ï½ Cholecystitis â—¦ Acute ï‚– Cholelithiasis...
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CholecystitisAcuteCholelithiasisAcalculous cholecystitisCalculous cholecystitisPathophysiologyAbnormal metabolism of cholesterol and bile saltsDecreased gallbladder-emptying ratesChanges in bile concentration or bile stasis w/in gallbladderCholangitisAscendingsupporative
Chronic cholecystitisRepeated episodesComplications of pancreatitis and cholangitisS/S: jaundice, pruritus, clay-colored stools, dark urineRisk 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 63-1Lab tests: nothing specific for gallbladder disease, tests look for ruling out other diseases.
InterventionsDiet therapy (see table 63-1)Drug therapy pain, antiemeticsPercutaneous Transhepatic Biliary CatherizationUnder fluoroscopyUsed for inoperable situations or for unstable high risk surgical candidatesSurgery laparoscopic most common nowSame day surgeryShort recovery periodBack to normal activities in 1-3 weeksTraditional method for cholecystectomyFar greater chance for complicationsNeed for T-tube, JP drains (see chart 63-2 and 3)Slower recoveryMay require home visits by RNRisk for postcholecystectomy syndrome
AcuteNecrotizing form dangerous, high mortalityUnderstand endocrine and exocrine functions of the organ (great chart pg 1403, figure 63-2)Complications See table 63-2Why might you see these problems occur? Understand the pathophysiology of what happens.Risk factors etoh most common followed by obstructionPhysical assessmentJaundiceCullens signTurners signNo bowel soundsRigid abdomen = perforation, peritonitis
LabsAmylase when is it helpful, accurate to dx?Lipase more specific, more accurate.Other tests to dx biliary obstruction (note that these dont indicate pancreatitis)Tests done to identify fat necrosisInterventionsNonsurgicalResting the bowel, TPNMeds: pain control, give gi tract chance to restComfort measuresERCP when is this done?SurgicalLaparoscopic cholecystectomy
ChronicThe acute form done over and over and over againType is defined by why the patient gets the attackCalcifying pancreatitis etohObstructive pancreatitis guessDoes 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 ulcersToo much acid, violation in integrity of mucous coating over stomach wall, H. pyloriWhat are those things that cause acid to be secreted? These are the things you need to teach your patient about re: change in lifestyle.ComplicationsHemorrhageHow can you tell an upper gi bleed from a lower gi bleed? An old bleed from a fresh one?PerforationPyloric obstruction not commonIntractable disease
Risk factorsNsaid usage, theophylline (when is this used?), steroids (remember these pesky little buggers?)GeneticsH. pyloriCaffeine products, lots and lots of themPhysical assessment see chart 59-4Dyspepsia (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.VomitingOrthostatic bp changesLabsH&H
Dx testsEGDIgG serologic testingUrea breath testStool testInterventions see chart 59-5Drug therapy what are the differences btwn these?AntibioticsProton pump inhibitorsH2 receptor antagonistsProstaglandin analoguesAntacidsMucosal barrier fortifiersDiet therapyAlternative medicine
Nonsurgical managementEndoscopic therapyAcid suppression (didnt we already cover this?)Add somatostatin to your med listNG tube (whats the difference btwn using this for an ulcer vs to treat pancreatitis?)Saline lavageManagement of perforationManagement of obstructionSurgical managementGastrectomyGastroenterostomyVagotomiesDumping syndrome see diet table 59-2Reflux gastropathyDelayed gastric emptyingAfferent loop syndromeRecurrent 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 assessmentWhat 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.