Cholelithiasis and Cholecystitis Overview
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Cholelithiasis and Cholecystitis Overview

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Questions and Answers

What is the indicated treatment for asymptomatic patients with gallstones and low risk for complications?

  • Administration of antibiotics
  • Immediate diagnostic testing
  • Surgical removal of the gallbladder
  • Conservative treatment (correct)

    • Elevated direct bilirubin levels indicate normal bile flow.

    False

    What diagnostic test can accurately diagnose cholelithiasis?

    Ultrasonography

    The water-soluble form of bilirubin is called __________.

    <p>direct bilirubin</p> Signup and view all the answers

    Which test uses a dye administered orally to evaluate gallbladder function?

    <p>Oral cholecystogram</p> Signup and view all the answers

    Match the following diagnostic tests with their features:

    <p>Ultrasonography = Noninvasive and accurate for cholelithiasis HIDA scan = Uses IV radioactive solution for diagnosis Abdominal x-ray = May show gallstones with high calcium content Oral cholecystogram = Dye administered orally to assess gallbladder function</p> Signup and view all the answers

    A high WBC count in a CBC test suggests the presence of infection and inflammation.

    <p>True</p> Signup and view all the answers

    What may elevated serum amylase and lipase levels indicate?

    <p>Possible pancreatitis related to common duct obstruction</p> Signup and view all the answers

    What is the primary purpose of inserting a T-tube during a cholecystectomy with common bile duct exploration?

    <p>To maintain patency of the duct and promote bile passage</p> Signup and view all the answers

    Laparoscopic cholecystectomy generally requires a hospital stay of more than 24 hours.

    <p>False</p> Signup and view all the answers

    What procedure may be performed if a stone is suspected to have been retained after surgery?

    <p>Postoperative cholangiogram or direct visualization with an endoscope</p> Signup and view all the answers

    The procedure used to break down large gallstones using shock waves is called __________.

    <p>extracorporeal shock wave lithotripsy</p> Signup and view all the answers

    Match the procedure with its description:

    <p>Cholecystostomy = Drainage of the gallbladder in high-risk patients Choledochostomy = Removal of stones from the common bile duct Laparoscopic cholecystectomy = Minimally invasive gallbladder removal Shock wave lithotripsy = Breaking down gallstones using shock waves</p> Signup and view all the answers

    Which of the following is a common nursing care task after laparoscopic cholecystectomy?

    <p>Monitoring for biliary colic</p> Signup and view all the answers

    Mild sedation is usually avoided during the extracorporeal shock wave lithotripsy procedure.

    <p>False</p> Signup and view all the answers

    What is the risk associated with laparoscopic cholecystectomy?

    <p>The need to convert to a laparotomy.</p> Signup and view all the answers

    What is the primary disadvantage of pharmacologic therapy for gallstones?

    <p>It is expensive and has a long duration</p> Signup and view all the answers

    Antibiotics are not used in the treatment of infections associated with gallstones.

    <p>False</p> Signup and view all the answers

    What is the purpose of cholestyramine in gallstone treatment?

    <p>To promote excretion of bile salts in the feces.</p> Signup and view all the answers

    Cholecystitis can be managed nonpharmacologically by inserting a __________ to relieve nausea and vomiting.

    <p>nasogastric tube</p> Signup and view all the answers

    Match the gallstone dissolution drugs with their examples:

    <p>Chenodiol = Chenodal Ursodiol = Actigall Goldenseal = Not recommended for use Berberine = Stimulates bile and bilirubin secretion</p> Signup and view all the answers

    Which type of gallstones are most effectively treated with pharmacologic therapy?

    <p>Cholesterol-rich stones</p> Signup and view all the answers

    Pharmacologic treatment of gallstones can lead to a reduction in stone formation when treatment is stopped.

    <p>False</p> Signup and view all the answers

    What might happen to bilirubin levels when bile flow from the gallbladder is obstructed by a gallstone?

    <p>Bilirubin levels in the blood may increase.</p> Signup and view all the answers

    What is the primary reason for converting from laparoscopic cholecystectomy to laparotomy during a procedure?

    <p>Inability to safely remove the gallbladder laparoscopically</p> Signup and view all the answers

    All patients can undergo laparoscopic cholecystectomy safely.

    <p>False</p> Signup and view all the answers

    What is inserted to maintain patency of the duct during common bile duct exploration?

    <p>T-tube</p> Signup and view all the answers

    Extracorporeal shock wave lithotripsy uses __________ to align gallstones with shock waves.

    <p>ultrasound</p> Signup and view all the answers

    Match the procedure with its indication:

    <p>Laparoscopic cholecystectomy = Symptomatic gallbladder disease Cholecystostomy = Poor surgical candidates Choledochostomy = Removal of stones in the bile duct Shock wave lithotripsy = Dissolving large gallstones</p> Signup and view all the answers

    In patients with mild sedation during extracorporeal shock wave lithotripsy, what is the main purpose of this sedation?

    <p>To relieve pain and anxiety</p> Signup and view all the answers

    A postoperative cholangiogram is performed only if bile flow is normal.

    <p>False</p> Signup and view all the answers

    What type of medication may be used to treat chronic pain during gallbladder attacks?

    <p>NSAIDs</p> Signup and view all the answers

    Study Notes

    Cholelithiasis and Cholecystitis Treatment

    • Conservative treatment is recommended for asymptomatic gallstones with a low risk for complications.
    • Surgical removal of the gallbladder and stones is usually indicated for patients experiencing frequent symptoms, acute cholecystitis, or very large stones.

