Bonzon, Jenika

Fernando, Floidas
Garcia, Jessica
CHOLELITHIASIS
GALLSTONES
Form in the gallbladder from solid constituents of bile.
They can also form if the gallbladder does not empty as it should.
People who are overweight or who are trying to lose weight quickly are more
likely to get gallstones.
They vary greatly in size, shape, and composition.
They are uncommon in children and young adults.
Cholecystitis - acute or chronic inflammation of the gallbladder.
ANATOMY AND PHYSIOLOGY
GALLBLADDER
is a pear shaped, hallow, sac like organ
3- 4 inches long
Lies in a shallow depression on the inferior surface of the liver which is attached
by a connective tissue.
it has the capacity to hold 30 to 50 ml of bile
PATHOPHYSIOLOGY

Risk
Factors:
4 Fs:
Fertile,
Forty,
Fertile Fat
DEC Bile
acid
synthesi
s

Supersatura
ted bile with
cholesterol
Feve
r

INC
cholester
ol acid in
Liver
Choleste
rol
saturate
d bile

Abdominal
pain
Gallsto
ne

Inflammati
on

Jaundic
e
Sweating
Loss of

appetite
ETIOLOGY
4 Fs

Bonzon, Jenika
Fernando, Floidas
Garcia, Jessica
-

Fat
Female
Forty
Fertile
Assessment Findings:

ASSESSMENT FINDINGS:
-Steatorrhea
-Pruritus
-Easy bruising
-Dark amber urine

DIAGNOSTIC FINDINGS
Abdominal x-ray
Cholecystography
Ultrasonography
DRUG THERAPY
Ursodeoxycholic Acid (ursodiol UDCA) and Chenodeoxycholic (chenodiol-CDCA )
to dissolve small, radiolucent gallstones.
Morphine for severe pain.
Anti - emetics

Bonzon, Jenika
Fernando, Floidas
Garcia, Jessica
MANAGEMENT
Lithotripsy
If the attack of cholelithiasis is mild
bed rest is prescribed.
patient is placed on NPO to allow GI tract and gallbladder to rest.
an NG tube is placed on low suction.
fluids are given IV in order to replace lost fluids from NG tube suction.

Cholecystectomy or Laparoscopic Cholecystectomy

removal of the gallbladder.
-This is the treatment of choice.
-The gallbladder along with the cystic duct, vein and artery are ligated.
Choledochostomy
- It involves making an incision in the common duct , usually for removal of
stones . After the stone have been evacuated, a tube is usually inserted into the
duct for drainage of bile until edema subside.

COMPLICATIONS
Cholecystitis
Choledocholithiasis
Gallstone pancreatitis
Severe abdominal pain
NURSING DIAGNOSIS
Acute pain and discomfort related to surgical incision
Impaired gas exchange related to high abdominal surgical incision
Imbalanced nutrition, less than body requirements related to inadequate bile
secretion
NURSING INTERVENTION (post-op)
Place pt. in low Fowlers position
Provide small frequent meals of modified diet ( low fat )
Avoid heavy lifting for at least 6 weeks
Resume sexual activity as desired unless ordered as otherwise by the physician
Clients having laparoscopy cholecystectomy usually resume normal activity within
2 weeks.
NURSING INTERVENTION ( T-TUBE)
Maintain and monitor functioning of T tube
Measure record drainage every shift
Expect 300 500 ml bile-colored drainage for 1 st 24 hours for 3 4 days
Assess for sign of peritonitis
Monitor color of urine and stool
Assess skin around T tube ( cleanse frequently)