Inflammation G allbladder Disease AampP Review Liver Biliary System and Pancreas Cholelithiasis Pathophysiology Pigment stones Cholesterol stones Risk factors Obesity Drugs Rapid Weight Loss ID: 646252
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Slide1
Hinkle, chapter 50, 1389-1401
Inflammation: G
allbladder
DiseaseSlide2
A&P Review:
Liver, Biliary System, and PancreasSlide3
Cholelithiasis
Pathophysiology
Pigment stones
Cholesterol stones
Risk factors
Obesity
Drugs
Rapid Weight Loss
Dehydration
Increased triglycerides
Fatty DietSlide4
Cholecystitis
Cholecystitis
is inflammation of the gallbladder
.
Acute
cholecystitis
is caused primarily by gallstone obstruction of the cystic duct with edema, inflammation, and bacterial invasion.
Chronic
cholecystitis
results from repeated attacks of
cholecystitis
, presence of stones, or chronic irritation. The gallbladder becomes thickened, rigid, fibrotic, and functions poorly
.Slide5
Cholecystitis
/
cholelithiasis
- manifestations
Can be caused by inflammation/infection alone or by inflammation/infection with stones.
--Sharp, cramping, or dull pain in RUQ
--May be constant or intermittent
--May refer to mid-back or right scapula
--+Murphy’s sign
--Clay-colored
stools
--Fever
--Nausea
and vomiting
--Jaundice of
skin and
sclera Slide6
Diagnostics
--
PE
--Elevated WBC, bilirubin, amylase and lipase, LFTs
(AST, ALT)
--+Abdominal CT or US
--+Oral
cholecystogram
--+Gallbladder
scan Slide7
Medical Management of
Cholelithiasis
Cholecystectomy—open or lap. Can range from
elective to emergency.
Lithotripsy
Basket extraction (see next slide)
Low fat diet
Medications: oral
ursodeoxycholic
acid and
chenodeoxycholic
acid to dissolve stones in poor surgical candidates. May take several months.Slide8
Nonsurgical Techniques for Removing GallstonesSlide9
Laparoscopic CholecystectomySlide10
Cholesterol Gallstones and Pigment GallstonesSlide11
Nursing
Management:
Preop Assessment
Patient history:
Pain
characteristics
GI
sx
Obstructive
sx
C
urrent
meds (Rx and OTC)
C
omorbidities
R
isk
factors for complications
Preop
knowledge and teaching needs (hint:
any postop abdominal surgery!)
Nutritional statusSlide12
Nursing Diagnoses
Acute pain
Impaired gas exchange
Impaired skin integrity
Imbalanced nutrition
Deficient knowledge
Risk for infectionSlide13
Collaborative Problems/Potential Complications
Bleeding
Gastrointestinal symptoms
Complications as related to surgery in general: atelectasis, thrombophlebitis Slide14
Nursing
Management: Planning and Outcomes
Relief of pain
Adequate ventilation
Intact incision
Improved biliary drainage
O
ptimal
nutritional intake,
A
bsence
of complications
U
nderstanding
of postop self-care Slide15
Postoperative Care Interventions
Low Fowler’s position
Care of drainage tubes: NG, JP, biliary
Care of IV and IV meds
Dressings
NPO until bowel sounds return, then a soft, low-fat, high-carbohydrate diet postoperatively
Analgesics as ordered and medicate to promote
ambulation and activities, including deep breathing
Turn, and encourage coughing and deep breathing, IS, splinting to reduce pain
Ambulation Slide16
Patient Teaching—Chart
50-2
Medications
Nutritious diet and avoid excess fat. Fat restriction is usually lifted in 4–6 weeks.
Wound care, dressing changes,
tube care
Activity
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