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Cholelithiasis (Nursing Dx (Acute Pain r/t surgical procedure, Ineffective…
Cholelithiasis
Clinical Manifestations
-Obstructive jaundice
-Dark amber urine, which foams when shaken
-No urobilinogen in urine
-Clay-colored stools
-Pruritus
-Intolerance for fatty foods (nausea, feeling full, anorexia)
-Bleeding tendencies
-Steatorrhea
Diagnostics
-History and physical examination
-Ultrasound
-ERCP
-Percutaneous transhepatic cholangiography
-Liver function studies
-WBC
-Serum bilirubin
Management
-IV fluid
-NPO with NG tube, later progressing to low-fat diet
-Fat Soluble vitamins (A, D, E, K)
-Transhepatic biliary catheter
-ERCP with sphincterotomy
-Extracorporeal shock-wave lithotripsy
-Laparoscopic cholecystectomy
-Incisional (open) cholecystectomy
Medications
-Antiemetics
-Analgesics
-Anticholinergics (antispasmodics)
-Antibiotics (for secondary infection)
-ursodeoxycholic acid (ursodiol [Actigall])
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Incidence
-8-10% American adults have cholelithiasis
-Cholecystectomy ranks among most common surgical procedures in U.S.
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