Cholelithiasis vs cholecystitis

what is the gall bladder?

an organ that is located just below the liver

it stores 20-50 ml of bile at a time

its function is to store and concentrate bile

what is bile?

facilitates fat digestion, absorption of fat and fat soluble vitamins, and cholesterol

emulsifies fat for absorption

600-800 ml/day is produced by the liver

define cholelithiasis

gallbladder stone

the formation of stone within the GB or biliary ducts

two major types of stones: cholesterol and dark brown from too much billirubin

what are risk factors for gall stones?

age, Native American, Northern European, family history, obesity, rapid weight loss (bariatric surgery), female, pregnancy, use of oral contraceptives, high carb low fiber diet

list symptoms of gall stone

right upper quad pain, can radiate to back or shoulder

pain can be acute, severe or intermittent

nausea and vomiting

what is a complication of gall stones?

back up can cause perforation of the gallbladder

what is cholecystitis?

inflammation of the gallbladder

90% of cases called by cholelithiasis

symptoms: similar to cholelithiasis, may have an abscess, necrosis, or a perforation

what happens with a biliary obstruction?

patients will appear jaundiced when total bilirubin exceeds > 3 mg/dl

urine will appear dark

stools clay colored/steatorrhea (high in fat)

vitamin deficiencies

what are some diagnostic tests?

ultrasonography-quick, non-ionizing radiation

gallbladder scan: HIDA, radioactive substance through bile duct if ultrasound not definitive

serum bilirubin

CBC: elevated WBCs

what is a cholecystectomy?

a procedure to remove the gall bladder to get rid of the gall stones

can be open or laparoscopic

what is medical management of cholecystitis?

reduce pain: morphine/opioids, antiemetics, antibiotics

NPO and low fat diet

semi-fowler position

pharmacological therapies: cholesterol stone dissolution with ursodiol or chenodiol

can also have the colectomy or an ERCP

what is an ERCP?

endoscopic retrograde cholangio pancreatography

direct visualization of the common duct- can via an endoscope to retrieve stones and place stents

what is the post op management?

pain relief

abdominal assessment: ileus, bile leak

pulmonary toilet

incisional care: t tube

antibiotic

diet: avoid excessive fat