med surg ✌🏾exam four

⭐What is cholecystitis?

Inflammation of the gallbladder which can be chronic or acute and calculous or acalculous

⭐Clinical manifestations of cholecystitis

Pain, tenderness, rigidity of the upper right abdomen that may radiate to the midsternal area or right shoulder, nausea, vomiting

⭐️What do you teach your patient about cholecystitis at the hospital?

They will be getting an NG tube

What do you teach a patient about risk factors for cholecystitis? ⚠

Fat, over 40, fertile, female, and family history

What do you teach a patient about ethnicity and cholecystitis risk? 🩺

Native American or Mexican-American ethnicity increases risk

What do you teach a patient with cholecystitis about foods to avoid? 🚫🍟

Sugar-rich, low-fiber, and fat-rich foods

What do you teach a patient with cholecystitis about specific high-fat foods? 🍳

Avoid eggs, cream, pork, fried foods, cheese, and rich dressings

What do you teach a patient with cholecystitis about gas-forming foods and alcohol? 🧅🍺

Avoid them

What do you teach a patient with acute cholecystitis about activity? 🛌

Rest

What do you teach a patient with cholecystitis about possible surgery? 🏥

A cholecystectomy may be needed

What do you teach a patient with acute cholecystitis about their diet? 🥛

Eat a low-fat liquid diet high in protein and carbohydrates

What do you teach a patient with cholecystitis about foods they can eat? 🍚🥔

Cooked fruits, rice, lean meat, mashed potatoes, bread, and non-gas-forming vegetables

What do you teach a patient with cholecystitis about urine and stool changes? 🚽⚠

What do you teach a patient with cholecystitis about urine and stool changes? 🚽⚠

When a patient gets their gallbladder removed, educate them to

Supplement vitamin ADE&K

What is the most common disorder of the biliary system? 🟡

Gallbladder disease with stones.

Are all occurrences of cholecystitis related to stones? 🪨

No. Not all occurrences of cholecystitis are related to stones.

What are gallstones also called? 🪨

Calculi

What is the term for stones (calculi) in the gallbladder? 💛

Cholelithiasis

What is the term for stones in the common bile duct (CBD)? 🩺

Choledocholithiasis

What is cholecystitis? 🩺

Inflammation of the gallbladder

Can cholecystitis be acute or chronic? ⏳

Yes! It can be acute or chronic

Where does cholecystitis typically cause pain? 🤕

The upper right abdomen

Where can the pain from cholecystitis radiate? ⚡

To the midsternal area or right shoulder

What abdominal findings can occur with cholecystitis? 🩻

Pain, tenderness, and rigidity of the upper right abdomen

What GI symptoms are associated with cholecystitis? 🤢

Nausea and vomiting

What type of inflammatory signs are associated with cholecystitis? 🔥

acute inflammation

What causes more than 90% of cases of acute cholecystitis? 🪨

Calculous cholecystitis

What happens in calculous cholecystitis? 🪨🚫

A gallbladder stone obstructs bile outflow

What happens to the bile after a gallbladder stone obstructs bile outflow? 💛

Bile remains in the gallbladder and initiates a chemical reaction.

What two changes occur after the Bile remains in the gallbladder and initiates a chemical reaction? 🧪

Autolysis and edema

What is autolysis? 🔬

Tissue breakdown

What happens to the gallbladder’s blood vessels in calculous cholecystitis? 🩸

They become compressed, compromising the gallbladder’s vascular supply

What serious complications may result from calculous cholecystitis? 🚨

Gangrene of the gallbladder with perforation

What is acalculous cholecystitis? 🔥

Acute gallbladder inflammation in the absence of obstruction by gallstones

What surgical procedures can acalculous cholecystitis occur after? 🏥

major surgical procedures or orthopedic procedures

What injuries can lead to acalculous cholecystitis? 🤕🔥

Severe trauma or burns

What type of obstruction can be associated with acalculous cholecystitis? 🚫

Cystic duct obstruction

What infection can be associated with acalculous cholecystitis? 🦠

Primary bacterial infection of the gallbladder

What blood-related treatment can be associated with acalculous cholecystitis? 🩸

Multiple blood transfusions

What is acalculous cholecystitis speculated to be caused by? 💧🩸

Alterations in fluids and electrolytes and alterations in regional blood flow in the visceral circulation.

what is the body’s response to the inflammation of the gallbladder vital sign wise?

Fever

In cholecystitis, you may have a palpable mass where?

RUQ

How would the patient be behaving with acute cholecystitis?

Restless

Why is the patient jaundice with acute cholecystitis?

Because the backup of bilirubin. Bilirubin is not getting excreted into the stool or digestive system.

Why does the patient with acute cholecystitis have dark color urine

The bilirubin Is being backed up into the bloodstream

What is a patient with acute cholecystitis have stool color, grayish or clay looking?

Due to the lack of bile

Acute cholecystitis causes a lack in what vitamins?

