Anda di halaman 1dari 33

CHOLECYSTITIS with CHOLECYSTOLITHIASIS

Overview The normal anatomy and physiology of the GB

GALLBLADDER

The GB which is a small pear-shaped organ that stores and concentrates the bile. The gallbladder is connected to the liver by the hepatic duct. It is approximately 3 to 4 inches (7.6 to 10.2 cm) long and about 1 inch (2.5 cm) wide. What is its Function? The function of the gallbladder is to store bile and concentrate. Bile is a digestive liquid continually secreted by the liver. The bile emulsifies fats and neutralizes acids in partly digested food. A muscular valve in the common bile duct opens, and the bile flows from the gallbladder into the cystic duct, along the common bile duct, and into the duodenum (part of the small intestine). Cholecystitis Cholecystitis is painful inflammation of the gallbladder, a small organ near the liver that plays a part in digesting food. Normally, fluid called bile passes out of the gallbladder on its way to the small intestine. If the flow of bile is blocked, it builds up inside the gallbladder, causing swelling, pain, and possible infection. Cholecystolithiasis

Overview What are the symptoms? The most common symptom of cholecystitis is pain in your upper right abdomen that can sometimes move around to your back or right shoulder blade. Other symptoms include: Nausea or vomiting. Tenderness in the right abdomen. Fever. Pain that gets worse during a deep breath. Pain for more than 6 hours, particularly after meals. Constant pain in the right upper abdomen. It is usually made worse by moving. Jaundiced skin Older people may not have fever or pain. Their only symptom may be a tender area in the abdomen. Eating fatty foods will often make the symptoms worse. When the bacterial infection sets in, many patients experience a higher fever and shaking chills.

What causes it?

Overview

A gallstone stuck in the cystic duct, a tube that carries bile from the gallbladder, is most often the cause of sudden (acute) cholecystitis. The gallstone blocks fluid from passing out of the gallbladder. This results in an irritated and swollen gallbladder. Infection or trauma, such as an injury from a car accident, can also cause cholecystitis. Who gets it? Cholecystitis strikes: Twice as many women than men, particularly those between the ages of twenty and sixty. Pregnant women, or those on birth control pills or estrogen replacement therapy have a greater risk of developing cholecystitis. People who are overweight, or who lose a large amount of weight quickly are also at greater risk for developing the condition.

PATIENTS PROFILE
Name : Patient X Birth date : 11-14-35 Nationality : Filipino Religion : Roman Catholic Occupation : Palay Buying Station (Self-proprietor) Admission : 8-13-09 Admission time : 9:15 am Physician : Dr. Lagunilla Chief Complaint : Right Lower Quadrant pain History of Present illness

One year prior to admission the patient experiences Right Lower Quadrant pain but did not consult a doctor and chose to self medicate with pain relievers. Few hours PTA as RLQ pain with vomiting, weakness.
Genetics Has family history of gallstones (-) Hypertension First hospital confinement (-) diabetes Non-smoker

CHOLECYSTITIS
Is inflammation of the gallbladder, usually resulting from a gallstone blocking the cystic duct. Gallbladder inflammation usually results from a gallstone blocking the flow of bile. Typically, people have abdominal pain that lasts more than 6 hours, fever, and nausea. Ultrasonography can usually detect signs of gallbladder inflammation. The gallbladder is removed, often using a laparoscope. Is the most common problem resulting from gallbladder stones. It occurs when a stone blocks the cystic duct, which carries bile from the gallbladder. Cholecystitis is classified as acute or chronic.

CHOLECYSTITIS
Acute Cholecystitis: Acute cholecystitis begins suddenly, resulting in severe, steady pain in the upper abdomen. At least 95% of people with acute cholecystitis have gallstones. The inflammation almost always begins without infection, although infection may follow later. Inflammation may cause the gallbladder to fill with fluid and its walls to thicken. Rarely, a form of acute cholecystitis without gallstones (acalculous cholecystitis) occurs.

CHOLECYSTITIS
Acalculous cholecystitis is more serious than other types of cholecystitis. It tends to occur after the following: Major surgery Critical illnesses such as serious injuries, major burns, and bodywide infections (sepsis) Intravenous feedings for a long time Fasting for a prolonged time A deficiency in the immune system It can occur in young children, perhaps developing from a viral or another infection.

