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