Medsurg Exam 2 PDF

# Medsurg Exam 2 ## Topic 5: Respiratory ### Tuberculosis * Airborne precautions * Effects: * Pulmonary * Bones * Kidneys * Reproductive organs * CNS * Caused by: * Mycobacterium tuberculosis * Tubercle bacilli * Acid-fast * Destroyed by heat * Risk Factors:...

# Medsurg Exam 2 ## Topic 5: Respiratory ### Tuberculosis * Airborne precautions * Effects: * Pulmonary * Bones * Kidneys * Reproductive organs * CNS * Caused by: * Mycobacterium tuberculosis * Tubercle bacilli * Acid-fast * Destroyed by heat * Risk Factors: * Close, constant contact with infected person * Autoimmunity * Alcoholism * ED workers * Prolonged use of corticosteroids * Infection * Latent * Dormant in lungs; reactivated by ex. stress * Active * Person experiences symptoms; active and spreading * Productive chronic cough * Hemoptysis * Fatigue * Anorexia * Diagnostics * Positive PPD * 10 mm or more positive * Positive sputum culture * Chest x-ray * Contraindications * BCG vaccine * HIV positive * Management * PPD 5 mm or more positive * 6-12 month therapy * INH & Rifampin * Eradicate infection * Combination Abx * S\E: peripheral neuropathy: tx: vit. B6 * Pyrazinamide * Active infection * Nursing Interventions * Airway clearance * Education * Drug regimen * Preventing spread * Avoid * Tuna * Yeast extract * Aged cheese * Soy sauce * Red wine * All cause excessive diaphoresis, palpitations * Nutrition * High protein, calorie, calcium, iron, vit. B6 ### Pneumonia * Inflammation of lungs * Types * Pneumonitis * Bronchopneumonia * Community-acquired * Hospital-acquired * Aspiration * Etiology * Influenza * Immunocompromised * Prolonged immobility * Smokers * Elderly * Risk Factors * Chronic diseases * Ineffective cough * Respiratory equipment * S&S * Cough * Fever * Tachycardia * Dyspnea * Respiratory distress * Nursing Diagnosis * FVD * Activity intolerance * Impaired gas exchange * Ineffective airway clearance * Complications * Atelectasis * Pleural effusion * Pericarditis * Superinfection * Shock ### Asthma * Chronic inflammation of the airway * Chronic obstruction of airway * Etiology * Allergy * Esophageal reflux * Risk Factors * Genetics * Elderly * Ethnicity * S&S * Chronic cough * Chest tightness * SOB * Wheezing * Management * Bronchodilators * Albuterol * Anti-inflammatory * Corticosteroids * Pulmicort * Mast Cell Stabilizers * Antihistamines * Methylxanthines * Complications * Pneumonia * Bronchospasm * Respiratory failure ### Emphysema * Loss of lung elasticity * Hyperinflation of lungs * Types * Panlobular * Destruction of entire alveoli & bronchioles * Centrilobular * Breakdown of bronchiole walls * Etiology * Smoking * Familial Alpha1-Antitrypsin deficiency * S&S * Cyanotic lips & fingers * SOB * Wheezing * Chronic cough * Phlegm * Complications * Acidosis * Pneumonia * Atelectasis * Cardiac failure * Hypoxemia ### Chronic Bronchitis * Inflammation of bronchi & bronchioles * Etiology * Smoking * Air pollution * S&S * Crackles * Fever * SOB * Wheezing * Chest pain * Muscle aches * Dependent edema * Management * Bronchodilators * ABX * Oxygen * Chest percussion * Hydration * Humidification * Complications * Emphysema * Superinfection * Pneumonia * Respiratory failure ## Topic 6: PVD & HTN ### Hypertension * Greater in African-Americans * Systemic arterial