A D E K

What do gallstones form from? 🪨

The solid constituents of bile

What are gallstones most commonly made of? 🟡

Cholesterol

How can gallstones differ from one another? 🔍

Size shape, and composition

In what age groups are gallstones uncommon? 👧🏽🧑🏽

Children and young adults

What happens to the prevalence of gallstones with age? 👵🏽

They become more prevalent with increasing age

What are the two types of gallstones? 🪨

Pigment stones and cholesterol stones

What conditions increase the risk of developing pigment stones? ⚠

Cirrhosis, hemolysis, and biliary tract infections

What is hemolysis? 🩸

The breakdown of blood

Can pigment stones be dissolved? 🚫🪨

No, they cannot be dissolved

Can cholesterol-rich stones be dissolved? 💊

Yes, medication can be used to help dissolve them

Is cholesterol normally found in bile? 🟡

Yes, cholesterol is a normal part of bile

Is cholesterol soluble in water? 💧

No, it is insoluble in water

What does cholesterol solubility depend on? 🧪

Bile acids and lecithin

Where is lecithin found? 🫧

In bile

What happens to bile acid synthesis in gallstone-forming patients? 📉

It decreases

What happens to cholesterol synthesis in the liver in gallstone-forming patients? 📈

It increases

What happens when bile acid synthesis decreases and cholesterol synthesis increases? 🧪

Bile becomes supersaturated with cholesterol

What can supersaturated cholesterol in bile lead to? 🪨

Stone formation

Who develops cholesterol stones more often: women or men? 👩🏽

Women

What age is common among women affected by cholesterol stones? 🎂

Older than 40

What age is common among women affected by cholesterol stones? 🎂

Older than 40, multiparous or fertile, and obesity

What does multiparous mean? 🤰🏽

Having given birth more than once

What medications can increase the frequency of stone formation? 💊

Oral contraceptives, estrogens, and clofibrate

How does clofibrate contribute to stone formation? 🪨

It increases biliary cholesterol saturation

Why does gallstone formation increase with age? 🧪

Cholesterol synthesis/secretion increases while bile acid synthesis decrease

A comorbidity commonly seen with gallstone formation? 🩸

Diabetes

What weight-related recommendation is given to high-risk patients? ⚖

Maintain an optimal body weight

What foods should high-risk cholelithiasis patients avoid? 🍭🚫

Sugar-rich foods

What fiber-related foods should be avoided to prevent cholelithiasis? 🌾🚫

Low-fiber foods

What fat-related foods should be avoided? 🍟🚫

Fat-rich foods

What conditions increase the risk of cholelithiasis? 🩺

Cystic fibrosis and diabetes

How can changes in weight increase the risk of cholelithiasis? ⚖

Frequent changes in weight increase the risk

Frequent changes in weight increase the risk of

Cholelithiasis

What intestinal condition or procedure is a risk factor for cholelithiasis? 🩻

Ileal resection or disease

what low-dose hormone therapy carries a small increase in gallstone risk? 💊

Estrogen

What weight condition is a risk factor for gallstones? ⚖

Obesity

How does rapid weight loss affect gallstone risk? 📉🪨

It can cause gallstones to develop quickly and increases the risk of symptoms

What hormone treatment is a risk factor for gallstones? 💊

High-dose estrogen treatment

What ethnicities listed are risk factors for gallstones? 🪨

Native American or U.S. southwestern Hispanic ethnicity

What two types of symptoms can occur with gallstone-related gallbladder disease? 🪨

Gallbladder disease symptoms and obstruction symptoms

Can gallbladder disease symptoms be acute or chronic? ⏳

Yes, symptoms can be acute or chronic

What abdominal symptoms can occur with gallbladder disease? 🤕

Epigastric distress, fullness, distention, and vague RUQ pain

When may vague RUQ pain occur with cholelithiasis? 🍽

After eating

What type of food usually causes the distress in cholelithiasis? 🍔

Rich and Fatty foods

In cholelithiasis, what happens if a gallstone obstructs the cystic duct? 🪨🚫

The gallbladder becomes distended and inflamed

What complications can cystic duct obstruction cause in cholelithiasis? ⚠

Infection or gallbladder rupture

What findings may occur with cystic duct obstruction in cholelithiasis? 🌡

Fever, RUQ mass, and biliary colic

What is biliary colic in cholelithiasis? 😣

Intense pain that won’t go away

When is biliary colic from cholelithiasis noticeable? 🍽⏰

Several hours after a heavy meal

What GI symptoms accompany biliary colic in cholelithiasis? 🤢

Nausea and vomiting

How may a patient with cholelithiasis behave during biliary colic? 🚶🏽‍♀️

Restless and unable to get comfortable

What causes biliary colic in cholelithiasis? 🫧

Gallbladder contraction when bile cannot move out

What is Murphy’s sign in gallbladder disease? 🩺

Marked RUQ tenderness on deep inspiration