CHOLECYSTITIS
Chronic Cholecystitis: Chronic cholecystitis is gallbladder inflammation that has lasted a long time. It almost always results from gallstones. It is characterized by repeated attacks of pain (biliary colic). In chronic cholecystitis, the gallbladder is damaged by repeated attacks of acute inflammation, usually due to gallstones, and may become thick-walled, scarred, and small. The gallbladder usually contains sludge (microscopic particles of materials similar to those in gallstones), or gallstones that either block its opening into the cystic duct or reside in the cystic duct itself. Gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. CHOLECYSTOLITHIASIS

CHOLECYSTOLITHIASI
CHOLECYSTOLITHIASIS The presence of one or more gallstones in the gallbladder.

DIAGNOSTIC PROCEDU
DIAGNOSTIC PROCEDURES ASSESSMENT and DIAGNOSTIC METHODS Abdominal radiograph ultrasonography or cholecytography radionuclide imaging or cholescintigraphy. (ERCP) Percutaneous transhepatic cholangiography (PTC) ULTRA- SOUND RESULTS The gallbladder is normal in size. The wall is thick, thickness measures 8mm. There is a large highly echogenic density inside with acoustic shadow at the neck measures 24 mm

DIAGNOSTIC PROCEDU
CD and CND are normal in caliber. No billiary obstruction. The liver is not enlarged. The echo texture is uniform. No focal lesion. The pancreas, spleen and both kidneys are unremarkable. The urinary bladder shows smooth wall no intraluminal echo. The uterus is atropic.

DIAGNOSTIC PROCEDU
BLOOD TEST

DIAGNOSTIC PROCEDU
IV FLUIDS TAKEN

DIAGNOSTIC PROCEDU
URINALYS IS

DIAGNOSTIC PROCEDU
DIAGNOSTIC SONOGRAPHY (ULTRASONOGRAPHY) Is an ultrasound-based diagnostic imaging technique used to visualize subcutaneous body structures including tendons, muscles, joints, vessels and internal organs foe possible pathology or lesions. CHOLESCINTIGRAPHY Is a test done by nuclear medicine physicians to diagnose obstruction of the bile ducts (foe example, by a gallstone or a tumor), disease of the gallbladder, and bile leaks. It sometimes is referred to as a HIDA scan or a GALLBLADDER scan. PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTHC or PTC) Is a radiologic technique used to visualize the anatomy of the biliary tract. A contrast medium is injected into a bile

PATHOPHYSIOLOGY
Risk Factors Heredity, age over 40, gender,obesity Bile is supersaturated with cholesterol and calcium The solute precipitate from solution as solid crystals Gallstones Crystals come together and fuse to form stones

Obstruction of the cystic duct and common bile duct Sharp pain in the right lower part of the abdomen

Distention of the gall bladder

Jaundice

Venous and lymphatic drainage is impaired

Proliferation of Bacteria

Localized cellular Irritation

The gall bladder gets inflammed

Cholelithiasis is the presence of stones in the gallbladder. Cholecystitis is acute or chronic inflammation of the gallbladder. Most gallstones result from supersaturation of cholesterol in the bile, which acts as an irritant, producing inflammation in the gallbladder, and which precipitates out of bile, causing stones. Risk factors include : gender (women four times as like to develop cholesterol stones as men), age (older than age 40), multiple parity, obesity, use of estrogen and cholesterol-lowering drugs, bile acid malabsorption with GI disease, genetic predisposition, rapid weight loss.

PATHOPHYSIOLOGY

Pigment stones occur when free bilirubin combines with calcium. These stones occur primarily in patients with cirrhosis, hemolysis,

MEDICAL MANAGEMEN

MEDICAL MANAGEMEN

MEDICAL MANAGEMEN

MEDICAL MANAGEMEN

MEDICAL MANAGEMEN

SURGICAL INTERVENTI
CHOLECYSTECTOMY
is the surgical removal of the gallbladder. The operation is done to remove gallstones or to remove an infected or inflamed gallbladder. BENEFITS and RISK Gallbladder removal will relieve pain, treat infection, and in most cases stop gallstones from coming back. The risks of not having surgery are the possibility of worsening symptoms, infection, or bursting of the gallbladder. Possible complications include bleeding, bile duct injury, fever, liver injury, infection, numbness, raised scars, hernia at the incision, anesthesia complications, puncture of the intestine, and death.

NURSING MANAGEMEN
Discharge planning: Advise patient to continue medication as ordered by the physician. Instruct the patient to do exercise as tolerated such as walking. Encourage the patient to increase fluid intake Encourage the patient to have enough and adequate rest Instruct patient to attend follow up checkups to the physician. Advised patient to a diet as tolerated but preferably low salt and low fat diet.

NURSING CARE PLAN

NURSING CARE PLAN

NURSING CARE PLAN

NURSING CARE PLAN

NURSING CARE PLAN

NURSING CARE PLAN