N212: Health Differences Across the Life Span 2

Health Differences Across the Lifespan 2 Study Guide

©2017 Achieve Test Prep Page 88 of 140 Cholelithiasis Cholelithiasis is the presence of gallstones in the gall bladder. Gallstones are usually composed of cholesterol, bile pigment, and calcium. They cause an obstruction preventing the gallbladder from contracting when fatty foods enter the duodenum. The inability to constrict causes pain. Approximately 80% of gallstones are composed of cholesterol; 20% have a mixture of bile components. Cholesterol stones develop slowly; they are hard, white, or yellow brown. They are radiolucent and can be up to 4cm in size; they are enhanced by the production of mucin glycoprotein, which traps cholesterol and leads to stasis of bile. Pigmented stones form due to an increase in unconjugated bilirubin and calcium with a concurrent decrease in bile salts; usually this develops within the intra and extrahepatic ducts and are preceded by bacterial invasion. Assessment: severe and steady Epigastric or RUQ pain that radiates to right scapula or shoulder; sudden onset, lasting 1-3 hours; may occur after a high fat meal; other symptoms are nausea, vomiting, heartburn, and flatulence; fever and chills occur with acute cholecystitis; biliary colic or cramping pain occurs when the stone is lodged in cystic or common bile duct; physical examination findings include positive Murphy’s sign (palpation of RUQ causes severe pain with inspiration); bowel sounds may be absent. Risk factors include: • Increasing age • Female gender • Family history • Obesity and hyperlipidemia • Rapid weight loss • Biliary stasis and prolonged TPN • Use of estrogen containing medications (oral contraception, hormone replacement therapy) • Comorbid medical diagnosis (Crohn’s disease or ileal resection, diabetes mellitus, sickle cell, or cirrhosis) • Native American and Northern European ethnicity Treatment: Oral urosodiol (Actigall) or chenodiol (Chenix) reduces cholesterol in stones to help dissolve them. Lithotripsy uses shock waves to disintegrate stones. ERCP uses a fiberoptic endoscope to visualize biliary tree, remove stones, drain bile sludge, and collect biopsies. Cholecystotomy is the surgical incision into the gallbladder to remove gallstones; occasionally a T tube is placed in the common bile duct to assist with the passage of bile until edema has decreased; bile collects in a bag by gravity drainage. Medication: treatment of pain and nausea with Morphine and anti-emetics; cholestyramine (Questran) is used for severe cases, as it binds to bile salts to hasten excretion through feces; urosodiol (Actigall) or chenodiol (Chenix) to dissolve cholesterol stones; actigall is usually well tolerated, but Chenix frequently causes diarrhea and is hepatotoxic (requiring monitoring of liver enzymes) Teaching: reinforce disease process and gallstone formation; review diagnostic procedures and expected outcomes; diet restriction for patient is to limit high fat foods