NUR 3219C – Adult Acute Exam 2, Nursing Course, Study Guide and System-Based Clinical
Review
cholelithiasis - ✔✔most common disorder of biliary system
-stones in gallbladder
cholecystitis - ✔✔-inflammation of the gallbladder
-usually associated with gallstones
cholecystitis risk factors - ✔✔"fair, fat, forty, female"
female
older than 40
estrogen therapy
sedentary life
family history
obesity
cholecystitis etiology - ✔✔-gallstones cause unknown
-develops when balance that keeps cholesterol, bile salts, and calcium is changed
-bile is supersaturated with cholesterol
-stasis of bile leads to biliary sludge
-stones can lodge in ducts and cause obstruction
cholecystitis manifestations - ✔✔-severe pain when stones move or obstruct (residual
tenderness in RUQ referring to right shoulder occurring 3-6 hours after high fat meal or when
lying down)
,-with total obstruction: dark urine, clay color stools, pruritus, intolerance to fatty foods,
steatorrhea
-leukocytosis
Stones moving/ lodged = spasms = pain - ✔✔Steady, excruciating
Tachycardia, diaphoresis, prostration
Residual tenderness in RUQ
Occur 3- 6 hours after high-fat meal or when patient lies down
When total obstruction occurs: - ✔✔Dark amber urine (bile into urine)
Clay-colored stools ( due to lack of bile)
Pruritus - bile salts >> itchy skin (jaundice in eyes)
Intolerance to fatty foods
Bleeding tendencies
r/t clotting factors bc < K abs = <prothrombin
Steatorrhea- fat in poop bc not digested
In addition to pain - ✔✔Indigestion
Fever, chills
Jaundice
Pain, tenderness RUQ
Referred to right shoulder, scapula
Nausea/vomiting
Restlessness
Diaphoresis
,Inflammation - ✔✔Leukocytosis
Fever
Physical examination findings - ✔✔RUQ or epigastrium tenderness
Abdominal rigidity
cholecystitis diagnostics - ✔✔-ultrasound, ERCP, percutaneous transhepatic cholangiography
-lab tests: increased WBC, serum and urinary bilirubin, liver enzymes, serum amylase
cholecystitis complications - ✔✔Gangrenous cholecystitis & bile peritonitis (most common
complication for older adults/ pts w/ diabetes)
Subphrenic abscess (accumulation of infected fluid between the diaphragm, liver, and spleen. )
Pancreatitis
Cholangitis (inflammation of biliary ducts)
Biliary cirrhosis
Fistulas
Gallbladder rupture leads to peritonitis
Choledocholithiasis
cholecystitis treatment - ✔✔Oral dissolution therapy
Ursodeozycholic acid (Ursodiol)- softens the stone so it passes thru easier
Chenodeozycholic acid (Chenodiol)
ERCP with sphincterotomy (wire basket snags stone) Extracorporeal shock-wave lithotripsy
(ESWL)
SURGERY:Cholecystotomy (Laporscopic* or Open)
DRUGS: analgesics, anticholinergics, biles Salts, fat soluble Vitamins (A, D,E & K)
Cholestyramine may be given for pruritus
, cholecystitis interventions - ✔✔-consult with nutritionist, have small frequent meals with
some fat, low in sat fat, high in fiber and calcium
- (diet < sat fat/calories, > fiber/Ca)
-treat severe pain
-fluid and electrolyte balance
- observe for complications
-manage nausea and vomitting (gastric decompression, oral hygiene, accurate intake and
output, antiemetics)
cholecystitis education - ✔✔Low-fat for 4-6 weeks following removal
Weight reduction if needed
Fat-soluble vitamin supplements
Teach what to report for T tubes if going home
Drainage tubes (dark green bile)
Follow-up care for open procedures: no heavy lifting for 4-6 weeks
Follow-up care for laparascopic procedures (see table 43.25)
Remove bandages day after surgery
NOTIFY: redness, sweliing, bile-color drainage/ pus | Severe abd pain, N&V, fever, chills
Return to work < 1 week
liver cancer - ✔✔-primary liver cancer originates as hepatocellular carcinomas
-metastatic liver cancer is more common than primary
liver cancer patho - ✔✔most common cause of death with patients diagnosed with cirrhosis
