Studied by 0 people
Looks like no one added any tags here yet for you.
What is the primary cause of GERD?
The primary cause of GERD is the relaxation of the Lower Esophageal Sphincter (LES), which allows stomach contents to back up into the esophagus.
Which medication is a proton-pump inhibitor (PPI) used to treat GERD?
Prilosec is a proton-pump inhibitor (PPI) used to decrease stomach acid production and help heal the esophagus.
What is the role of Reglan in GERD treatment?
Reglan is a prokinetic drug that helps by improving gastric emptying, increasing pressure in the lower esophageal sphincter (LES), and improving peristalsis in the GI tract.
Which medication is an anticholinergic used to treat overactive bladder and IBS?
Oxybutynin (Ditropan XL) is an anticholinergic medication that blocks neurotransmitters in the brain and is used to treat overactive bladder and irritable bowel syndrome (IBS).
What symptom is most commonly associated with GERD?
Heartburn is the most common symptom associated with GERD, caused by stomach acid backing up into the esophagus.
What is the main function of Pepcid (a Histamine H2 blocker) in GERD treatment?
Pepcid (a Histamine H2 blocker) helps relieve heartburn by reducing stomach acid production. It starts working within 15-30 minutes.
Which medication works by blocking neurotransmitters to treat overactive bladder and IBS?
Oxybutynin (Ditropan XL) works by blocking neurotransmitters in the brain and is used to treat overactive bladder and irritable bowel syndrome (IBS).
What surgical intervention may be required to treat GERD when medications are ineffective?
When medications are ineffective, surgical intervention to repair or strengthen the Lower Esophageal Sphincter (LES) may be required to prevent acid reflux.
How do Proton Pump Inhibitors (PPIs) help treat GERD?
PPIs, like Prilosec, reduce stomach acid production, thereby helping to heal the esophagus and reduce acid reflux symptoms.
Which drug is typically used to prevent and treat ulcers in the duodenum and stomach?
Prilosec is typically used to prevent and treat ulcers in the duodenum and stomach by reducing stomach acid.
What is the purpose of an Esophagogastroduodenoscopy (EGD)?
The purpose of EGD is to examine the lining of the esophagus, stomach, and duodenum (first part of the small intestine) to diagnose and treat upper GI tract disorders.
What is the priority nursing action after a patient has undergone an EGD?
The priority nursing action is to check for the return of the gag reflex, ensuring that the patient can safely swallow and preventing aspiration.
Which symptoms might indicate the need for an EGD?
EGD may be indicated for symptoms like abdominal pain, difficulty swallowing, prolonged nausea and vomiting, heartburn, unexplained weight loss, anemia, and blood in bowel movements.
What sedation is typically used during an EGD?
Conscious Sedation (Moderate Sedation) is commonly used during an EGD, making the patient drowsy and forgetful but able to follow simple instructions, or Deep Sedation, which puts the patient into a deeper sleep to ensure no discomfort.
What is the role of sedation during an EGD?
Sedation during an EGD helps relax the patient, subdues the gag reflex, and ensures comfort by putting the patient in a moderate to deep sleep during the procedure.
What is the purpose of performing an EGD in the context of Peptic Ulcer Disease (PUD)?
An EGD is performed to diagnose and assess upper GI tract disorders like Peptic Ulcer Disease (PUD), providing a clear view of the esophagus, stomach, and duodenum to guide treatment.
What is the most important post-procedure assessment after an EGD?
The most important post-procedure assessment is to check for the return of the gag reflex, as this is crucial for ensuring the patient can swallow safely and avoid aspiration.
What is a key consideration for a nurse when a patient is recovering from an EGD?
A key consideration is ensuring that the gag reflex has returned before allowing the patient to eat or drink to prevent aspiration.
What is the patient experience during conscious sedation for an EGD?
During conscious sedation, the patient feels drowsy and forgetful but can still follow simple instructions while in a light sleep.
