Gallbladder Disease Exam Ultimate Study Guide

Cholelithiasis

Gallstones, the calculi that form within the gallbladder or biliary ductal system.

Cholecystitis

Inflammation of the gallbladder wall, most commonly caused by obstruction of the cystic duct by an impacted stone.

Cholangitis

Inflammation of the bile ducts, usually caused by migration of gallstones into the biliary tree.

Biliary colic

Severe, steady visceral ache in the epigastric or RUQ region caused by distention of the cystic or common bile duct from a lodged stone.

Gallstone ileus

Mechanical obstruction of the small bowel caused by an eroded, large gallstone passing through the intestinal lumen.

Empyema (of the gallbladder)

A localized collection of infected, purulent exudate within the lumen of the gallbladder.

Fistula formation

An abnormal connection formed when stones erode through an inflamed gallbladder wall into adjacent organs such as the duodenum, colon, or stomach.

Gangrene

Ischemic death of gallbladder tissue that can lead to wall rupture and peritonitis.

Choledocholithiasis

Stones lodged in the common bile duct, which can cause jaundice, pain, and pancreatitis.

Jaundice

Yellowing of the skin and sclera caused by retention of bilirubin when bile flow is obstructed.

Acholic stools

Acholic, clay-colored stools caused by absence of bilirubin reaching the intestine due to biliary obstruction.

Direct (conjugated) bilirubin

Water-soluble bilirubin formed in hepatocytes by conjugation with glucuronic acid, which is excreted into bile.

Indirect (unconjugated) bilirubin

Lipid-soluble, water-insoluble bilirubin derived from hemoglobin breakdown that must bind albumin for transport to the liver.

Cholesterol gallstones

Stones composed predominantly of cholesterol, accounting for about $80\%$ of gallstones.

Pigmented gallstones

Stones made of bile salts, bilirubin, and calcium compounds, accounting for about $20\%$ of gallstones.

Cholesterol supersaturation of bile

Condition in which bile contains more cholesterol than bile salts and lecithin can solubilize, leading to crystallization and stone formation.

Biliary stasis

Delayed or incomplete gallbladder emptying that allows bile to concentrate and promotes stone precipitation.

HIDA scan (cholescintigraphy)

Radiopaque imaging test using an intravenous radioactive tracer cleared by hepatocytes into bile; failure to visualize the gallbladder indicates cystic duct obstruction.

Gallbladder ultrasonography

The premier, rapid, non-invasive diagnostic test for confirming cholelithiasis, superior in accuracy to CT scanning.

ABCG5/G8 variants

Genetic variants of the hepatic and intestinal cholesterol transporter that are the most prevalent hereditary predisposition to gallstone formation.

Referred pain pattern in biliary disease

Pain radiating to the back, right scapula, or right shoulder, commonly seen with gallbladder disease.

Total serum bilirubin normal range

Adult normal reference range for total serum bilirubin, approximately $0.1\text{ to }1.2\,mg/dL$.

Nursing interventions for acute cholecystitis

Withhold oral intake (NPO) and insert a nasogastric tube to low suction to prevent gallbladder contraction; place the patient in Fowler position to decrease pressure on the gallbladder; administer prescribed analgesics (avoiding meperidine) and IV antibiotics; monitor vital signs for signs of peritonitis; and provide education on adhering to a low-fat diet.