pressure= CO x peripheral vascular resistance * Systolic >140 mm Hg, Diastolic > 90 mm Hg * Progressive disease * JNC 8 (target BP with pre-existing HTN 150/90 or less) * Risk Factors * Medication non-compliance * Atherosclerosis * Smoking * Alcohol * Dyslipidemia * Diabetes * Elderly * Family history * Types * Primary * No known cause * Secondary * Disease * Medications * Malignant * Severe * Systolic 200 mm Hg * Diastolic 150 mm Hg * Blurred vision * SOB * Pulmonary * Increased vascular resistance of pulmonary vessels * Rebound * Discontinuing medication * Whitecoat * Anxiety from clinical setting * Isolated systolic * Elderly * Decreased elasticity of heart & blood vessels ### S&S * Early * High BP * HA * Progression * Late * Blurred vision * Papilledema * Heart failure * Ventricular hypertrophy * Kidney damage * Stroke * Diagnostics * Blood chemistry * Cholesterol levels * ECG * Medications * Thiazide diuretics * Beta-blockers * Calcium channel blockers * ACE inhibitors * ARBS * Nursing Care * Monitor K+ levels * High fiber diet * Drug compliance ### Crisis * Orthostatic hypotension * Urgency * No organ damage * Nml BP within 24-48 hours * Emergency * Beta-blockers * ACE inhibitors * Organ damage * Decrease BP by 25% within 1 hour * Gradual reduction over next 6 hours * IV vasodilators ### PVD * Venous insufficiency * Incompetent or damaged valve * Blood cannot be pumped back up toward heart * Blood pools * S&S * Red/blue discoloration * Pain with ambulation * Ankle edema * Lipodermatosclerosis * Stasis dermatitis ### PAD * Arterial insufficiency * Risk Factors * Atherosclerosis * Coronary artery disease * HTN * Diabetes * Obesity * Dyslipidemia * Diagnostics * Ankle-brachial index * Compared BP in foot to arm * Duplex screening * Identifies narrowed or blocked vessel * Stress Test * Angiography * Magnetic resonance * Computerized tomography * Catheter * Neurovascular checks to determine circulation * 5 P's * Pallor * Pulse * Pain * Paralysis * Paraesthesia * Management * Reduce progression of atherosclerosis * Dependent positioning * Ambulation * Smoking cessation * Check feet daily * Reduce caffeine intake ### Arterial Ulcers * Affects toes * Sharp edges * Pain * No blood flow * Nail beds * Grey * Rigid * Deep * Minimal drainage * Minimal pulses * Cool ### Venous Stasis Ulcers * Affects ankle * Irregular shape * Healthy base * Palpable pulses * Heavy drainage * Superficial * Warm ### Diabetic Ulcer * Affects plantar surface and heal ### Intermittent Claudication * Distance causes cramping & burning * Relieved by rest * Pain causes progression * Ambulation encouraged * Build collateral circulation- blood to pass blockage * Stages * 1. Asymptomatic * 2. Claudication * 3. Claudication at rest * Dependent positions * 4. Necrosis & gangrene * Medications * Antiplatelet aggregation agents * ASA * Statins * Vitamins * Folic acid * B6 & B12 * Surgery * Endarterectomy * Angioplasty * Atherectomy * Revascularization * Sympathectomy * Nursing Care * Assess ­­­­­ * Extremities­­­­­ * BP * Pulse * Bleeding * Limited ROM * Avoid crossing legs ### Buerger's Disease: * Upper and lower extremities * Young adult male smokers * S&S * Pain at rest * Increased sensitivity to cold * Ulcers * Gangrene * Tx * Smoking cessation * Amputation * Medication * Vasodilators ### Raynauds Phenomenon: * Vasospasms of hands and feet * Worsens with cold and stress * Secondary to: * Connective tissue disorders * Autoimmune disorders * S&S * Throbbing pain * Medications * Calcium channel blockers * Adrenergic blockers * Tx * Smoking cessation * Avoid OTC decongestants ### DVT * Blood clot deep in veins * Risk Factors * Surgery * Estrogen * Obesity * Prolonged standing * S&S * Calf or groin tenderness * Positive Homan's * Redness * Warmth * Tx * Compression stockings * Bed rest * Elevation * Rx warm soaks * Pulmonary Embolism: * Fat embolus * S&S * Chest pain * Tachycardia * Dyspnea * Dry cough * Blood tinged sputum * Tx * Heparin * Warfarin * Complete bed rest * Thrombectomy ### Varicose Veins: * Protruding veins, vein wall thickens and dilates * Pain with standing * Risk factors * Obesity * Prolonged standing * Heart disease * Family history * Tx * Anti-embolic stockings * Walking * Elevation * Vein removal ## Topic 7: Hematology ### Types of Anemia: * Hemorrhagic * Nutritional * Iron * B12 * Folic Acid * Hypoproliferative * BM unable to produce RBCs * Hemolytic * Destruction of RBCS * RES destroys * Chronic * Moderate: * Hgb 6-10 g/dl * Severe: * Hgb < 6 g/dl * Nursing Diagnosis * Fatigue * Activity intolerance * Periods of rest * Altered tissue perfusion * O2 therapy * Altered nutrition * Vitamin C * Cast iron pans/pots * Risk for ineffective management of therapeutic regimen ### Iron Deficiency Anemia * Total body iron decreased * 1mg absorbed for every 10-20mg ingested * Nml is 3mg * Ferritin<12 g/L * Microcytic * Risk Factors * Blood loss * Menstruation * Pregnancy * GI tumors * Alcoholism * High fiber diet * S&S * Dyspnea * Tachycardia * Pallor * Irritability * pica * Diagnostics * Barium studies * Occult blood * Colonoscopy * Management * Increase iron intake * Supplements * Food: bananas, lentils * Injections ### Folate Deficiency (Megaloblastic) * Big RBCs, insufficient carrying of O2 * Risk Factors * Genetics * Alcoholism * Insufficient intake * S&S * Pallor * Fatigue * Glossitis * Red beefy tongue * Diagnostics * Barium study * Management * Increased folic acid intake * PO supplement * Injection ### Pernicious Anemia * Decreased absorption of B12 (need intrinsic factors) * Megaloblastic & Microcytie * Nerve function * Decreased conduction * Paraesthesia * Risk Factors * Chronic gastritis * Medications * S&S * Heart failure * Glossitis * Pulmonary edema * Confusion * Vitiligo * Diagnostics * Schilling test * Management * B12 monthly injections * Daily weight * H&H 2x/week ### Aplastic Anemia * BM hypoplasia & aplasia * Normochromic * Pancytopenia * Deficiency of WBC, RBC, and platelets * Risk Factors * Congenital * Idiopathic * Acquired * Myelotoxins * Autoimmune * Infections * BM is replaced by fat * S&S * Pancytopenia * Lassitude * Dyspnea * Anorexia * Petichiate * Hypoxia * Thrombocytopenia * Diagnostics * CBC * BM aspiration * Management * Immediate withdrawal of cause * Transfusion * BM transplant ### Sickle Cell Anemia: * Both parents must have trait * Partial or complete replacement of abnormal Hgb S for normal Hgb A * RBC, crescent shape * Due to decreased 02 * Blood cells become dehydrated * High blood viscosity * Asymptomatic 4-6 months * Diagnostics * Hgb electrophores * Compares Hgb S to A * Sickledex * Assessment * History * Physical exam * Pain * Organ pain * "Sickle cell crisis" * S&S * Hemolysis ­­­­­­­ * Hgb 5-11 g/dl * Jaundice * Bone expansion * Cardiomegaly * Fatigue * Tolerance to pain medications * Management * Pain * Hydration * ABX * Chemo * Corticosteroids * Stem cell transplant * Nursing Diagnosis * Ineffective coping * Fatigue * Acute pain * Risk for infection * Deficient knowledge * Complications * Hypoxia * Ischemia * Dehydration * CVA * Organ failure * Polycythemia * Acute chest syndrome ### Vaso-Occlusive Crisis: * Organ & tissue swelling * Severe pain * Ischemia * Tx * Blood transfusions * Opioids on routine ### Splenic Sequestration Crisis: * Life threatening * Blood pools in spleen * Hypovolemic shock * Distended abdomen ### Aplastic Crisis: * Parvovirus B19 * Destroys RBCs ### Secondary Polycythemia * Excessive production of erythropoetin * Cyanotic heart disease * Tx * Transfusions * Hemosiderosis * Iron & Vit. C to promote iron excretion * Phlebotomy * Reduces production of abnormal cells * Reduces pain * Hydronurea ## Topic 8: GI disorders: ### GI Tract * Mouth * Saliva buffers HCl * Epiglottis * Prevents aspiration * Esophagus * Peristalsis * Lower esophageal sphincter prevents reflux * Stomach * Stores & mixes food with juices * Passes chime into small intestine * Empties 4-6 hours * Small intestine * Breaks down and absorbs CHO, fats, amino acids, glucose, fatty acids, vitamins, minerals * Large intestine * Absorbs excess water & electrolytes * Elimination ### GERD: * Backflow of gastric juices into esophagus * Risk factors * Obesity * Pregnancy * Lying flat * Calcium channel blockers * Estrogen * Smoking * Weak LES tone * Spicy & citrus food * Alcohol * Caffeine * Elderly * Pathophysiology * Change in pressure of gastroesophageal sphincter * Incompetent LES * Severity * Depends on frequency of reflux * Contents of reflux * Bufferin ability of saliva * Rate of gastric emptying * S&S * Dyspepsia * Burning sensation * After meals * Relieved with antacid * Pain * After activities * Walking can relieve * Nitroglycerin * Esophageal spasm ­­­­­­­ * Odynophagia * Beginning of meal * Sharp * Constricting * Stabbing * Intermittent dysphagia * Beginning of meal * Acid regurgitation * Water brash * Erucatation * Diagnostics * Barium swallow * Esophagoscopy * Esophageal biopsy * Management * Mild * Antacids * Work in 30 minutes * After meal * Mylanta * Persistent * Histamine receptor antagonist * Reduce gastric secretions * One hour before or after antacid * Pepcid * Severe * Cholinergic drugs * Increases LES pressure * Increases gastric emptying * Before meals * Metoclopramide * Proton-pump inhibitors * Suppresses gastric secretions * Omeprazole * Nursing Diagnosis * Imbalanced nutrition * Risk for aspiration * Pain * Deficient knowledge * Teaching * Chew food thoroughly * Avoid spices, hot/cold food * Avoid eating 2-3 hours before bed * Sleep at 30° angle * Sleep on left side to promote gastric emptying ### Hiatal Hernia: * Type 1 * Sliding hernia * Upper stomach & gastroesophageal junction in thoracic cavity * S&S * GERD like * Heartburn after meals * Substernal pain * Type 2 * Rolling or paraesophageal hernia * Gastroesophageal junction below diaphragm * All or part of stomach in thoracic cavity * Complications * Strangulation * Obstruction * S&S * Fullness after meals * Dyspnea * Chest pain * Etiology * Trauma * Congenital muscle weakness * Increased intraabdominal pressure * Management * Post-op * NG tube * Avoid gas-bloat syndrome * Ambulate to aid with eructation * Avoid activities that increase intra-abdominal pressure * More common in African Americans * Risk factors * Alcohol * Tobacco * GERD * Barrett's esophagus * Change in the cells in the esophagus * Skin cells - intestinal cells * Diagnostics * Barium swallow * Endoscopy * Esophagus biopsy * S&S: * Dysphagia * Painful swallowing * Weight loss * Fullness * Regurgitation of undigested food * Foul breath * Hiccups * Nocturnal aspiration * Sialorrhea * Management * Cure * Palliation * Surgery * Esophagectomy * Esophagogastrostomy * Esophagoenterostomy * chemotherapy/radiation * NG tube * PEG tube * Receptacle for saliva ### Gastric Cancer * Risk factors * H. pylori * Smoking * Alcohol * Late diagnosis * S&S * Cure almost 0% * Weight loss * Abdominal pain * Bloating * Reflux * Elderly * Confusion * Restlessness * Severe bloating * Diagnostics * CT * Biopsy * Tx * Surgery * Billroth 1 * Gastroduodenostomy * Billroth 2 * Gastrojejunostomy * Total gastrectomy * Esophagojejunostomy * Lifelong B12 injection * Chemotherapy/radiation * Management * Incentive spirometer * TPN * PEG * Assess for abdominal distention * Anti-inflammatory drugs with food * Nursing Diagnosis * Altered nutrition ­­­­­­­ * Deficient knowledge ### Dumping Syndrome: * Food rapidly enters jejunum * S&S * Weakness * Dizziness * Diaphoresis * Tachycardia * Abdominal cramps * Fullness * Teaching * No fluids with meals * No high carbs * High protein & fat * Small meals ### Peptic Ulcer Disease: * Stress Ulcer * Increase gastric secretions * Duodenal Ulcer * Chronic breaking in mucosal lining * Gastric Ulcer * Deep break in lesser curvature of stomach * Pathophysiology * Mucosal lesion * Risk Factors * H. Pylori * HCl * Biliary acid * NSAIDS * S&S * Dyspepsia * Pyrosis * Reflux into mouth * Vomiting * Burning sensation * Weight loss * Bloating * Tx * Proton pump inhibitors * Antacids * Stress reduction * Smoking cessation * Dietary changes * Complications * Hemorrhage * Intractable disease ­­­­­­­ * Pyloric obstruction * Peritonitis * Diverticular disease: * Acquired or congenital * Diverticula * Pouchlike herniations of mucosa through small intestine or sigmoid colon * Diverticulosis * Diverticula low fiber diets predispose * Asymptomatic ­­­­ * Inflammation of diverticula * Diverticulitis ­­­­­­­ * Etiology ­­­­­­­ * Low fiber diet ­­­­­­­ * Chronic constipation ­­­­­­­ * Pathophysiology ­­­­­­­ * Herniations where intestinal musculature is weak ­­­­­­­ * Food trapped in herniated area * Fecalith ­­­­­­­ * Infection ­­­­­­­ * Undigested food that decomposes ­­­­­­­­ * Compromises blood supply ­­­­­­­ * Spastcity of colon ­­­­­­­ * Complications ­­­­­­­ * Fistulas ­­­­­­­ * Obstruction ­­­­­­­ * Abscess formation ­­­­­­­ * Perforation ­­­­­­­ * Peritonitis ­­­­­­­ * S&S ­­­­­­­ * Bowel irregularity ­­­­­­­ * Diarrhea ­­­­­­­ * Occult blood ­­­­­­­ * Weakness ­­­­­­­ * Anorexia ­­­­­­­ * Fever ­­­­­­­ * LLQ pain ­­­­­­­ * Guarding & rigidity due to peritonitis ­­­­­­­ * Diagnostics ­­­­­­­ * Decreased het & hgb ­­­­­­­ * Elevated WBC ­­­­­­­ * 20% positive occult