CHOLECYSTITIS/CHOLELITHIASIS OUTLINE: A. CHOLELITHIASIS- gallstones B. CHOLECYSTITIS- Inflammation of the lining of the gallbladder, assoc, w/ obstruction C. PRECIPATATING FACTORS a.

Obesity b. Sedentary lifestyle c. Family disposition d. Postmenopausal women on estrogen therapy D. ETIOLOGY a. Unknown b. Preceipation of calcium, bile salts, cholesterol c. Bile stasis 7 obstruction E. S/S CHOLECYSTITIS/CHOLELITHIASIS a. Indigestion b. RUQ pain- shoulder pain- referred c. N&V, dyspepsia, flatulence, N&V, diaphoresis, erunctation, feeling of fullness d. Jaundice e. Increased WBC w/ tachycardia 7 dehydration f. Increased serum 7 urinary amylase g. Increased liver enzymes 7 bilirubin h. Steatorrhea i. Fever j. Sausage shaped mass k. Murphys sign- palpation of costal margin yields pain w/ deep inspiration l. Blumbergs sign- guarding w/ rebound tenderness F. LABS & DIAGNOSTICS a. Abdominal ultrasound b. ERCP c. Choleangiography d. WBC e. Amylase f. Liver enzymes & bilirubin G. COMPLICATIONS a. Gangeranous cholecystitis b. Pancreatitis c. Abscess d. Peritonitis e. Fistulas f. Biliary cirrhosis g. Cholangitis-infection of common bile duct h. Carcinoma H. COLLABORATIVE & NSG CARE a. CONSERVATIVE THERAPY i. Encourage pt eat frequent sm low fat meals ii. Admin fat-sol vitamins & bile salts when gallstones causing obstruction iii. NPO when N&V; NG w/ sxn when severe

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b. DRUGS i. Opiods ii. Anticholinergics& antispasmodics iii. Antiemetics iv. Bile salts- actigal, decholin v. Vit A, D, E, K vi. Cholestyramine (questran) c. SURGERY i. Percutaneous transhepatic catheter- to decompress hepatic duct allows bile flow ii. Cholecystectomy 1. Pre-op a. Teach cough/deep bx, turning, early ambulation b. Teach splint incision while cough 2. Laparoscopic procedure a. Post-op i. Early ambulation ii. Return to normal activities in 1-3wks 3. Traditional- requires T-tube insertion into biliary ducts to maintain patency a. Post-op i. Administer IV opiods ii. Administer antiemetics iii. Advance diet from liquid to solid iv. Manage t-tube: 1. Keep t-tube below level of gallbladder 2. Assess characteristics drainage 3. Report drainage >1000mL in 24hrs 4. Assess foul & purulent drainage & report 5. Assess insertion site 6. Do not clamp or irrigate tube without D.O 7. Maintain patency of t-tube 8. Place semi-fowlers 9. Assist early ambulation 10. Teach to observe for brown stools 7-10dys NURSING INTERVENTIONS a. I.D those at risk b. Acute interventions i. Relief of pain ii. Relief of nausea iii. Comfort 7 support iv. Fluid & e-lyte balance 1. Oral & nasal hygiene if NPO w/ NG sxn v. Assess s/s obstruction: jaundice, puritis, steatorrhea vi. Assess infection