Disorders of the Biliary Tract Module 3

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Disorders of the Biliary TractModule 3

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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

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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

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Cholelithasis-Etiology

• Unknown
• Alteration in cholesterol, bile salts, calcium
• Stasis of bile

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Cholecystitis-Etiology

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

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Cholecystitis-Pathophysiology

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

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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

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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

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Cholecystitis-Complications

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

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Cholelithasis-Complications

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

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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

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Cholelithasis-Diagnostic studies

• If common bile duct obstructed, no urobilirubin
  will be present
• Serum amylase will be elevated if pancreas is
  involved

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Cholecystitis-Treatment

• Pain management
• Antibiotics
• Maintain fluid/electrolyte balance
• Anticholinergics

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Cholelithasis-Non Surgical Treatment

• ERCP
• Placement of stents
• Removal of stones
• Sphinterotomy
• Mechanical lithotripsy (crush stones)-can create
  pancreatitis

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Cholelithasis-Non Surgical Treatment

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

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Cholelithasis-Surgical Treatment

• Laparoscopic Cholecystectomy
• Cholecystectomy
• Cholecysotomy
• Others

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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

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CholelithasisPost-op Open Chole

• Prevent respiratory complications
• Monitor for bleeding
• Increase activity
• Avoid heavy lifting
• Advance diet as per MD
• Monitor bowel sounds, flatus