What could be an indication of a Peptic Ulcer?
Common indications of a Peptic Ulcer include abdominal pain, nausea, vomiting, heartburn, unexplained weight loss, and in some cases, blood in the stool or anemia.
What does the Biliary System consist of?
The Biliary System consists of the gall bladder, hepatic duct, cystic duct, and the common bile duct, all of which are involved in the production and transportation of bile.
What is the main function of the Biliary System?
The main function of the Biliary System is to drain waste products from the liver into the duodenum and help with digestion by releasing bile.
What is bile and what does it contain?
Bile is a greenish-yellow fluid produced by the liver that contains cholesterol, bile salts, and waste products like bilirubin. It aids in digestion, especially the breakdown of fats.
What are the two primary functions of bile?
The two primary functions of bile are to carry away waste (bilirubin) and to break down fats during digestion.
What happens when bile ducts become blocked?
When bile ducts become blocked, bile builds up in the liver, causing jaundice (yellowing of the skin) due to the increased bilirubin levels in the blood.
What is the role of bile salts?
Bile salts help the body break down and absorb fats during digestion. They are eventually excreted in the feces, which gives them their dark brown color.
What are some common causes of benign bile duct strictures?
Benign bile duct strictures are often caused by surgical inexperience, failure to recognize abnormal biliary anatomy, congenital anomalies, acute inflammation, and misplacement of clips or excessive cautery, leading to ischemic injury.
What can bile duct strictures lead to?
Bile duct strictures may lead to obstructive jaundice, which includes symptoms like abdominal pain, nausea, vomiting, fever, and leukocytosis.
How is bile released into the small intestine?
After being stored in the gallbladder, bile is released into the small intestine following a meal to aid in the digestion of fats.
What happens if bile is not properly released into the small intestine?
If bile is not properly released due to bile duct obstruction, it can result in jaundice, as the accumulated bilirubin in the blood causes a yellowing of the skin.
What is Cholelithiasis?
Cholelithiasis refers to the presence of gallstones in the gallbladder. It is the most common biliary disorder.
What are the clinical manifestations of Cholelithiasis?
Clinical manifestations of Cholelithiasis include:
Stationary or mobile stones (when lodged or moving through ducts).
Severe steady pain in the right upper quadrant (RUQ).
Excruciating pain with tachycardia, diaphoresis, and extreme physical weakness.
Pain often occurs 3-6 hours after a high-fat meal or when the patient lies down.
What long-term effects can occur due to Cholelithiasis?
Over time, bile overflow blockage due to gallstones can lead to liver fibrosis and cirrhosis.
What are the three main types of Cholelithiasis?
The three main types of Cholelithiasis are:
Cholesterol stones
Pigment stones
Mixed stones
What is the pathophysiology of Cholelithiasis?
Cholelithiasis occurs due to the overproduction of cholesterol, bilirubin, and calcium salts, which form gallstones. Stones may migrate to the cystic or common bile ducts, causing pain and potential obstruction, which can lead to cholecystitis.
What is cholesterol supersaturation, and how does it contribute to Cholelithiasis?
Cholesterol supersaturation occurs when the cholesterol concentration in bile exceeds its solubility, leading to the formation of gallstones. This is essential for the development of cholesterol stones.
What is the prevalence of Cholelithiasis in the U.S.?
Cholelithiasis affects more than 20 million Americans each year. It is more common in women and is often referred to by the 4 Fs: Female, Fertile, Fat, Forty.
What is the economic impact of Cholelithiasis?
The medical costs of Cholelithiasis amount to $6.3 billion annually in the United States.
What is the role of Cholesterol 7α-Hydroxylase in bile acid biosynthesis?
Cholesterol 7α-Hydroxylase is a key enzyme for bile acid biosynthesis and cholesterol elimination. Reduced enzyme activity can lead to excessive cholesterol secretion, contributing to gallstone formation.
