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NSG 3850 Final Exam 4

HEAL100 Health Care — exam and revision material · Other

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Health Care exam material, 20 pages. Originally published on StudyMerit.

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20
Academic year
2025/2026
Language
English

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NSG 3850 Exam 4 Notes Pathophysiology For Nurses II (Galen College of Nursing) messages.pdf_cover_qr_code_label messages.studocu_not_sponsored_or_endorsed_by_college NSG 3850 Exam 4 Notes Pathophysiology For Nurses II (Galen College of Nursing) messages.pdf_cover_qr_code_label messages.studocu_not_sponsored_or_endorsed_by_college messages.downloaded_by lOMoARcPSD|6879242

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UNIT 9 🟢 DISORDERS OF THE GALLBLADDER Anatomy & Physiology Review ● Function: Stores and concentrates bile produced by the liver. ○ Capacity: Distensible sack with about 30 to 50 mL capacity. ● Bile Composition: Water, electrolytes, bile acids (salts), pigment, cholesterol, phospholipids. ● Flow Path: Liver ➡ Hepatic Ducts ➡ Cystic Duct ➡ Gallbladder (storage) ➡ Common Bile Duct ➡ Ampulla of Vater ➡ Duodenum. ● Regulation: ○ Fasting: Sphincter of Oddi contracts ➡ bile stored in gallbladder. ○ Eating: Cholecystokinin (CCK) stimulates contraction ➡ bile released for fat digestion. Cholelithiasis (Gallstones) De fi nition: Formation of stones (calculi) within the gallbladder. Pathophysiology of Cholesterol Stone Formation (3 Phases) 🧠 1. Supersaturation: Bile becomes supersaturated with cholesterol (Most common cause). 2. Nucleation: Cholesterol crystals aggregate (stick together) and form stones. 3. Hypomotility: Stasis of bile allows stones to grow. ● Key Factor: Lecithin normally stops crystallization by emulsifying fats. If lecithin drops, stones form. Risk Factors (The "F"s & Medical Causes) ● Female: 2x more common than in men. ● Fat (Obesity): BMI > 30. ● Rapid Weight Loss: Mobilizes cholesterol. ● Forty: Age correlation. ● Fertile: Pregnancy, oral contraceptives. ● Ethnicity: Native American, Asian, Caucasian. ● Medical: TPN (Total Parenteral Nutrition), Spinal Cord Injuries (stasis), Diabetes, Prolonged Fasting . Types of Stones ● Cholesterol: Most common in the US. ● Pigment Stones: ○ Black: Associated with cirrhosis or hemolysis. ○ Brown: Common in developing countries; associated with biliary parasites/infection. Chronic Cholelithiasis De fi nition: Gallstones present with intermittent symptoms. messages.downloaded_by lOMoARcPSD|6879242

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Clinical Manifestations ● Biliary Colic (Hallmark Symptom): ⚠ ○ Persistent epigastric or Right Upper Quadrant (RUQ) pain. ○ Radiation: To the back or right shoulder . ○ Timing: Precipitated by a meal (fatty foods). Lasts 15 mins to 1 hour, then slowly decreases. ○ Mechanism: Periodic obstruction of cystic duct or spasm of sphincter of Oddi . ● Associated Symptoms: Nausea/Vomiting (N/V), sweating, fl atus, bloating, belching, epigastric burning. ● Pediatric Note: Children usually have underlying conditions (sickle cell, cystic fi brosis) and need surgery. Adults can be asymptomatic. Management ● Asymptomatic: "Watchful waiting." ● Symptomatic: ○ Surgery: Laparoscopic cholecystectomy (Treatment of Choice). ○ Chemical Dissolution: Oral bile acids (Ursodiol/UDCA). Takes months, causes diarrhea, low success. ○ Lithotripsy (ESWL): Shock waves to break stones. Acute Cholecystitis De fi nition: Acute in fl ammation of the gallbladder wall. ● Etiology: Cholelithiasis (stones) present in 90% of cases. ● Pathophysiology: Stone obstructs cystic duct ➡ Stasis ➡ In fl ammation of gallbladder wall and/or sphincter of Oddi ➡ Fibrosis/Thickening. Clinical Manifestations 🔥 ● Severe RUQ Pain: Radiates to back/shoulder. Increases with deep breath. ● Positive Murphy's Sign: Inspiratory arrest on palpation of RUQ. ● Systemic: Fever, Leukocytosis (High WBCs). ● GI: Nausea, vomiting, anorexia, fat intolerance, abdominal distention, feeling of fullness. ● Labs: Mild elevation in bilirubin and AST/ALT. Jaundice may occur. Complications (Red Flags ⚠ ) ● Gangrene/Rupture: Leads to Peritonitis and Septic Shock . ● Empyema: Abscess (pus- fi lled gallbladder). ● Cholecystoenteric Fistula: Abnormal connection to bowel (GI tract). Acalculous Cholecystitis ● De fi nition: In fl ammation without stones. ● Risk Factors: Major surgery, Trauma, Critical illness, Burns, TPN. ● Mechanism: Bile stasis and ischemia. ● Warning: More rapid progression to gangrene/perforation than stone-type. messages.downloaded_by lOMoARcPSD|6879242

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