due to hep c
-single or multiple nodular lesions
Review
cholelithiasis - ✔✔most common disorder of biliary system
-stones in gallbladder
cholecystitis - ✔✔-inflammation of the gallbladder
-usually associated with gallstones
cholecystitis risk factors - ✔✔"fair, fat, forty, female"
female
older than 40
estrogen therapy
sedentary life
family history
obesity
cholecystitis etiology - ✔✔-gallstones cause unknown
-develops when balance that keeps cholesterol, bile salts, and calcium is changed
-bile is supersaturated with cholesterol
-stasis of bile leads to biliary sludge
-stones can lodge in ducts and cause obstruction
cholecystitis manifestations - ✔✔-severe pain when stones move or obstruct (residual
tenderness in RUQ referring to right shoulder occurring 3-6 hours after high fat meal or when
lying down)
,-with total obstruction: dark urine, clay color stools, pruritus, intolerance to fatty foods,
steatorrhea
-leukocytosis
Stones moving/ lodged = spasms = pain - ✔✔Steady, excruciating
Tachycardia, diaphoresis, prostration
Residual tenderness in RUQ
Occur 3- 6 hours after high-fat meal or when patient lies down
When total obstruction occurs: - ✔✔Dark amber urine (bile into urine)
Clay-colored stools ( due to lack of bile)
Pruritus - bile salts >> itchy skin (jaundice in eyes)
Intolerance to fatty foods
Bleeding tendencies
r/t clotting factors bc < K abs = <prothrombin
Steatorrhea- fat in poop bc not digested
In addition to pain - ✔✔Indigestion
Fever, chills
Jaundice
Pain, tenderness RUQ
Referred to right shoulder, scapula
Nausea/vomiting
Restlessness
Diaphoresis
,Inflammation - ✔✔Leukocytosis
Fever
Physical examination findings - ✔✔RUQ or epigastrium tenderness
Abdominal rigidity
cholecystitis diagnostics - ✔✔-ultrasound, ERCP, percutaneous transhepatic cholangiography
-lab tests: increased WBC, serum and urinary bilirubin, liver enzymes, serum amylase
cholecystitis complications - ✔✔Gangrenous cholecystitis & bile peritonitis (most common
complication for older adults/ pts w/ diabetes)
Subphrenic abscess (accumulation of infected fluid between the diaphragm, liver, and spleen. )
Pancreatitis
Cholangitis (inflammation of biliary ducts)
Biliary cirrhosis
Fistulas
Gallbladder rupture leads to peritonitis
Choledocholithiasis
cholecystitis treatment - ✔✔Oral dissolution therapy
Ursodeozycholic acid (Ursodiol)- softens the stone so it passes thru easier
Chenodeozycholic acid (Chenodiol)
ERCP with sphincterotomy (wire basket snags stone) Extracorporeal shock-wave lithotripsy
(ESWL)
SURGERY:Cholecystotomy (Laporscopic* or Open)
DRUGS: analgesics, anticholinergics, biles Salts, fat soluble Vitamins (A, D,E & K)
Cholestyramine may be given for pruritus
, cholecystitis interventions - ✔✔-consult with nutritionist, have small frequent meals with
some fat, low in sat fat, high in fiber and calcium
- (diet < sat fat/calories, > fiber/Ca)
-treat severe pain
-fluid and electrolyte balance
- observe for complications
-manage nausea and vomitting (gastric decompression, oral hygiene, accurate intake and
output, antiemetics)
cholecystitis education - ✔✔Low-fat for 4-6 weeks following removal
Weight reduction if needed
Fat-soluble vitamin supplements
Teach what to report for T tubes if going home
Drainage tubes (dark green bile)
Follow-up care for open procedures: no heavy lifting for 4-6 weeks
Follow-up care for laparascopic procedures (see table 43.25)
Remove bandages day after surgery
NOTIFY: redness, sweliing, bile-color drainage/ pus | Severe abd pain, N&V, fever, chills
Return to work < 1 week
liver cancer - ✔✔-primary liver cancer originates as hepatocellular carcinomas
-metastatic liver cancer is more common than primary
liver cancer patho - ✔✔most common cause of death with patients diagnosed with cirrhosis
due to hep c
-single or multiple nodular lesions