How does reduced activity of Cholesterol 7α-Hydroxylase contribute to gallstone formation in non-obese individuals?
In non-obese individuals, reduced activity of Cholesterol 7α-Hydroxylase leads to excessive cholesterol secretion, which contributes to gallstone formation.
What happens when there is an interruption of enterhepatic circulation of bile acids?
Interruption of enterohepatic circulation of bile acids increases bile saturation, promoting the formation of cholesterol gallstones.
How does overnight fasting contribute to cholesterol gallstone formation?
During overnight fasting, there is a temporary interruption of enterhepatic circulation, which increases the cholesterol/phospholipid ratio in liver-secreted vesicles, promoting gallstone formation.
How does estrogen treatment affect the risk of cholesterol gallstones?
Estrogen treatment reduces bile acid synthesis in women, which increases the risk of cholesterol supersaturation and gallstone formation.
What are the clinical manifestations of Cholelithiasis?
Clinical manifestations of Cholelithiasis include:
Stationary or mobile stones (depending on whether the stone is lodged or moving).
Severe, steady pain in the right upper quadrant (RUQ).
Excruciating pain with tachycardia, diaphoresis, and extreme physical weakness.
Pain often occurs 3-6 hours after a high-fat meal or when the patient lies down.
Over time, bile overflow blockage can lead to liver fibrosis and cirrhosis.
What do radiology results typically show in a patient with Cholelithiasis?
Radiology results (such as an abdominal ultrasound) often show retained stones in the common bile duct.
What surgical procedure is commonly performed to treat Cholelithiasis?
A laparoscopic cholecystectomy is commonly performed to treat Cholelithiasis by removing the gallbladder.
What lab result should you look for in Cholelithiasis regarding WBCs?
WBCs may be elevated due to inflammation or infection, such as cholecystitis.
What lab result should you look for in Cholelithiasis regarding bilirubin levels?
Bilirubin levels may be elevated if there is bile duct obstruction, leading to jaundice.
What lab result should you look for in Cholelithiasis regarding ALT/AST levels?
ALT and AST liver enzymes may be elevated in cases of liver involvement or bile duct obstruction.
What lab result should you look for in Cholelithiasis regarding amylase and lipase?
Amylase and lipase may be elevated in the case of pancreatitis, which can result from gallstone obstruction.
What is the normal WBC count?
The normal WBC count is 4,000 to 11,000 cells/µL.
What is the normal total bilirubin level?
The normal total bilirubin level is 0.3 to 1.2 mg/dL.
What is the normal direct bilirubin (conjugated) level?
The normal direct bilirubin (conjugated) level is 0 to 0.3 mg/dL.
What is the normal indirect bilirubin (unconjugated) level?
The normal indirect bilirubin (unconjugated) level is 0.2 to 0.8 mg/dL.
What are some conservative treatments for Cholelithiasis?
Dietary modifications (low-fat diet)
Pain management with NSAIDs or opioids as needed
What medication is used to dissolve small cholesterol gallstones?
Ursodeoxycholic acid (Actigall, Urso) can be used to dissolve small cholesterol gallstones.
What is the most common surgical treatment for Cholelithiasis?
The most common surgical treatment is Laparoscopic Cholecystectomy (gallbladder removal).
What procedure is used to remove stones from the bile duct in Cholelithiasis?
Endoscopic Retrograde Cholangiopancreatography (ERCP) is used to remove stones from the bile duct.
What postoperative complications should you monitor for after a cholecystectomy?
Monitor for infection and bile leakage after surgery.
What is the primary clinical manifestation of Cholelithiasis (Gallstones)?
Cholecystitis (inflammation of the gallbladder) is the main complication of cholelithiasis.
What are the risk factors for Cholelithiasis?
Age: Older individuals have a higher prevalence of gallstones.
Gender, Parity, and Oral Contraceptives: Women, especially during fertile years, are more likely to have gallstones.
