what issues are common in gallbladder problems?
motility disturbances, biliary sludge, and biliary stasis (not moving)
what is cholelithiasis?
presence of gallstones in gallbladder
what is cholecystitis?
gallbladder inflammation, obstruction, infection caused from biliary sludge or biliary colic
what is choledocholithiasis?
gallstones occluding the common bile duct
what are the risk factors for gallbladder dysfunction?
- age > 40 y/o
- female, estrogen level, multiparous
- low calorie diets
- fatty, high cholesterol foods
- obesity, sedentary lifestyle
- disturbances in metabolism
what kind of disturbances in metabolism will cause a gallbladder dysfunction?
- diabetics
2. pregnant, multiparous, menopausal, or using birth control pills
what are the clinical manifestations of acute cholecystitis?
- RUQ pain- guarding, radiating occurring after a meal
- fever
- N/V
- anorexia
- jaundice may occur
what is murphy’s sign seen in acute cholecystitis?
press down under right side of rib cage, ask the patient to take a deep breath. when pt takes the deep breath it forces gallbladder into HCP’s hand causing the patient pain. this would be a positive sign
rupturing of the gallbladder does what?
relieves pain!!
when may acute acalculous cholecystitis occur? (AAC)
complication that may occur due to other various medical or surgical complications such as:
- prolonged immobility or fasting
- TPN
- Diabetes
what are the clinical manifestations of chronic cholecystitis?
- chronic inflammation
- calculi
- fibrosis or thickening of gallbladder
what are the complications for cholecystitis?
- choledocholithiasis
- gangrenous gallbladder
- pancreatitis
where is the gallbladder pain usually located?
RUQ and right shoulder
what labs will be done to diagnose cholecystitis?
- wbc
- erythrocyte sedimentation rate (ESR)
- c- reactive protein (CRP)
- liver functions test: ALT, AST, bilirubin, alk phos
what radiological diagnostic testing will be done to diagnose cholecystitis?
- abd CT, MRI, X-ray, ultrasound
- hepatobiliary imilodiacetic acid (HIDA scan, aka cholecystogram)
- endoscopic retrograde cholangiopancreatography (ERCP)
what are the acute care admission treatments for cholecystitis?
- NPO/ possible NGT for bowel and pancreas rest
- iv fluids
- meds: ATBs, antiemetics, PPIs, Questran, oral meds to dissolve gallstones
- pain meds: dilaudid recommended (morphine, codeine can cause spasms)
what procedures will be done to treat cholecystitis?
- ERCP
- extracorporeal shockware lithotripsy (ESWL)
- t-tube,
- intraoperative cholangiography
- direct cholelitholysis therapy
what surgical procedures will be done to treat cholecystits? where may the patient have pain? why?
- open vs laparoscopic removal of the gallbladder
2. post-op lap chole may have referred pain due to the CO2 used during surgery
what are some discharge teachings for a patient with cholecystitis?
- may need dietary changes initially, with small meals and decreased fat
- short term activity restrictions
- may shower in 1-2 days
