Cholelithiasis and Cholecystitis Treatment

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Questions and Answers

What condition typically necessitates the surgical removal of the gallbladder?

Low risk for complications

Stable health status with no complications

Frequent symptoms and large stones (correct)

Asymptomatic gallstones

What test is more accurate than a CT scan for diagnosing cholelithiasis?

Oral cholecystogram

Abdominal x-ray

Gallbladder scan (HIDA scan)

Ultrasonography of the gallbladder (correct)

What does elevated direct bilirubin indicate?

Gallbladder removal

Normal bile flow

Hemolytic anemia

Obstructed bile flow (correct)

Which diagnostic test is performed with dye administered orally?

Oral cholecystogram Signup and view all the answers

What type of bilirubin is water-soluble and excreted in bile?

Direct bilirubin Signup and view all the answers

What serum test can indicate infection or inflammation in relation to gallbladder disease?

CBC with elevated WBC count Signup and view all the answers

Which diagnostic test is specifically used to diagnose cystic duct obstruction?

Gallbladder scan (HIDA scan) Signup and view all the answers

What defines indirect bilirubin?

Produced from hemoglobin breakdown Signup and view all the answers

What is the normal range for total bilirubin levels in adults?

0.1 to 1.2 mg/dL Signup and view all the answers

What type of bilirubin levels rise due to RBC hemolysis?

Indirect (unconjugated) bilirubin Signup and view all the answers

What is the appropriate surgical intervention for symptomatic cholelithiasis?

Laparoscopic cholecystectomy Signup and view all the answers

What risk is associated with laparoscopic cholecystectomy?

Conversion to an open surgical procedure Signup and view all the answers

What is a primary disadvantage of pharmacologic therapy for treating gallstones?

Cost and long duration Signup and view all the answers

What is the function of cholestyramine in treating bile flow obstruction?

Binds bile salts for fecal excretion Signup and view all the answers

Which gallstone dissolution drug works by decreasing cholesterol secretion from the liver?

Chenodiol Signup and view all the answers

Which condition can cause an increase in direct (conjugated) bilirubin levels?

Liver disease Signup and view all the answers

What is the reason for inserting a T-tube during a cholecystectomy when stones are lodged in the ducts?

To maintain patency of the duct Signup and view all the answers

What nursing care consideration should be monitored after shock wave lithotripsy?

Biliary colic Signup and view all the answers

In cases of biliary obstruction, which vitamins may need to be supplemented?

Fat-soluble vitamins A, D, E, and K Signup and view all the answers

What is the primary action of NSAIDs in managing the chronic pain of gallbladder attacks?

Decrease inflammation Signup and view all the answers

What type of stones are gallstone dissolution drugs less effective on?

Calcified stones Signup and view all the answers

What should be avoided when considering the herbal treatment of goldenseal during pregnancy?

Stimulation of the uterus Signup and view all the answers

Study Notes

Treatment of Cholelithiasis and Cholecystitis

Treatment for cholelithiasis and cholecystitis depends on the severity of the condition and the patient's overall health.
Conservative treatment is indicated for asymptomatic patients with low risk for complications.
Surgical removal of the gallbladder and stones is usually performed for patients with frequent symptoms, acute cholecystitis, or very large stones.

Diagnostic Tests

Serum bilirubin, CBC, serum amylase, and lipase are measured to evaluate for complications and differentiate gallbladder disease from other conditions.
Abdominal x-ray may show gallstones with high calcium content.
Ultrasonography of the gallbladder accurately diagnoses cholelithiasis and assesses gallbladder emptying.
Oral cholecystogram assesses the gallbladder's ability to concentrate and excrete bile.
A gallbladder scan, like cholescintigraphy (HIDA scan), helps diagnose cystic duct obstruction and acute or chronic cholecystitis.

Bilirubin Levels

Total bilirubin includes both indirect and direct forms.
Increased total bilirubin levels can be due to increased production, impaired metabolism or excretion.
Elevated direct bilirubin levels indicate impaired excretion due to liver or biliary system obstruction.
Elevated indirect bilirubin levels indicate increased red blood cell (RBC) hemolysis.

Surgery

Laparoscopic cholecystectomy is the preferred method for symptomatic cholelithiasis or cholecystitis.
This minimally invasive procedure has a low complication risk and typically requires less than 24 hours of hospitalization.
A cholecystectomy with common bile duct exploration might be necessary for stones lodged in the ducts.
A T-tube is used to maintain duct patency and promote bile passage while edema decreases.
A postoperative cholangiogram or endoscopic visualization of the duct may be performed to check for retained stones.
A cholecystostomy or choledochostomy might be considered for high-risk patients who cannot undergo laparoscopic cholecystectomy.
Extracorporeal shock wave lithotripsy may be an option to dissolve large gallstones.
Percutaneous cholecystostomy, ultrasound-guided gallbladder drainage, can delay or eliminate surgery in high-risk patients.

Pharmacologic Therapy

Nonsteroidal anti-inflammatory drugs (NSAIDs) can manage chronic pain from gallbladder attacks.
Narcotic analgesics like morphine may be necessary for acute pain relief.
Pharmacologic therapy is an alternative to surgery for high-risk patients who cannot undergo laparoscopic cholecystectomy.
Gallstone dissolution drugs like chenodiol (Chenodal) and ursodiol (Actigall, Urso Forte) can dissolve non-calcified gallstones smaller than 20 mm in diameter.
Antibiotics may be prescribed to treat infection and reduce inflammation and edema.
Cholestyramine (Questran) may be used to treat pruritus caused by bile salt accumulation in the blood.

Nonpharmacologic Therapy

Nasogastric tube insertion can relieve nausea and vomiting during acute cholecystitis.
Dietary fat intake may be limited, particularly for obese patients.
Fat-soluble vitamins (A, D, E, K) and bile salts may need to be administered if bile flow is obstructed.

Medications 10.2: Drugs Used to Treat Gallbladder Disease

Gallstone dissolution drugs: Chenodiol (Chenodal) and ursodiol (Actigall, Urso Forte) decrease cholesterol secretion from the liver and lower the cholesterol content of gallstones, promoting dissolution.
Nursing considerations include advising patients that these drugs do not dissolve calcified gallstones and that diarrhea may occur, requiring dose reduction.
Serum aminotransferase levels should be monitored for elevations.
Goldenseal, an herb used to treat cholecystitis, is not sufficiently supported for safe use by the National Center for Complementary and Integrative Medicine.
Berberine, an active component of goldenseal, stimulates bile and bilirubin secretion and inhibits pathogen growth, including those commonly found in the gallbladder.
Goldenseal is contraindicated during pregnancy and for nursing mothers due to uterus stimulation.

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Description

This quiz covers the treatment options for cholelithiasis and cholecystitis, focusing on both conservative and surgical approaches. It also explores the diagnostic tests used to evaluate gallbladder disease, including imaging and lab tests. Test your knowledge on this critical topic in gastroenterology!