Cholecystitis◦ Acute

Cholelithiasis Acalculous cholecystitis Calculous cholecystitis

Pathophysiology◦ Abnormal metabolism of cholesterol and bile salts◦ Decreased gallbladder-emptying rates◦ Changes in bile concentration or bile stasis w/in

gallbladder Cholangitis

◦ Ascending◦ supporative

Chronic cholecystitis◦ Repeated episodes◦ Complications of pancreatitis and cholangitis◦ S/S: jaundice, pruritus, clay-colored stools, dark

urine◦ Risk factors: Genetic relationship, cholesterol-

lowering meds, age (>60), type I DM, rapid wgt loss, low-calorie or liquid protein diets, etoh abuse, white women, Native Americans, Mexican American, pregnancy (to name but a few-your book has more)

◦ Assessment – see key features of cholecystitis chart 63-1

◦ Lab tests: nothing specific for gallbladder disease, tests look for ruling out other diseases.

Interventions◦ Diet therapy (see table 63-1)◦ Drug therapy – pain, antiemetics◦ Percutaneous Transhepatic Biliary Catherization

Under fluoroscopy Used for inoperable situations or for unstable high risk

surgical candidates◦ Surgery – laparoscopic most common now

Same day surgery Short recovery period Back to normal activities in 1-3 weeks

◦ Traditional method for cholecystectomy Far greater chance for complications Need for T-tube, JP drains (see chart 63-2 and 3) Slower recovery May require home visits by RN Risk for postcholecystectomy syndrome

Acute◦ Necrotizing form dangerous, high mortality◦ Understand endocrine and exocrine functions of the

organ (great chart pg 1403, figure 63-2)◦ Complications

See table 63-2 Why might you see these problems occur? Understand the

pathophysiology of what happens.◦ Risk factors – etoh most common followed by obstruction◦ Physical assessment

Jaundice Cullen’s sign Turner’s sign No bowel sounds Rigid abdomen = perforation, peritonitis

Labs◦ Amylase – when is it helpful, accurate to dx?◦ Lipase – more specific, more accurate.◦ Other tests to dx biliary obstruction (note that

these don’t indicate pancreatitis)◦ Tests done to identify fat necrosis

Interventions◦ Nonsurgical

Resting the bowel, TPN Meds: pain control, give gi tract chance to rest Comfort measures ERCP – when is this done?

◦ Surgical Laparoscopic cholecystectomy

Chronic◦ The acute form done over and over and over

again◦ Type is defined by why the patient gets the attack

Calcifying pancreatitis – etoh Obstructive pancreatitis – guess

◦ Does the chronic form of the disease have the same manifestations as the acute form? What is the same, what is different?

◦ How is your nursing care changed when dealing with the chronic form vs the acute form?

◦ See chart 63-8 for prevention of exacerbations

Term includes both gastric and duodenal ulcers Too much acid, violation in integrity of mucous

coating over stomach wall, H. pylori What are those things that cause acid to be

secreted? These are the things you need to teach your patient about re: change in lifestyle.

Complications◦ Hemorrhage

How can you tell an upper gi bleed from a lower gi bleed? An old bleed from a fresh one?

Perforation Pyloric obstruction – not common Intractable disease

Risk factors◦ Nsaid usage, theophylline (when is this used?),

steroids (remember these pesky little buggers?)◦ Genetics◦ H. pylori◦ Caffeine products, lots and lots of them

Physical assessment – see chart 59-4◦ Dyspepsia (another word for your vocab.)◦ Pain: upper epigastrium with localization to L of

midline relieved with food; R of epigastrium 90 min. to 3 hours after eating. Exacerbating foods, meds.

◦ Vomiting◦ Orthostatic bp changes

Labs◦ H&H

Dx tests◦ EGD◦ IgG serologic testing◦ Urea breath test◦ Stool test

Interventions – see chart 59-5◦ Drug therapy – what are the differences btwn

these? Antibiotics Proton pump inhibitors H2 receptor antagonists Prostaglandin analogues Antacids Mucosal barrier fortifiers

◦ Diet therapy◦ Alternative medicine

Nonsurgical management◦ Endoscopic therapy◦ Acid suppression (didn’t we already cover this?)

Add somatostatin to your med list◦ NG tube (what’s the difference btwn using this for an

ulcer vs to treat pancreatitis?)◦ Saline lavage◦ Management of perforation◦ Management of obstruction

Surgical management◦ Gastrectomy◦ Gastroenterostomy◦ Vagotomies

Dumping syndrome – see diet table 59-2 Reflux gastropathy Delayed gastric emptying Afferent loop syndrome Recurrent ulceration

You had care of the surgical patient back in Nursing 2. If you need to review that material to refresh it, you had best do so.

See chart 59-7 for home care assessment What do you need to teach this person now

that they have had surgery? Can you figure out how all of these diseases

are linked? If so, you will know how I will approach teaching this material in class.