NSG 3850 Exam 4 Studyguide
• Gallbladder and cystic duct
o Forms controlled system to deliver bile to intestinal tract
o Holds 30 to 50 mL of bile (approximately 1 to 1.5 oz)
▪ Bile made in liver
• Contains water/electrolytes/organic solutes
o Transports bilirubin, toxins, cholesterol out of body
o Cystic duct—connects to HEPATIC DUCT to form the COMMON BILE DUCT
Unit 9 Part 1: Alterations of the Gallbladder:
1. CHOLELITHIASIS (GALLSTONES)
• Patho—developed by:
o Supersaturation of bile with CHOLESTEROL (most common)
o Nucleation of cholesterol crystals (aggregate or stick together and create stones)
o HYPOMOTILITY and STASIS of bile in the gallbladder
• Types of stones:
o Cholesterol stone—most common
o Pigment stone—made of pigment and calcium salts
▪ Black pigment stone—idiopathic or associated with CIRRHOSIS/HEMOLYSIS
▪ Brown pigment stone—associated with biliary parasitosis and bacterial infection;
more common in developing countries
• Etiology:
o TPN
o Obesity/high cholesterol
o High carb/low fat diet
o High Spinal cord injuries
o Pregnancy
o RAPID WEIGHT LOSS
• Risk Factors—WOMEN, Native Americans, white Europeans, OBESITY WITH RAPID WEIGHT LOSS,
prolonged fasting, oral contraceptives, Diabetes Mellitus, octreotide therapy (somatostatin analog)
• S/S:
o Mild GI symptoms
o Epigastric fullness
o RUQ pain
o Often asymptomatic
CHRONIC CHOLELITHIASIS
• S/S:
o Intermittent biliary colic—persistent epigastric/RUQ pain (radiates to right shoulder)
▪ Especially with fatty food intake
▪ Caused by periodic obstruction of cystic duct by stone OR a spasm of sphincter of
Oddi
▪ Pain can be due to meal or spontaneous (often AT NIGHT)
• Pain ↑ for 15 mins and lasts for 1 hour, then decreases
, o Nausea/vomiting
o Sweating
o Flatus/Belching/Bloating
o Epigastric burning
o PATIENT MAY THINK THEY ARE HAVING A HEART ATTACK
• Complications:
o Calicified gallbladder
o Porcelain gallbladder
o Biliary sepsis
• Dx—ultrasound
2. CHOLECYSTITIS
• Acute cholecystitis:
o Patho—Inflammation of the gallbladder wall and/or sphincter of Oddi that causes
thickening/fibrosis
o Etiology—stasis of bile/obstruction of cystic duct, CHOLELITHIASIS (gallstones)
▪ ACALCULOUS (without stone)--following surgery/trauma/burns/TPN
• From circulatory shock leading to decreased perfusion and ischemia
• RF—Men, over 50, on TPN
• Complications—gangrene and perforation, emphysematous
cholecystitis, empyema
o S/S:
▪ Severe RUQ pain that radiates to back/right shoulder
▪ Abdominal tenderness
▪ Fever
▪ Leukocytosis
▪ Mildly elevated bilirubin/transaminases
o Complications—gangrene and rupture of gallbladder, peritonitis, septic shock,
localized abscesses (empyema), cholecystoenteric fistula (between gallbladder and GI
tract)
• Chronic cholecystitis:
o Patho—persistent irritation/inflammation to gallbladder wall from cholelithiasis
o RF—diabetes and obesity
o S/S--radiating RUQ pain, abdominal tenderness, intermittent biliary colic,
ASYMPTOMATIC
o Complications—biliary sepsis, CALCIFIED/PORCELAIN GALLBLADDER, increased
cancer risk
Unit 9 Part 2: Alterations in Liver
• Functions of liver:
o Secretes bile salts/bile for fat digestion
, o Carb/fat/protein metabolism via glucocorticoids
o Storage of blood and removal of bilirubin (produces clotting factors)
o Excretion of bile pigment/cholesterol
o Urea synthesis⟶ detox drugs/substances
1. LIVER DISEASE
• Patho—hepatocellular failure and portal hypertension
• S/S:
o Weakness/fatigue
o Anorexia/weight loss/MUSCLE WASTING
o Bruising/increased bleeding
o Palmar erythema/cutaneous spider telangiectasis/irregular menses (WOMEN)
o Gynecomastia/erectile dysfunction/feminine body hair distribution/testicular atrophy
(MEN)
o Hepatic encephalopathy
o Fetor hepaticus
o Pruritis
o Wide pulse pressure/tachycardia
o Cyanosis
o Jaundice
o ASCITES/PERIPHERAL EDEMA
o Splenomegaly/hepatomegaly
o Varices throughout body (esophageal/rectal/gastric)
o Abnormal abdominal vascular pattern—caput medusae/umbilical bruit
o Osteomalacia/HYPOCALCEMIA
o Night blindness
o Anemia/leukopenia
o Hypoglycemia OR hyperglycemia
o High cholesterol levels
▪ Waste product build up may eventually affects LOC and orientation
2. PORTAL HYPERTENSION
• Patho—sluggish blood flow resulting in increased portal circulation
• Etiology—congested venous drainage of the GI tract ⟶ vessels become leaky
• S/S:
o Anorexia
o Varices (esophageal/gastric/rectal or hemorrhoids)
o Ascites (from increased pressure)
3. JAUNDICE
• Results from impaired bilirubin metabolism
• Characteristic sign of liver disease
o 3 types: hemolytic jaundice, hepatocellular jaundice, obstructive jaundice
• S/S: green/yellow staining of tissues by bilirubin
o Seen first in the sclera/whites of eyes
