NURS 642 Exam 2. Maryville University questions
with correct answers
Cholelithiasis (Quick) (what is it? what does it look like? what imaging?
Tx?) Correct Answer-o Stone formation in the gallbladder.
o Colicky (comes and goes) RUQ pain - worse with fatty foods.
o Dx: RUQ US.
o Tx: elective cholecystectomy.
Cholelithiasis (in depth) Correct Answer-• Is the creation/presence of
gallstones (calculi) in the gallbladder. Not usually with any
complications.
• High risk: Female >male, Increasing age, family Hx, Pregnancy, DM,
Dyslipidemia (>HDL), Obesity, Rapid weight loss, Cirrhosis, Crohn
disease, & Hyperbilirubinemia. Medication use: Fibrates, Ceftriaxone,
Somatostatin analogues, Hormone replacement, Oral contraceptives.
• Physical activity, statins, vitamin C, coffee, vegetable protein, nuts,
and mono/poly saturated fats may all help prevent gallstone formation.
• Evaluated via Ultrasound of abdomen.
• Most gallstones do not have complications and do not require
intervention.
o S/SX: Majority are asymptomatic.
o Expectant management = no TX needed.
o Cholecystectomy is not recommended for these patients as possible
complications from surgery > non-symptomatic gallstones.
Patients at risk for gallbladder cancer may choose to have preventative
cholecystectomy. High risk: Patients with gallbladder adenomas, with
,porcelain gallbladder, large gallstones (>3 cm), or if pancreatic duct is
draining into their common bile duct.
o Educate on symptoms of gallstone disease / biliary colic / acute
cholecystitis.
o May consider gallstone dissolution trial with Ursodiol. Typical trial is
3 months, may need >/= 2 years of this to dissolve gallstones.
• Can cause pain attacks with no complications; that is referred to as
biliary colic.
o TX: is pain control: NSAIDS (ex: Ketorolac, Diclofenac, Tenoxicam,
Flubiprofen, Ketoprofen), then opioids if needed or if NSAIDS are
contraindicated.
o Report to ED after 4 hours if pain is uncontrolled; potential to advance
to a complication such as acute cholecystitis.
o May have elective cholecystectomy to prevent further pain flairs (lap
prefered over open).
o Final Tx: cholecystectomy. Can do elective to prevent future reocurr
Cholecystitis (Quick) (what is it? what does it look like? what imaging?
Tx?) Correct Answer-o Cystic duct obstruction (inflammation).
o + Murphy sign.
o Constant RUQ pain.
o Fever, leukocytosis.
o Dx: RUQ US, HIDA scan.
o TX: cholecystectomy.
,Cholecystitis (in depth) Correct Answer-• Is a complication from outlet
obstruction (usually from gallstones) resulting in gallbladder
inflammation.
• Acute cholecystitis is a primary diagnostic consideration in patients
presenting with RUQ pain.
• Primarily a result of gallbladder outlet obstruction
• Gallstones cause the majority of acute cholecystitis cases.
• Gangrene and perforation can result if inflammation is not treated
• Colicky pain in the RUQ - severe - usually with radiation to the flank
and occasionally to the right shoulder. Accompanied by nausea and
vomiting.
• Ultrasound (for diagnosis) will demonstrate the presence of stones or
calculi, gallbladder wall thickening (greater than 4 to 5 mm),
pericholecystic fluid, and, on occasion, sonographic Murphy sign.
• WBC elevated
• Elevated liver enzymes: AST, ALT, ALP. (Most common in chronic).
• Mild elevation in serum aminotransferase, amylase, and
hyperbilirubinemia can occur.
• Usually have fever.
• A positive Murphy's sign on physical examination supports the
diagnosis. (elicited by firmly placing a hand at the costal margin in the
right upper abdominal quadrant and asking the patient to breathe deeply;
if the patient abruptly ceases inhaling due to pain.)
• Cholecystectomy is the mainstay of treatment for acute calculous
cholecystitis. Lap chole > open.
• Poor surgical candidates may benefit from initial nonoperative
management with antibiotics and a gallbladder drainage procedure.
, • Acute calculous cholecystitis should be admitted to the hospital and
provided with supportive care:
o Intravenous hydration.
o Correction of any electrolyte abnormalities.
o Pain control - (NSAIDs) or opioids.
o Intravenous antibiotics.
o Patients should be kept fasting, and although uncommonly needed,
those who are vomiting should have placement of a nasogastric tube.
• Can escalate to gallbladder perforat
Choledocolithiasis (Quick)(what is it? what does it look like? what
imaging? Tx?) Correct Answer-o Common bile duct obstruction.
o Proximal inflammation.
o Obstructive Jaundice.
o Dilated hepatic bile ducts.
o Tx: ERCP.
Choledocolithiasis (in depth) Correct Answer-is the presence of a
gallstone in the common bile duct.
o Labs: Elevated bilirubin (>4 very strong, 1.8 - 4 strong), and alkaline
phosphatase (late). Elevated AST and ALT (early).
o High risk: >55 y/o
o S/SX: biliary-type pain (right upper quadrant or epigastric
pain/tenderness), nausea, and vomiting. Patients may also appear
jaundiced. Courvoisier's sign (a palpable gallbladder on physical
with correct answers
Cholelithiasis (Quick) (what is it? what does it look like? what imaging?
