■bilirubin: 1.2○Liver enzymes may be elevated.■AST 5-40■ALT 7-56○Diagnostic tests: Ultrasound**, ERCP●Management○Rest, IV fluids, NG suction, analgesic, antibiotics. Delay surgery until acutesymptoms subside, then proceed with surgery.○Diet after acute episode- liquids (low fat) progress slowly. Avoid fatty, fried, orgas-forming foods.○Medications: ursodeoxycholic acid and chenodeoxycholic acid- may dissolvesmall gallstones.○Nonsurgical removal■By instrumentation■Intracorporeal or extracorporeal lithotripsy○Laparoscopic cholecystectomy or Open cholecystectomy●Complications○Bleeding, infection○GI symptoms○Complications related to surgery in general:common bile duct injury,atelectasis, thrombophlebitis, infection●Education○Care of the patient after cholecystectomy■NPO until fully awake, then liquids; progress to soft, low-fat, high-carbohydrate diet as tolerated.■Care of biliary drainage system if the patient has a T-tube.●Observe for blockage of drainage and accompanying symptoms●Read care of T tube (ATI- page 344)■Analgesics, pain management.■Turn, cough, and deep breathing; splinting to reduce pain■Lap Chole:EARLY Ambulation promotes absorption of CO2 gas used inprocedure.■Report pain, vomiting abd. Distension (may be a leak)○Discharge education■Discharge education- Frequently same day discharge.■Diet- low-fat, avoid dairy and fried foods,avoid gas forming foods,chocolate, nuts, gravy). Small frequent meals■Take fat-soluble vitamins■Include when to call, postop visit, activity.KNOW chart 50-2.(Will bequestions directly from this chart!!).●heating pad sitting upright in bed or chair will help ease pain●call for signs of infection redness swelling heat drainage pain●call if fever >2 days■Pain unrelieved by analgesics may be a common bile duct injury. Patient