• Gallbladder and cystic duct
o Forms controlled system to deliver bile to intestinal tract
o Holds 30 to 50 mL of bile (approximately 1 to 1.5 oz)
▪ Bile made in liver
• Contains water/electrolytes/organic solutes
o Transports bilirubin, toxins, cholesterol out of body
o Cystic duct—connects to HEPATIC DUCT to form the COMMON BILE DUCT
Unit 9 Part 1: Alterations of the Gallbladder:
1. CHOLELITHIASIS (GALLSTONES)
• Patho—developed by:
o Supersaturation of bile with CHOLESTEROL (most common)
o Nucleation of cholesterol crystals (aggregate or stick together and create stones)
o HYPOMOTILITY and STASIS of bile in the gallbladder
• Types of stones:
o Cholesterol stone—most common
o Pigment stone—made of pigment and calcium salts
▪ Black pigment stone—idiopathic or associated with CIRRHOSIS/HEMOLYSIS
▪ Brown pigment stone—associated with biliary parasitosis and bacterial infection;
more common in developing countries
• Etiology:
o TPN
o Obesity/high cholesterol
o High carb/low fat diet
o High Spinal cord injuries
o Pregnancy
o RAPID WEIGHT LOSS
• Risk Factors—WOMEN, Native Americans, white Europeans, OBESITY WITH RAPID WEIGHT LOSS,
prolonged fasting, oral contraceptives, Diabetes Mellitus, octreotide therapy (somatostatin analog)
• S/S:
o Mild GI symptoms
o Epigastric fullness
o RUQ pain
o Often asymptomatic
CHRONIC CHOLELITHIASIS
• S/S:
o Intermittent biliary colic—persistent epigastric/RUQ pain (radiates to right shoulder)
▪ Especially with fatty food intake
▪ Caused by periodic obstruction of cystic duct by stone OR a spasm of sphincter of
Oddi
▪ Pain can be due to meal or spontaneous (often AT NIGHT)
• Pain ↑ for 15 mins and lasts for 1 hour, then decreases
, o Nausea/vomiting
o Sweating
o Flatus/Belching/Bloating
o Epigastric burning
o PATIENT MAY THINK THEY ARE HAVING A HEART ATTACK
• Complications:
o Calicified gallbladder
o Porcelain gallbladder
o Biliary sepsis
• Dx—ultrasound
2. CHOLECYSTITIS
• Acute cholecystitis:
o Patho—Inflammation of the gallbladder wall and/or sphincter of Oddi that causes
thickening/fibrosis
o Etiology—stasis of bile/obstruction of cystic duct, CHOLELITHIASIS (gallstones)
▪ ACALCULOUS (without stone)--following surgery/trauma/burns/TPN
• From circulatory shock leading to decreased perfusion and ischemia
• RF—Men, over 50, on TPN
• Complications—gangrene and perforation, emphysematous
cholecystitis, empyema
o S/S:
▪ Severe RUQ pain that radiates to back/right shoulder
▪ Abdominal tenderness
▪ Fever
▪ Leukocytosis
▪ Mildly elevated bilirubin/transaminases
o Complications—gangrene and rupture of gallbladder, peritonitis, septic shock,
localized abscesses (empyema), cholecystoenteric fistula (between gallbladder and GI
tract)
• Chronic cholecystitis:
o Patho—persistent irritation/inflammation to gallbladder wall from cholelithiasis
o RF—diabetes and obesity
o S/S--radiating RUQ pain, abdominal tenderness, intermittent biliary colic,
ASYMPTOMATIC
o Complications—biliary sepsis, CALCIFIED/PORCELAIN GALLBLADDER, increased
cancer risk
Unit 9 Part 2: Alterations in Liver
• Functions of liver:
o Secretes bile salts/bile for fat digestion
, o Carb/fat/protein metabolism via glucocorticoids
o Storage of blood and removal of bilirubin (produces clotting factors)
o Excretion of bile pigment/cholesterol
o Urea synthesis⟶ detox drugs/substances
1. LIVER DISEASE
• Patho—hepatocellular failure and portal hypertension
• S/S:
o Weakness/fatigue
o Anorexia/weight loss/MUSCLE WASTING
o Bruising/increased bleeding
o Palmar erythema/cutaneous spider telangiectasis/irregular menses (WOMEN)
o Gynecomastia/erectile dysfunction/feminine body hair distribution/testicular atrophy
(MEN)
o Hepatic encephalopathy
o Fetor hepaticus
o Pruritis
o Wide pulse pressure/tachycardia
o Cyanosis
o Jaundice
o ASCITES/PERIPHERAL EDEMA
o Splenomegaly/hepatomegaly
o Varices throughout body (esophageal/rectal/gastric)
o Abnormal abdominal vascular pattern—caput medusae/umbilical bruit
o Osteomalacia/HYPOCALCEMIA
o Night blindness
o Anemia/leukopenia
o Hypoglycemia OR hyperglycemia
o High cholesterol levels
▪ Waste product build up may eventually affects LOC and orientation
2. PORTAL HYPERTENSION
• Patho—sluggish blood flow resulting in increased portal circulation
• Etiology—congested venous drainage of the GI tract ⟶ vessels become leaky
• S/S:
o Anorexia
o Varices (esophageal/gastric/rectal or hemorrhoids)
o Ascites (from increased pressure)
3. JAUNDICE
• Results from impaired bilirubin metabolism
• Characteristic sign of liver disease
o 3 types: hemolytic jaundice, hepatocellular jaundice, obstructive jaundice
• S/S: green/yellow staining of tissues by bilirubin
o Seen first in the sclera/whites of eyes
