Best NCLEX-RN Practice: The Client with Biliary Tract Disorder
The NCLEX title cover:
- The Client with Cholecystitis
- The Client with Pancreatitis
- The Client with Viral Hepatitis
- The Client with Cirrhosis
- Managing Care Quality and Safety
- Answers, Rationales, and Test Taking Strategies
Gallbladder stones are an extremely common disorder and are usually asymptomatic. Some patients experience biliary colic, an intermittent and often severe pain in the epigastrium or right upper quadrant, and at times between the scapula because of temporary obstruction of the cystic duct with a gallstone. If the cystic duct obstruction persists, the gallbladder becomes inflamed and the patient develops cholecystitis, an acute inflammation and infection of the gallbladder.
Most gallstones are composed primarily of cholesterol, with smaller amounts of mucus, calcium bilirubinate, and protein. Pigment stones, a result of hemolysis, are less common and are made primarily of calcium bilirubinate. Symptoms occur with gallstones when the gallbladder contracts, often after a meal, resulting in occlusion of the cystic duct with a stone that produces symptoms, typically pain.
The vast majority of patients with gallstones are asymptomatic. Symptomatic gallstones typically manifest with right upper quadrant abdominal pain, often accompanied by nausea and vomiting. The pain is often severe, may abate over several hours (biliary colic), or may progress to cholecystitis, with persistent pain and fever. On examination, there is pain to palpation in the right upper quadrant (Murphy’s sign).
The imaging study of choice is a right upper quadrant ultrasound, which, in the presence of cholecystitis, typically shows the presence of gallstones, a thickened gallbladder wall, and pericholecystic fluid. In those patients with symptomatic gallstones and a negative ultrasound examination, endoscopic ultrasound may be helpful. To confirm the suspicion of cholecystitis, a hydroxyiminodiacetic acid (HIDA) scan can be useful. The radionuclide material is concentrated in the liver and excreted into the bile but does not fill the gallbladder because of cystic duct obstruction.