Genetics: Higher prevalence in Native American populations.
Obesity: Increases the risk, particularly in women.
Rapid Weight Loss: Increases the risk by reducing gallbladder function.
Physical Activity: Lack of exercise increases the risk.
Drugs: Certain drugs (e.g., fibric acid derivatives, PPIs, ceftriaxone) increase the risk.
Diabetes: High triglycerides and impaired gallbladder function increase risk.
How does age influence the risk of Cholelithiasis?
Increasing age is associated with a higher prevalence of gallstones, as biliary cholesterol saturation increases with age due to reduced activity of cholesterol 7α hydroxylase.
How do gender and oral contraceptives impact Cholelithiasis?
Women are nearly twice as likely as men to experience cholelithiasis, especially during their fertile years.
Increased estrogen levels (from pregnancy, hormone therapy, or oral contraceptives) raise cholesterol levels in bile and reduce gallbladder movement, leading to increased gallstone formation.
What racial differences exist in cholesterol gallstone prevalence?
Low in Asian and African populations (<5%).
Intermediate in European and Northern American populations (10-30%).
High in Native American populations, such as Pima Indians (30-70%)
How does obesity contribute to Cholelithiasis?
Obesity increases biliary cholesterol secretion due to increased HMG-CoA reductase activity, raising the risk of gallstones, particularly in women.
How does rapid weight loss increase the risk of Cholelithiasis?
Weight loss of 10-25% over a few weeks increases the risk by secreting extra cholesterol.
Reduced gallbladder contraction promotes stasis, favoring gallstone formation.
How does physical activity affect Cholelithiasis risk?
Regular exercise helps with weight control and improves metabolic abnormalities, reducing the risk of gallstones. Sedentary behavior increases the risk.
What drugs are associated with an increased risk of Cholelithiasis?
Fibric acid derivatives (e.g., clofibrate)
Proton pump inhibitors (PPIs)
Ceftriaxone
These drugs may increase biliary cholesterol saturation and impair gallbladder function.
How does diabetes contribute to Cholelithiasis?
People with diabetes often have high triglycerides, impairing gallbladder function and raising the lithogenic index. Insulin therapy can also contribute to this risk.
What is Cholecystitis?
Cholecystitis is the inflammation of the gallbladder, typically caused by an obstruction, often due to gallstones or biliary sludge, blocking the bile ducts and causing bile buildup in the gallbladder.
What are the 3 types of Cholecystitis?
Acute Cholecystitis: Sudden onset of severe, steady pain in the upper abdomen.
Chronic Cholecystitis: Recurring dull pain in the right upper quadrant, radiating to waist and back.
Acute Superimposed on Chronic: Acute cholecystitis occurring on top of pre-existing chronic cholecystitis.
What is the pathophysiology of Cholecystitis?
Dehydration, fever, and prolonged absence of oral intake reduce gallbladder contraction.
Gallstones or biliary sludge block the bile duct, causing bile to accumulate in the gallbladder, leading to inflammation.
What are the risk factors for Cholecystitis?
Older Adults
Critical Illness
Prolonged Immobility and Fasting
Prolonged Parenteral Nutrition
Diabetes Mellitus (DM)
Adhesions
Neoplasms
Opioids
What are the clinical manifestations of Cholecystitis?
Pain: Sharp, cramping, or dull pain in the upper right or upper middle abdomen.
Duration: 1-5 hours, increasing in severity.
Radiation: Can radiate to the right upper back or between the scapulae.
Sudden onset, often after a fatty meal or at night.
What are the additional symptoms of Cholecystitis?
Leukocytosis (elevated WBC count) and fever with chills due to inflammation.
Epigastric tenderness and abdominal rigidity.
Cramping and bloating.
Nausea and vomiting.
Loose, light-colored stools.
Fat intolerance, indigestion, heartburn, and flatulence.