Tx?) Correct Answer-o Stone formation in the gallbladder.
o Colicky (comes and goes) RUQ pain - worse with fatty foods.
o Dx: RUQ US.
o Tx: elective cholecystectomy.
Cholelithiasis (in depth) Correct Answer-• Is the creation/presence of
gallstones (calculi) in the gallbladder. Not usually with any
complications.
• High risk: Female >male, Increasing age, family Hx, Pregnancy, DM,
Dyslipidemia (>HDL), Obesity, Rapid weight loss, Cirrhosis, Crohn
disease, & Hyperbilirubinemia. Medication use: Fibrates, Ceftriaxone,
Somatostatin analogues, Hormone replacement, Oral contraceptives.
• Physical activity, statins, vitamin C, coffee, vegetable protein, nuts,
and mono/poly saturated fats may all help prevent gallstone formation.
• Evaluated via Ultrasound of abdomen.
• Most gallstones do not have complications and do not require
intervention.
o S/SX: Majority are asymptomatic.
o Expectant management = no TX needed.
o Cholecystectomy is not recommended for these patients as possible
complications from surgery > non-symptomatic gallstones.
Patients at risk for gallbladder cancer may choose to have preventative
cholecystectomy. High risk: Patients with gallbladder adenomas, with
,porcelain gallbladder, large gallstones (>3 cm), or if pancreatic duct is
draining into their common bile duct.
o Educate on symptoms of gallstone disease / biliary colic / acute
cholecystitis.
o May consider gallstone dissolution trial with Ursodiol. Typical trial is
3 months, may need >/= 2 years of this to dissolve gallstones.
• Can cause pain attacks with no complications; that is referred to as
biliary colic.
o TX: is pain control: NSAIDS (ex: Ketorolac, Diclofenac, Tenoxicam,
Flubiprofen, Ketoprofen), then opioids if needed or if NSAIDS are
contraindicated.
o Report to ED after 4 hours if pain is uncontrolled; potential to advance
to a complication such as acute cholecystitis.
o May have elective cholecystectomy to prevent further pain flairs (lap
prefered over open).
o Final Tx: cholecystectomy. Can do elective to prevent future reocurr
Cholecystitis (Quick) (what is it? what does it look like? what imaging?
Tx?) Correct Answer-o Cystic duct obstruction (inflammation).
o + Murphy sign.
o Constant RUQ pain.
o Fever, leukocytosis.
o Dx: RUQ US, HIDA scan.
o TX: cholecystectomy.
,Cholecystitis (in depth) Correct Answer-• Is a complication from outlet
obstruction (usually from gallstones) resulting in gallbladder
inflammation.
• Acute cholecystitis is a primary diagnostic consideration in patients
presenting with RUQ pain.
• Primarily a result of gallbladder outlet obstruction
• Gallstones cause the majority of acute cholecystitis cases.
• Gangrene and perforation can result if inflammation is not treated
• Colicky pain in the RUQ - severe - usually with radiation to the flank
and occasionally to the right shoulder. Accompanied by nausea and
vomiting.
• Ultrasound (for diagnosis) will demonstrate the presence of stones or
calculi, gallbladder wall thickening (greater than 4 to 5 mm),
pericholecystic fluid, and, on occasion, sonographic Murphy sign.
• WBC elevated
• Elevated liver enzymes: AST, ALT, ALP. (Most common in chronic).
• Mild elevation in serum aminotransferase, amylase, and
hyperbilirubinemia can occur.
• Usually have fever.
• A positive Murphy's sign on physical examination supports the
diagnosis. (elicited by firmly placing a hand at the costal margin in the
right upper abdominal quadrant and asking the patient to breathe deeply;
if the patient abruptly ceases inhaling due to pain.)
• Cholecystectomy is the mainstay of treatment for acute calculous
cholecystitis. Lap chole > open.
• Poor surgical candidates may benefit from initial nonoperative
management with antibiotics and a gallbladder drainage procedure.
, • Acute calculous cholecystitis should be admitted to the hospital and
provided with supportive care:
o Intravenous hydration.
o Correction of any electrolyte abnormalities.
o Pain control - (NSAIDs) or opioids.
o Intravenous antibiotics.
o Patients should be kept fasting, and although uncommonly needed,
those who are vomiting should have placement of a nasogastric tube.
• Can escalate to gallbladder perforat
Choledocolithiasis (Quick)(what is it? what does it look like? what
imaging? Tx?) Correct Answer-o Common bile duct obstruction.
o Proximal inflammation.
o Obstructive Jaundice.
o Dilated hepatic bile ducts.
o Tx: ERCP.
Choledocolithiasis (in depth) Correct Answer-is the presence of a
gallstone in the common bile duct.
o Labs: Elevated bilirubin (>4 very strong, 1.8 - 4 strong), and alkaline
phosphatase (late). Elevated AST and ALT (early).
o High risk: >55 y/o
o S/SX: biliary-type pain (right upper quadrant or epigastric
pain/tenderness), nausea, and vomiting. Patients may also appear
jaundiced. Courvoisier's sign (a palpable gallbladder on physical
