Adrian Jose Gonzales

09/02/09
BSN IV-3A Mr Sigua,
RN

1. Define:
a. Cholelithiasis - Cholelithiasis is the presence of stones in the
gallbladder or bile ducts: chole- means "bile", lithia means "stone", and
-sis means "process".
b. Cholecystitis - Cholecystitis is inflammation of the gall bladder.
Cholecystitis is often caused by cholelithiasis, with choleliths most
commonly blocking the cystic duct directly.
c. Traditional/Open Cholecystectomy - This procedure is performed via an
incision into the abdomen (laparotomy) below the right lower ribs.
Recovery typically consists of 3–5 days of hospitalization, with a return
to normal diet a week after release and normal activity several weeks
after release.
d. Laparoscopic Cholecystectomy - This procedure, introduced in the
1980s, is performed via three to four small puncture holes for a camera
and instruments. Post-operative care typically includes a same-day
release or a one night hospital stay, followed by a few days of home
rest and pain medication. Laparoscopic cholecystectomy patients can
generally resume normal diet and light activity a week after release,
with some decreased energy level and minor residual pain continuing
for a month or two. Studies have shown that this procedure is as
effective as the more invasive open cholecystectomy, provided the
stones are accurately located by cholangiogram prior to the procedure
so that they can all be removed. The procedure also has the benefit of
reducing operative complications such as bowel perforation and
vascular injury.
e. Common Bile Duct Exploration - The CBD is a tube connecting the liver,
gallbladder, and pancreas to the small intestine that helps deliver fluid
to aid in digestion. The CBD exploration is a procedure used to see if a
stone or some obstruction is blocking the flow of bile from your liver
and gallbladder to your intestine.

2. Identify signs and symptoms of:

a. Cholelithiasis:
i. Upper abdominal pain ii. Back pain
(intense) iii. Nausea and vomiting
 iv. Abdominal bloating viii. Chills
v. Fatty foods intolerance ix. Low-grade fever
vi. Belching x. Jaundice
vii. Indigestion xi. Clay-colored stools
b. Cholecystitis:
i. RUQ pain (constant & severe)
ii. Cholelithiasis signs and symptoms

3. Predisposing factors of Cholelithiasis:

a. Age and Sex - The disease was commoner in the females. The F: M
ratio for the whole group was 1.3:1; it was 2.3:1 in patients under 50;
however, in patients over 50, the F: M ratio was 0.82:1. The peak
incidence was observed in the fifth and sixth decades; the youngest
patient was a girl aged 13 years and the oldest, a 93 year old woman.
b. Inflammation and stagnation due to liver damage
c. Chronic gallbladder disease
d. Obesity
e. Hereditary blood disorders (e.g. sickle-cell anemia)
f. Cancer of the biliary tract

4. Laboratory studies to diagnose acute cholelithiasis:

a. Murphy’s sign - the patient is instructed to breathe in while the gall
bladder is deeply palpated. If the gallbladder is inflamed, the patient
will abruptly stop inhaling due to the pain, a positive Murphy's sign.
b. Ultrasound scan – to visualize the gallbladder and associated ducts,
and also to determine the size and precise position of the obstruction.
c. Hepatocellular liver enzymes (AST, ALT) - raised
d. White cell count (WBC) – high
e. Serum bilirubin – raised
f. Endoscopic Retrograde Cholangiopancreatography (ERCP)
g. Sonography
h. Alkaline Phosphatase –elevated
i. C-reactive protein – elevated
j. CT scan

5. Standard pre-operative teaching for abdominal surgery:

a. Tell the patient to avoid eating and drinking anything, except for the
ice chips.
b. Balance telling too little versus too much
c. Avoid anxiety producing words like pain or wounds.
d. Teach the patient early pain management for post-operative pain like
deep breathing exercises, and other diversional activities.
e. Teach the patient how to splint post-operative wound when sneezing or
coughing.
f. Teach the patient how to perform abdominal exercises to strengthen
his abdominal muscles.