Jaundice.
What happens in total obstruction of bile in Chronic Cholecystitis?
No bilirubin reaches the small intestine to be converted to urobilinogen.
Bilirubin is excreted by the kidneys, causing dark amber to brown urine.
What are the symptoms of Chronic Cholecystitis?
Dull right upper abdominal pain, often radiating around the waist to the mid-back or right scapular tip.
Pain typically occurs after eating fatty foods or large meals.
What are the causative factors of Chronic Cholecystitis?
Inflammation of the mucous lining or the entire wall of the gallbladder.
Bacterial agents such as E. Coli, Streptococci, and Salmonella (may travel via vascular or lymphatic route).
What are other contributing factors to Chronic Cholecystitis?
Adhesions (scar tissue from previous surgeries or infections).
Neoplasm (tumors affecting the gallbladder).
Anesthesia (can contribute to decreased gallbladder function).
What happens in the gallbladder when significant fibrosis develops in chronic cholecystitis?
Impaired contraction and emptying of the gallbladder.
Fibrosis (scarring) in the gallbladder wall contributes to further symptoms and decreased function.
What is chronic cholecystitis?
A condition where the gallbladder's functionality is compromised due to ongoing inflammation, fibrosis, and possible bacterial infection.
What is Murphy's Sign and how is it related to cholecystitis?
Murphy’s Sign: A physical exam finding where the patient experiences sharp pain upon deep inspiration when the examiner palpates the right upper quadrant (RUQ), indicating acute cholecystitis.
What are some complications of cholecystitis?
Gallbladder rupture
Biliary fistula
Pancreatitis
Peritonitis
Cholangitis (infection of the bile ducts)
What are the collaborative care roles in managing cholecystitis?
Physician: Diagnoses, creates treatment plan, and may perform surgery (e.g., cholecystectomy).
Nurse: Monitors vitals, manages pain, assesses for complications, administers antibiotics, and provides patient education.
Dietitian: Offers dietary counseling, especially on fat intake, post-surgery.
Pharmacist: Ensures appropriate medication for pain and infection control
What are key discharge teachings for a patient post-cholecystectomy?
Low-fat diet post-surgery.
Wound care instructions.
Signs of infection to watch for: fever, redness, swelling.
Follow-up care and check-ups after surgery.
Pain management at home.
Importance of medication adherence (antibiotics, pain management)
What are the diagnostic studies used for cholecystitis?
Abdominal X-ray: Can show gallstones, but less sensitive than ultrasound.
Ultrasound (US): Preferred for diagnosing gallstones, especially in jaundiced patients or those allergic to contrast.
CT Scan: Used when ultrasound results are inconclusive or to assess for complications.
ERCP (Endoscopic Retrograde Cholangiopancreatography): Used to diagnose and treat bile duct issues like blockages or stones.
CBC (Complete Blood Count): To check for signs of infection or inflammation.
Bilirubin: Elevated levels suggest bile duct obstruction.
Liver Function Tests (LFTs): Elevated levels may indicate liver involvement due to bile duct obstruction.
Amylase/Lipase: Elevated in pancreatitis.
HIDA Scan: Imaging study to assess gallbladder function, liver, biliary tract, and small intestine.
Percutaneous Transhepatic Cholangiography (PTCA): Detects bile duct blockage and can insert stent if needed.
ERCP: Direct visualization of the gallbladder, cystic duct, common hepatic duct, and common bile duct; can remove stones, drain bile, collect biopsies, and place a biliary drainage bag.
What pharmacologic therapy is used for cholecystitis?
Antibiotics:
Levofloxacin and Metronidazole for prophylactic coverage against common organisms.
Antiemetics:
Promethazine or Prochlorperazine for nausea control.
Pain Control:
Oxycodone or Acetaminophen for pain relief.
Avoid morphine due to potential sphincter of Oddi spasm.
Preferred options: Dilaudid, Demerol, or Fentanyl.
