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Terms in this set (43)
bilirubin doesn't enter the intestine, blood levels of bilirubin increase, causing increased renal excretion of urobilinogen causing gallbladder disorders
What happens if the flow of bile is impeded?
-increasing age (50-70)
-native american ancestry
-intestinal bypass surgery
-rapid weight loss
Cholesterol stones are associated with?
Pigment stones are associated with?
oral contraceptives and estrogens
Stone formation is frequent in those who use?
acute or chronic inflammation of the gallbladder
-pain that radiates to back, RUQ, and right shoulder
-biliary colic with n/v
-clay/gray feces and very dark urine
-vitamin a,d,e,k deficiency
-epigastric distress occuring after a meal
-murphy's sign (inspiratory arrest following palpation of RUQ due to pain)
Manifestations of cholecystitis
UDCA (continued 6-12 mo. with high recurrence rate) or CDCA
Medication for gallstones (cholelithiasis)
-ttube elevated above abdomen level
-measure and record drainage every 24 hrs
-clamp tube 1 hr before and after meals
-tube removed within 7 days to 3 weeks
-record i and o's
-expect 500-1500 mL drainage first day postop
Biliary drainage system care:
-low fowlers (15-30 degrees)
-may have NGT
-NPO until bowel sounds return
-soft, low-fat, high carb and protein diet
-ambulate, turn, coughing and deep breathing
Post-Op Cholecymectomy Care
bile duct injury- bile leaks, fluid collects, infection
Most serious postop cholecystectomy complication
4-6 weeks because may induce episode of cholecystitis
Postop cholecystectomy fat restriction for how many weeks?
appetite loss, fever, vomiting, pain, abdominal distention
postop cholecystectomy should report signs of :
-frequent changes in weight
-ileal resection or disease
Risk factors cholelithiasis
inflammation and autodigestion of the pancreas develops when pancreatic duct blocked, increase in enzymes of pancreas secreted and enter bile duct and reflux in to pancreatic duct.
; serious and unknown cause
-appears acutely ill
-sever abdominal pain and guarding
-fever and jaundice
-confusion and agitation
-ecchymosis in the flank or umbilical area
Manifestations of acute pancreatitis
-recurrent attacks of severe upper abdominal and back pain accompanied by vomiting
-steatorrhea (excess fat in feces, bulky, pale, oily and foul-smelling)
Manifestations of chronic pancreatitis
-narcotics for pain, no mereperdine
-IVF for electrolyte imbalance
-drugs to < gastric acid: H2 antagonist and proton pump inhibitor, antacids
-monitor for shock, hyperglycemia and renal failure
-no alcohol, low fat, bland diet and small frequent meals
Nursing management of acute pancreatitis
-meds to decrease gastric acid: PPIs, h2 antagonits, ocreotide
-bland, low-fat diet
-six small feedings daily, > caloric intake
-monitor for s/s diabetes mellitus
Nursing care for chronic pancreatitis
refers to incision of the common bile duct for the removal of stones
refers to opening and draining of the gallbladder
1. gallbladder stones (most common reason)
2. acalculous cholecystitis: post-ortho procedure/surgery, trauma/blood transfusions, burn patients, cystic duct obstruction, bacteria infection in gallbladder
Causes of cholecystitis:
-chemical changes and compressed gallbladder blood vessels causing increased risk for gangrene and perforated bladder
-can lead to secondary infection of normal gut flora
What problems could occur if bile outflow is blocked by stones left in the gallbladder?
Gallbladder disorders occur when there is an interference with normal drainage into the --.
liver, gallbladder, bile ducts
stores bile; emulsifies fat to make it more absorbable and eliminates biliruben
RUQ under liver surface; holds 30-50 mL of bile
Where is the gallbladder located?
CCK and cholecystokinin
Food with fat enters digestive tract and stimulates ---.
—> Gallbladder contracts and releases bile into common bile duct
-antibiotics and pain meds
-pt NPO until symptoms subside
-NG tube to suction out stomach content
-avoid fatty, fried foods
Cholecystitis nursing management:
gallbladder removal for severe/chronic
surgery to remove stones, bile or pus; decompression with tube placed to drain contents
opening of common bile duct to remove obstruction stones; may have t-tube after surgery to drain at surgical site
extracorporeal shock wave lithotripsy
shock wave therapy to destroy stones in biliary system
-strong analgesics and sedation before
-followed with oral dissolution therapy
-ng tube insertion before surgery
Preop surgery care for cholecystectomy:
Obstruction of bile flow interferes with absorption of the fat-soluble vitamins A,D,E,K
Why will patients with cholelithiasis have vitamin deficiencies?
Severe pain, tachycardia, diaphoresis
Biliary colic causes...
uses endoscope to go to the duodenum and identify location and presence of stones. Can insert catheter through endoscope to removed stone as well during this procedure. Can remove stones from common bile duct. Not used for initial evaluation but rather to actually remove the stones.
-analgesics, no mereperdine
-antiemetics and antispasmodics
-ng tube for gastric decompression
-hydrating fluids, monitor for dehydration
Nursing care for cholelithiasis:
Gland behind stomach on left side of abdomen
Where is the pancreas located?
chronic- hard to detect
acute- medical emergency
Acute vs. Chronic pancreatitis:
Amylase (carb breakdown), lipase (fat breakdown), trypsin (protein breakdown)
tumors, cysts, ulcers, infection, ETOH ABUSE, and Abdominal Trauma/ injury
Pancreatitis could be related to:
Increase with age; 80% of people with pancreatitis also have cholelithiasis or ETOH abuse
Risk factors for pancreatitis:
-repeated episodes of alcohol induced acute pancreatitis
-chronic obstruction of bile duct
What causes chronic pancreatitis?
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