blood ­­­­­­­ * Barium contract ­­­­­­­ * Barium enema ­­­­­­­ * Colonoscopy ­­­­­­­ * Sigmoidoscopy ­­­­­­­ * Management ­­­­­­­ * Mild-moderate ­­­­­­­ * Clear liquids until inflammation subsides ­­­­­­­ * Low fat diet ­­­­­­­ * ABX ­­­­­­­ * Laxatives ­­­­­­­ * Hospitalization ­­­­­­­ * Severe ­­­­­­­ * NG tube ­­­­­­­ * NPO ­­­­­­­ * Low fiber diet in beginning ­­­­­­­ * Severe ­­­­­­­ * Oral intake as symptoms subside ­­­­­­­ * Antispamodics ­­­­­­­ * Bowel antimircobials ­­­­­­­ * Stool softeners ­­­­­­­ * Oil rententine enemas ­­­­­­­ * Surgey ­­­­­­­ * Removal of area affected by diverticulitis ­­­­­­­ * Temporary colostomy ­­­­­­­ * Medications ­­­­­­­ * Metronidazole or Cirpo ­­­­­­­ * Out-patient ­­­­­­­ * Metronidazole & Cefoxitin IV ­­­­­­­ * Hospitalized ­­­­­­­ * Morphine or Demerol ­­­­­­­ * No laxatives or enemas ­­­­­­­ * Post-op ­­­­­­­ * NPO ­­­­­­­ * Liquid diet ­­­­­­­ * NG tube immediately ­­­­­­­ * Abdominal drain ­­­­­­­ * Teaching ­­­­­­­ * No veggies with seeds ­­­­­­­ * Get lodged - flare ups ­­­­­­­ * Fiber from whole grains & veggies ­­­­­­­ * Nursing Diagnosis ­­­­­­­ * Acute pain related to increased peristalsis & GI inflammation ­­­­­­­ * Actvity intolernace related to generalized weakness ­­­­­­­ * Deficient fluid volume related to anorexia, nausea, diarrhea ### Inflammatory Bowel Disease * Acute * Appendicitis * Peritonitis * Gastroenteritis * Chronic * Crohn's * Ulcerative colitis * Etiology * Unknown * Pesticides * NSAIDS * Radiation * Autoimmune * Enteric pathogens * Genetics * Ulcerative Colitis: * Inflamed lining of colon & rectum * Colon wall thickens ­­­­­­­ * Begins at rectum proceeds to colon * S&S * pus/mucus in stool * Decreased absorption of fluids * Weight loss * Dehydration * Vomiting * Fever * Hemorrhage * LLQ pain * Fistulas * Toxic megacolon * Fibrosis * Diagnostics * Barium enema * Positive occult blood * Low H&H * Decreased electrolytes & albumin * Management * Induced remission * Control flare ups * Maintain remission * Prevent flare ups ­­­­­­­ * Improved quality of life * Medication * Salicylate compounds * Sulfasalazine * Reduces inflammation * Take with food * Take with folic acid * Increase fluids * Immunosuppressive agent * With corticosteroids * Remicade (IV) * IgG monoclonal antibodies * Used when nothing works * Antidiarrheal * Immodium * Anticholinergics ­­­­­­­ * Before meals * Bentyl * Nutrition * Low fiber * Low fat * High protein * High calories * Avoid gas forming foods and caffenated beverages * Avoid dairy ­­­­­­­ * Surgical ­­­­­­­ * NPO during acute exacerbations * Total colectomy with ileostomy * Total colectomy with ileoanal anastomosis * Colon and rectum removed * Permanent ileostomy * Colon, rectum, anus removed * Intra-abdominal pouch, continent ileostomy or "kock's" * Ileum brought through abdominal wall * J pouch * Colon removed * Pre-op * Psychological exam * Bowel prep * Neomycin * Cleansing enema * Incentive spirometry * Colostomy specialist * Post-op * NPO right after * Increased fluid intake * Avoid high fiber & cellulose * Wash incision site with warm water * Change ostomy every 5-7 days * Irrigate with 500-1000 ml warm tap water * Empty ½ full * Avoid enteric coated pills * Avoid laxatives & enemas * 20+ liquid stools/day * Daily wei­ght * Progressive diet * Crohn's