Exam (elaborations)
NUR 6111 Adv Nursing Practice 1 NUR 6111 Week 2 GI Disorders
- Institution
- William Paterson University
NUR 6111 Adv Nursing Practice 1
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● Cholecystitis○ Inflammation of the gallbladder, usually associated with gallstone disease, can be
acute or chronic
■ Gallstones obstruct the gallbladder-cystic duct junction, resulting in
inflammation and acute pain
■ In some cases, calculous cholecystitis, or gallbladder inflammation
without stones, is more common than obstruction of the common bile
duct.
■ Increases with age and BMI, most common in ages 50-70 years
● Females > males (2:1)
● 4 F’s (Female, Fair, Fat, Forty-Fifty)
■ Increased incidence in Native Americans
○
○ Types
■ Classic obstruction - cystic duct or junction obstruction - mild WBC
elevation, bilirubin normal, amylase/lipase normal, LFT’s slight elevation
■ Bile duct obstruction - WBC elevation, bilirubin elevated, amylase/lipase
elevated, LFT’s normal
■ Pancreatic duct obstruction - WBC elevation, bilirubin elevated,
amylase/lipase elevated, LFT’s elevated
■
○ Risk Factors
■ Pregnancy
■ Rapid weight loss (e.g., bariatric surgery)
■ Obesity
■ Gallstones
■ Surgery or trauma
, ■ Sickle cell anemia
■ Parental feeding over a prolonged period
■ Family history of gallstones
○ Clinical Presentation
■ typically present with RUQ pain, nausea, and vomiting
■ Pain may radiate from the shoulder to the scapula
■ Fever may or may not be present
○ Assessment
■ Subjective
● RUQ pain that is steady and severe, whose onset may have been
gradual or sudden with radiation to the right shoulder or back, and
has lasted at least 4-6 hours
● May report fever
● c/o nausea/vomiting
● c/o anorexia
● May report that pain started after a meal, particularly a fatty meal,
one or more hours before the onset of pain
■ Objective
● Appears ill
● May be febrile
● May be tachycardic
● Abdominal guarding
● + Murphy’s sign (to perform, have the patient take a deep breath
while palpating the area of gallbladder/ With acute choley, the
patient will respond to pain by catching their breath) is considered
highly sensitive
● May have a palpable RUQ mass
○ Differentials Diagnosis
■ Biliary colic-mild intermittent complaints
■ Peptic ulcer disease
■ Cardiac disease
■ Pancreatitis
■ Hepatitis
■ Bowel obstruction
■ Appendicitis
■ Right-sided pneumonia
○ Diagnostics
■ Labs
● CBC - leukocytosis
● CMP
● Bilirubin
● Liver Function Tests (LFT) - ALT/AST & ALP
● Amylase
● Lipase
, ● GGT
■ Diagnostics
● Abdominal Ultrasound – most specific for the presence of
stones, wall thickening, fluid, and enlargement
● HIDA scan – if negative but still suspected – uses a radioactive
tracer to view the liver, gallbladder, bile ducts, and small intestine
● MRCP (magnetic resonance cholangiopancreatography) –
magnetic resonance to visualize biliary and pancreatic ducts
● ERCP (endoscopic retrograde cholangiopancreatography) –
combines endoscopy and fluoroscopy to examine pancreatic and
bile ducts
○ Management
■ Mild attacks - avoid fatty foods and hydration
■ Severe - NPO, surgical referral
● Diverticulitis & Diverticulosis
○ Definitions
■ A diverticulum is a sac-like protrusion of the colonic wall
■ Acute diverticulitis is due to micro-perforation of the diverticulum
■ Complicated diverticulitis involves bowel obstruction, abscess, fistula or
perforation
■
○ Description
■ Inflammation of the Diverticula along the wall of the large intestine
■ Can cause severe abdominal pain, fever, nausea, and changes in bowel
habits.
■
○ Etiology
■ Diverticula develop when naturally weak places in your colon give way
under pressure
● causes marble-sized pouches to protrude through the colon wall.
■ Diverticulitis occurs when the diverticula tears, resulting in inflammation
● Aerobic and anaerobic bacteria invade diverticula, causing
infection
■ *The cause of diverticulitis is chronic constipation.
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