip sits in the duodenum opposite the common bile duct, which snares the stone using a basket like attachment.
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| What is the treatment of choice for 80% -85% of PTs with cholelithiasis/cholecystitis? | Laparoscopic Cholecystectomy
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| What is done with the abdominal cavity during a Laparoscopic Cholecystectomy? | Abdomen is inflated with 3-4L of CO2 to improve visibility
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| Why is a Laparoscopic Cholecystectomy the prefered treatment? | *Less invasive, with shorter healing and recovery time *Less chance for infection or respiratory impairment *Less pain with more rapid return to normal activities
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| A small number of post op PTs who recieved a Laparoscopic Cholecystectomy will c/o of what? | Shoulder pain resulting from diaphragmatic irritation secondary to abdominal stretching or residual CO2
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| Within how long after a Laparoscopic Cholecystectomy can the PT resume moderate activity? | 48 - 72 hours
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| When can a PT who received a Laparoscopic Cholecystectomy return to work | w/in 3 days
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| When can a PT who recieved a Laparoscopic Cholecystectomy resume FULL actiity? | 1 week
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| When is a cholecystectomy performed? | If the gallbladder is extremely inflamed, infected, or has large gallstones
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| How is a cholecystectomy performed? | A small incision is made just below the rib cage on the right side of the abdomen and the gallbladder and all the vessels and tubes to and from the gallbladder are removed.
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| slide 64 |
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