What are the preoperative care considerations for a patient undergoing cholecystectomy?
Consent Form: Ensure the patient understands the procedure and risks involved.
Bowel Prep: The patient may need to drink a solution to clean out the intestines.
NPO After Midnight: The patient should refrain from eating or drinking after midnight before surgery.
Stop Certain Medications/Supplements: Discontinue medications or supplements that increase the risk of bleeding (e.g., anticoagulants).
What are the two types of surgical options for cholecystectomy?
Laparoscopic Cholecystectomy: Preferred for 90% of cases due to smaller incisions, quicker recovery, and less postoperative pain.
Incisional (Open) Cholecystectomy: May be required if laparoscopic surgery is not an option (e.g., severe inflammation or scarring).
What is the surgical treatment goal for cholecystectomy?
To remove the gallbladder and resolve issues related to cholecystitis.
What are the postoperative care considerations following cholecystectomy?
Monitor for Bleeding: Watch for signs of bleeding or complications at the incision site.
Pain Management: Address shoulder pain caused by CO2 used during surgery.
Transient Nausea and Vomiting: Common for 1-2 days after surgery.
Activity Resumption:
Laparoscopic Procedure: Return to normal activities (driving, light lifting, work) within 1 week.
Open Procedure: Requires 4-6 weeks for normal activities.
When should the postoperative follow-up appointment be scheduled after a cholecystectomy?
Within 2-3 weeks after the operation.
What are some key aspects of postoperative care for a patient after cholecystectomy?
Pulmonary Toilet: Encourage deep breathing exercises (TCDB), incentive spirometry (IS), and turning every 2 hours to prevent pneumonia.
Infection Prevention: Monitor WBC levels, assess for peritonitis (temp > 100°F), and keep the incision clean and dry.
Fowler’s Position for T-Tube: Promotes gravity drainage of bile if a T-tube is placed.
Bile Leakage Monitoring: Assess for signs of bile leakage, including skin inflammation.
Bile Drainage: Report bile drainage > 500 ml after 3 days.
Stool Monitoring: Monitor stool color, consistency, and frequency; pale stools may indicate ongoing bile duct obstruction.
What is the nutritional therapy after a cholecystectomy?
Eat Small, Frequent Meals
Low-Fat Diet, High in Fiber: Improves digestion after gallbladder removal.
Gradually Reduce Weight: If needed.
What should the nurse include in discharge teaching for a patient after laparoscopic cholecystectomy?
Lower-Fat Diet: A low-fat diet is recommended for several weeks post-surgery for better digestion.
Work and Activities: Normal activities can typically resume in 1 week for laparoscopic surgery and 3 weeks for open surgery.
Bile-Colored Drainage: Drainage from the incision should not be bile-colored. Contact healthcare provider if it occurs.
Incision Care: Keep the bandages on and the incision site dry until healed.
What is the nurse’s priority question for discharge teaching after laparoscopic cholecystectomy?
Question: What information should the nurse include for discharge teaching after laparoscopic cholecystectomy?
Answer: A – A lower-fat diet may be better tolerated for several weeks.
Rationale: A low-fat diet is usually better tolerated for the first several weeks to help the digestive system adjust.
What dietary teaching should be given to Mrs. Mills after her cholecystectomy?
Follow a low-fat diet: Incorporate a weight reduction program to prevent further complications and improve recovery.
What should Mrs. Mills know about analgesic use post-surgery?
Take prescribed analgesics as directed: To manage postoperative pain effectively.
How can Mrs. Mills prevent fluid and electrolyte imbalance at home after surgery?
Monitor for signs of dehydration or electrolyte imbalance: Maintain proper hydration to support recovery.
What signs should Mrs. Mills watch for to monitor for bile duct obstruction?
Monitor for changes in stool and urine color: Watch for jaundice or pruritus, which may indicate bile duct obstruction.
