Topic: Cholelithiasis

Subject: AHN

Objectives • At the end of this presentation the student will be able

to:• Define Cholelithiasis.• Identify types of gall stones.• Describe Pathophysiology of Cholelithiasis.• Enlist signs, symptoms and causes of Cholelithiasis.• Discuss medical diagnosis and treatment Cholelithiasis• Make nursing diagnosis and nursing intervention for

Cholelithiasis.

Cholelithiasis

• Cholelithiasis is derived from the Greek word

chol means "bile" + lith means "stone”

• Presence of stones in the gallbladder is referred to as cholelithiasis

Types of gallstones There are three types which is given

below.• Cholesterol stones (80% cholesterol by

weight) vary in color from light-yellow to dark-green or brown and are oval 2 to 3 cm in length, often having a tiny dark central spot.

• Pigment stones are small, dark stones made of bilirubin, calcium salts and 20% cholesterol that are found in bile.

Conti…

• Mixed gallstones typically contain 20–80% cholesterol. Other common constituents are calcium carbonate, palmitate phosphate, bilirubin, and other bile pigments. Because of their calcium content, they are often radiographically visible.

Pathophysiology

• Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts

Two other factors are important in causing gallstones are:

• Incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation.

Conti…

• The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones.

Etiology

Cholelithiasis is mainly caused by• Obesity• Pregnancy• Gallbladder stasis• Drugs• Heredity

Signs and symptoms

• Gallstones may be asymptomatic, even for years. These gallstones are called "silent stones" and do not require treatment.

• Symptoms commonly begin to appear once the stones reach a certain size (>8 mm).

• A characteristic symptom of gallstones is a "gallstone attack", in which a person may experience intense pain in the upper-right side of the abdomen.

Conti….

• Often, attacks occur after a particularly fatty meal and almost always happen at night. Other symptoms include

• Abdominal bloating• Intolerance of fatty foods• Belching• Gas• Indigestion.

Medical Diagnosis

• Abdominal Ultrasound• History and Physical Exam• Abdominal CT Scan• Plain X-ray

Treatments

• Surgical Removal of Gallbladder

• Laparoscopic Cholecystectomy

Complication

• Cholecystitis .• Choledocholelithiasis.• Perforated Gallbladder.• Gallbladder Cancer.• Cholangitis.• Pancreatitis.• Gangrene or Abscesses.

Nursing Diagnosis• Acute pain related to gallbladder stones.• Ineffective breathing pattern related to pain

secondary to disease.• The risk of dehydration related to vomiting• Imbalanced nutrition less than body requirements

related to altered lipid metabolism and increased nutritional needs during healing.

• Risk for infection related to complications of disease.

Nursing Interventions

• Monitor and record vital signs.• Administer medication as ordered.• Administer analgesic agents as ordered • Place the patient in low Fowler’s position to

facilitates breathing.• Provide intravenous fluids and nasogastric suction.• Provide water and other fluids and soft diet.• Observe for indications of infection, leakage of bile,

or obstruction of bile drainage.

References

• Huffman JL, Schenker S. Acute acalculous cholecystitis - a review. Clin Gastroenterol Hepatol. Sep 9 2009;[Medline].

• Donovan JM. Physical and metabolic factors in gallstone pathogenesis. Gastroenterol Clin North Am. Mar 1999;28(1):75-97. [Medline].

• Sitzmann JV, Pitt HA, Steinborn PA, et al. Cholecystokinin prevents parenteral nutrition induced biliary sludge in humans. Surg Gynecol Obstet. Jan 1990;170(1):25-31. [Medline].

• Cullen JJ, Maes EB, Aggrawal S, et al. Effect of endotoxin on opossum gallbladder motility: a model of acalculous cholecystitis. Ann Surg. Aug 2000;232(2):202-7. [Medline].

• Forbes LE, Bajaj M, McGinn T, et al. Perihepatic abscess formation in diabetes: a complication of silent gallstones. Am J Gastroenterol. Apr 1996;91(4):786-8. [Medline].