    Diagnostic Tests

    • Elevated direct bilirubin levels can indicate obstructed bile flow in the biliary duct system.
    • Elevated white blood cell count may indicate infection and inflammation.
    • Serum amylase and lipase levels are measured to identify possible pancreatitis related to common duct obstruction.
    • Abdominal x-ray may show gallstones with high calcium content.
    • Ultrasonography of the gallbladder is a noninvasive test that accurately diagnoses cholelithiasis and assesses gallbladder emptying.
    • Oral cholecystogram evaluates the gallbladder's ability to concentrate and excrete bile using an oral dye.
    • Gallbladder scan (cholescintigraphy or HIDA scan) employs an IV radioactive solution to assess cystic duct obstruction and acute/chronic cholecystitis.

    Bilirubin Levels

    • Total bilirubin includes both indirect (unconjugated) and direct (conjugated) bilirubin.
    • Indirect bilirubin is bound to albumin and transported to the liver.
    • Direct bilirubin is water-soluble and excreted in bile.
    • Normal total bilirubin levels for adults are 0.1 to 1.2 mg/dL.
    • Elevated total bilirubin levels can occur due to increased production or impaired metabolism/excretion.
    • Normal direct bilirubin levels for adults are 0.1 to 0.3 mg/dL.
    • Elevated direct bilirubin levels can occur due to impaired excretion from liver or biliary system obstruction.
    • Normal indirect bilirubin levels for adults are less than 1.1 mg/dL.
    • Elevated indirect bilirubin levels can occur due to red blood cell hemolysis.

    Laparoscopic Cholecystectomy

    • Laparoscopic cholecystectomy is the preferred treatment for symptomatic gallstones or gallbladder inflammation.
    • This minimally invasive procedure typically results in a short hospital stay of less than 24 hours.
    • While generally safe, a laparoscopic cholecystectomy may need to be converted to an open abdominal surgery (laparotomy) during the procedure.

    Common Bile Duct Exploration

    • When gallstones are lodged in the bile ducts, a cholecystectomy with common bile duct exploration may be performed.
    • A T-tube is inserted into the common bile duct to maintain patency and facilitate bile flow.
    • Excess bile is collected in a drainage bag secured below the surgical site.

    Postoperative Cholangiogram

    • If a retained stone is suspected after surgery, a cholangiogram (imaging of the bile ducts) via the T-tube or endoscopic visualization of the duct may be performed.

    Alternative Procedures

    • Cholecystostomy (draining the gallbladder) or choledochostomy (removing stones and placing a T-tube) may be considered for high-risk patients who are not suitable for laparoscopic cholecystectomy.
    • Shock wave lithotripsy, using ultrasound to break down large gallstones, can be used in conjunction with drug therapy.

    Extracorporeal Shock Wave Lithotripsy

    • This procedure requires precise positioning and typically takes an hour to complete.
    • Mild sedation may be administered during the procedure.

    Nursing Care After Gallstone Procedures

    • Postoperative care includes monitoring for biliary colic (pain from gallbladder contractions to remove fragments), nausea, and transient hematuria (blood in the urine).

    Percutaneous Cholecystostomy

    • This procedure, using ultrasound guidance to drain the gallbladder, can be performed on high-risk patients to postpone or potentially avoid surgery.

    Laparoscopic Cholecystectomy

    • The gold standard treatment for symptomatic gallstones or inflammation of the gallbladder
    • Minimally invasive, with low complication risk
    • Usually requires less than 24 hours of hospital stay
    • Some patients may not be candidates for this procedure
    • May be converted to laparotomy if necessary during surgery

    Cholecystectomy with Common Bile Duct Exploration

    • Performed when stones are lodged in the ducts
    • T-tube inserted to maintain duct patency and promote bile passage
    • Excess bile is collected in a drainage bag
    • Post-operative cholangiogram or endoscopy may be performed to check for retained stones

    Alternative Treatments

    • Cholecystostomy: Drains the gallbladder in high-risk patients
    • Choledochostomy: Removes stones and positions a T-tube in the common bile duct (for high-risk patients)
    • Shock Wave Lithotripsy: Uses ultrasound to break up large gallstones
    • Percutaneous Cholecystostomy: Ultrasound-guided drainage of the gallbladder in high-risk patients

    Pharmacologic Therapy

    • NSAIDS: Treat chronic pain of gallbladder attacks
    • Narcotic Analgesics (e.g., morphine): Used for pain relief during acute attacks
    • Dissolving Drugs (e.g., chenodiol, ursodiol): For non-calcified stones less than 20mm in diameter
    • Antibiotics: For suspected gallbladder infection
    • Cholestyramine (Questran): Binds with bile salts to promote their excretion, treating pruritus

    Nonpharmacologic Therapy

    • Nasogastric tube: Inserted to relieve nausea and vomiting during acute cholecystitis
    • Dietary fat limitation: Especially for obese patients
    • Fat-soluble vitamin and bile salt supplementation: If bile flow is obstructed

    Nursing Considerations

    • Monitor for biliary colic: Following lithotripsy
    • Monitor for nausea: Post-procedure
    • Monitor for transient hematuria: Post-procedure
    • Advise on dietary limitations and potential side effects of medications
    • Educate on goldenseal contraindications (pregnancy, breastfeeding)

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    Description

    This quiz covers the diagnosis and treatment of cholelithiasis and cholecystitis. You will learn about conservative treatment options, surgical interventions, and important diagnostic tests such as ultrasound and blood tests. Test your knowledge on this significant topic in gallbladder health.

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