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Disorders of the Biliary Tract Module 3

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Disorders of the Biliary Tract Module 3 Disorders of the Biliary Tract Cholelithasis Stones in the gallbladder Stones can be lodged in neck of gallbladder or cystic ... – PowerPoint PPT presentation

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Title: Disorders of the Biliary Tract Module 3


1
Disorders of the Biliary TractModule 3

2
Disorders of the Biliary Tract
  • Cholelithasis
  • Stones in the gallbladder
  • Stones can be lodged in neck of gallbladder or
    cystic duct
  • Cholecystitis
  • Inflammation of the gallbladder
  • Usually associated with Cholelithasis
  • Can be acute or chronic

3
Disorders of the Biliary Tract
  • Cholecystectomy-one of the most common surgical
    procedures
  • Highest incidence of Cholelithasis (fair, fat,
    40)
  • Women
  • Multipara
  • Over 40
  • Obesity
  • White

4
Cholelithasis-Etiology
  • Unknown
  • Alteration in cholesterol, bile salts, calcium
  • Stasis of bile

5
Cholecystitis-Etiology
  • Obstruction caused by gall stones or biliary
    sludge
  • Acalculous cholecystitis
  • Prolonged fasting/immobility
  • Diabetes
  • Bacteria-E.Coli
  • Adhesions
  • Anesthesia
  • Narcotics

6
Cholecystitis-Pathophysiology
  • Inflammation
  • During acute attack, gallbladder is edematous and
    hyperemic
  • May be distended with bile or pus

7
Cholecystitis-Clinical Manifestations
  • Indigestion to severe pain with fever and
    jaundice
  • Silent cholelithasis
  • Severity of symptoms will depend if stones are
    stationary or mobile
  • Pain (RUQ) may refer to shoulder and scapula
  • N/V
  • Diaphoresis
  • Leukocytosis
  • Abdominal rigidity

8
Cholecystitis-Clinical Manifestations
  • Fat intolerance
  • Attacks of pain occur 3-6 hours after ingestion
    of meal
  • If stone is lodged
  • Biliary colic
  • Severe pain
  • Spasm

9
Cholecystitis-Complications
  • Subphrenic abscess
  • Pancreatitis
  • Cholangitis (inflammation of biliary ducts)
  • Biliary cirrhosis
  • Fistulas
  • Gallbladder rupture-bile peritonitis

10
Cholelithasis-Complications
  • Cholangitis (inflammation of biliary ducts)
  • Biliary cirrhosis
  • Carcinoma
  • Peritonitis
  • Choledocholithasis (stone in common bile duct)

11
Cholelithasis-Diagnostic studies
  • US-best diagnostic
  • ERCP
  • Percutaneous transhepatic cholangiography-obstruct
    ive jaundice
  • Increase liver enzymes?
  • Increased WBC
  • Direct and indirect bilirubin elevated
  • Urinary bilirubin elevated with obstruction

12
Cholelithasis-Diagnostic studies
  • If common bile duct obstructed, no urobilirubin
    will be present
  • Serum amylase will be elevated if pancreas is
    involved

13
Cholecystitis-Treatment
  • Pain management
  • Antibiotics
  • Maintain fluid/electrolyte balance
  • Anticholinergics

14
Cholelithasis-Non Surgical Treatment
  • ERCP
  • Placement of stents
  • Removal of stones
  • Sphinterotomy
  • Mechanical lithotripsy (crush stones)-can create
    pancreatitis

15
Cholelithasis-Non Surgical Treatment
  • Medications
  • Cholesterol solvents-MTBE
  • Dissolution medication-Actigall
  • Shock wave lithotripsy
  • Also known as ESWL
  • High energy waves dissolve stones

16
Cholelithasis-Surgical Treatment
  • Laparoscopic Cholecystectomy
  • Cholecystectomy
  • Cholecysotomy
  • Others

17
Cholelithasis-Post op Lap Chole
  • Monitor for bleeding, VS-usually have 2-3 small
    bandaids
  • Common post op pain-shoulder, since CO2 has been
    introduced-place client on left side
  • Liquids first day, advance
  • Monitor bowel sounds, abdomen, flatus
  • Analgesics
  • Low fat diet
  • Monitor for DVT
  • Increase activity
  • Deep breathe
  • May discharge same day

18
CholelithasisPost-op Open Chole
  • Prevent respiratory complications
  • Monitor for bleeding
  • Increase activity
  • Avoid heavy lifting
  • Advance diet as per MD
  • Monitor bowel sounds, flatus
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