Presence of stones in the gallbladder The most common disorder of the biliary
system.
The actual cause of cholelithiasis is unknown
Bilary sludge ( calcium, cholesterol & mucin) develops during gallbladder stasis as occurs during pregnancy or when receiving TPN. Sludge is asymptomatic. The sludge can evolve into stones.
Caused by the inflammation of the gallbladder.
May be acute or chronic, these conditions usually occur together.
Cholecystitis is most commonly associated with obstruction caused by gallstones or biliary sludge.
Affect about 20% of population The incidence is higher in women,
multiparous women, and people over 40 years of age.
Obesity High cholesterol Race or ethnicity(Native American/Northern
European heritage. Disorders : cirrhosis, small intestine
disorders, sickle cell anemia
Can vary from indigestion to moderate to severe pain, fever and jaundice.
Can get tenderness in the right upper quadrant, which may be referred to the right shoulder and scapula.
Accompanied by nausea and vomiting, restlessness and diaphoresis.
Ultrasonography to detect the stones and it is useful for people who have jaundice, because it does not rely on liver function.
ERCP(Endoscopic Retrograde Cholangiopancreatography) allows for visualization of the gallbladder, cystic duct, common hepatic duct and common bile duct. Sent for culture and sensitivity.
Laboratory tests will show and increase white blood cell count.
Bilirubin levels are elevated Serum enzymes such ALT, and AST may be
elevated
Acute pain related to obstruction of bile flow, inflammation in gallbladder.
Intolerance to certain kinds of foods, related to gallbladder or bile ducts disease
Anxiety related to the symptoms of disease and fear of the unknown
Increased risk of dehydration and electrolytes and metabolic disturbances due to inflammation, related to gallbladder or bile ducts diseases.
Treatmentso Symptomatico MTBE (methyl tertiary terbutyl ether)
dissolves stones MedicationsoUrsodeoxycholic acido Indomethacin(anti-inflammatory agent)
Diet◦ Monitor fluids and output closely◦ Decreased cholesterol and weight ◦ Avoid dairy products
Surgery - laparoscopic cholecystectomy - minimal
invasion less than 24 hours hospitalization. - incisional cholecystectomy - incision inside
the abdomen and NG tube in place post-op and several days hospitalized.
Health teaching- learning needs of client and family/caregiver include pain control, deep breathing, mobilization, incisional care and nutritional/fluids needs.
Laparoscopic Cholecystectomy Procedure
Burke, K., LeMone, P., Mohn-Brown, L. (2006). Medical surgical
nursing care (2nd ed.). Upper Saddle River, NJ: Prentice Hall.
Lewis, S.M., Heitkemper, M., Dirksen, S., Goldsworthy, S.,
Barry, M. (2006). Medical surgical nursing in Canada. (1st Cdn ed.). St. Louis, MO: Elsevier/Mosby.
Med for all. (producer).(December 21, 2007) Laparoscopic
Cholecystectomy Procedure. Retrieved November 2, 2008 from http://www.youtube.com/watch?v=7tTGfYCqH5w
Mosby’s medical nursing and allied health dictionary (7th ed.).
(2006). Toronto: Elsevier Mosby