Disense: * "Regional enteritis" * Inflammation of small intestine or colon * Terminal ileum * Each attack causes scarring & decreased absorption * Abnormal immune response * S&S * Steatorrhea * Fatty stools 5-6/day * RLQ pain * Periumbilical pain ­­­­­­­ * Weight loss * Fistulas ­­­­­­­ * Abnormal tunnelig that connected two organs * Deficiency in fat soluble vitamins * Diagnostics * Occult blood * Pyuria ­­­­­­­ * Pus in urine * Nursing Diagnosis * Fistula in bowel or bladder * Nutritional imbalance * FVD * Activity intolerance * Management * Anti-diarrheal medications * Corticosteroids * High protein & vitamin diet * TPN * Bed rest * Maintain fluid intake * No fresh fruits or vegetables * Intestinal Obstruction: * Complete or partial impaired forward flow * Small in ileum ­­­­­­­ * Large in sigmoid ­­­­­­­ * Emergency, tx needed in 24 hours ­­­­­­­ * Etiology ­­­­­­­ * Adhesions ­­­­­­­ * Hernias ­­­­­­­ * Fecal impactions ­­­­­­­ * Strictures ­­­­­­­ * Intussusception ­­­­­­­ * Bowel goes into itself, causing it to shorten ­­­­­­­ * Volvulus ­­­­­­­ * Bowel is twisted * S&S * Abdominal cramps * Small bowel * Mid & upper pain * Colon * Lower pain * Nausea & vomiting * orange/brown with fecal odor * Obstipation ­­­­­­­ * Nothing can pass ­­­­­­­ * Partial obstruction ­­­­­­­ * Diarrhea ­­­­­­­ * Ribbon-like stools ­­­­­­­ * Diagnostics ­­­­­­­ * CBC ­­­­­­­ * Elevated amylase (pancreas affected) * ABG abnormal * Colonoscopy ­­­­­­­ * Tx ­­­­­­­ * Nonmechanical obstruction ­­­­­­­ * NG tube­ ­­­­­­­­ * Mechanical obstruction ­­­­­­­ * Removal of obstruction * Fluid & electrolyte replacement ­­­­­­­ * Pain ­­­­­­­ * Avoid opioids ­­­­­­­ * ABX ­­­­­­­ * Surgery ­­­­­­­ * Unknown cause ­­­­­­­ * Laparotomy ­­­­­­­ * Adhesions removal ­­­­­­­ * Bowel resection * Cholecystitis: * Inflammation of gallbladder ­­­­­­­ * Calculous ­­­­­­­ * Gall stones * Empyema * Pus in blood * Perforation * Edema ­­­­­­­ * Acalculous ­­­­­­­ * No gall stones * After trauma or severe burns * S&S * Biliary colic- spasm of biliary duct * RUQ pain & tenderness/rigidity * Fullness feeling * Jaundice * Pruritis * Clay colored stools * Tea colored urine * Elevated bilirubin in blood * Cholelithiasis: * Calculi in gallbladder * Pigment 25% gallstones * Cholesterol 75% gallstones * Biliary colic * Obstruction of cystic duct * Choledocholithiasis: * Stones in common bile duct * Gall Bladder: * Stores bile * Releases bile * Common bile duct connects with duodenum * Bile: * Made in liver * Aids in digestion * Emulsification of fats * Excretion of RBC * Incidence: * Obesity * Women 70% * Higher mortality in men * Hormone therapies * Frequent changes in weight * Diseases * Diabetes * Cystic fibrosis * High fat diet * Diagnostics: * Ultrasonography * 95% accuracy * Endoscopoic retrograde cholangiopancreatography * Percutaneous transhepatic cholangiography * MRI * Tx: * Identify calified stones * ERCP/PTC * Removal of stones * Extracorporeal Lithotripsy * Dissolves stones * Stones >3mm in size * >4 stones in quantity * Low fat/cholesterol diet * Avoid alcohol * ABX * Lipid & cholesterol lowering drugs * Antispamodics * Demerol * Post-op: * Monitor vital signs * Biliary drainage normal in beginning * T-tube * Empty every 8 hours * Incentive spirometer * Low fat diet * Report * Fever * Pru