CHOLELITHIASIS

( GALLSTONES)
DEFINITION:- Gallstones are a 
collection of one or more stones in the
gallbladder, When the gallstones are in
the gallbladder, the condition is called
cholelithiasis; when they are in the bile
ducts the condition is called
choledocolithiasis.
Affects both sexes  but twice as common
in females. It is also more common in
certain groups of people, such as Native
 CAUSES

• Alterations in bile composition, such as

increased concentration of cholesterol or
decrease in concentration of phopholipids or
bile acids; 
• Failure of gallbladder to emptadequately 
• Infection; Hemolytic disorders such as sickle
cell anemia.
 Risk factors for gallstones

• Fair, fat, female, fertile (four Fs)

• High fat diet
• Obesity and family history
• Rapid weight loss, NPO.
• Increases with age, alcoholism.
• Diabetics
• Pregnancy
Other illnesses that predispose to
gallstone formation include the
following:
• Burns
• Use of total parenteral nutrition
• Paralysis( Impaired motility can
predispose to stones.)
• ICU care
• Major trauma
 PATHOPHYSIOLOGY
• Bile consists of lethicin, bile acids, phospholipids
in a fine balance.
• There are three types of stones, cholesterol,
pigment, mixed.
• Formation of each types is caused by
crystallization of bile.
• Cholesterol stones most common.
• Sludge is crystals without stones. It may be a
first step in stones, or be independent of it.
• Pigment stones (20%) are from calcium
bilirubinate.
• Diseases that increase RBC destruction will
cause these. Also in cirrhotic patients, parasitic
infections.
 C
LINICAL MANIFESTATIONS
– Recurrent Abdominal pain in the right upper
or middle upper abdomen:
– May spread to the back or below the right
shoulder blade
– May be made worse by fatty or greasy foods
– Occurs within minutes of a meal
– Fever /chills occur in acute
– Yellowing of skin and whites of the eyes
(jaundice)
– Colic and crampying pain
ocures when stone lodges in
the common bile duct.
– Positive murph’s sign
 DIAGNOSTIC AND
LABORATORY TESTS
• Diagnostic tests may include
laboratory studies such as
• Blood count and blood chemistry
• CT scan, ultrasound,
cholecystography, and X-rays of the
gallbladder. Ultrasound scanning is
the best method for diagnosing
gallstones in the gallbladder.
 MEDICATIONS

• Anticholinergics such as Bentyl

(dicyclomine hydrochloride) to decrease
GB and biliary tree tone. (20mg IM q4-
6).
• Strong antipains such as Demerol 25-
75mg IV/IM q3
• Antiemetics (phenergan, compazine).
• Antibiotics
• SURGERY can be done with an open or
laparoscopic technique.
• Cholecystectomy can be performed after the
first 24-48h or after the inflammation has
subsided.
• Oral dissolution therapy using
ursodeoxycholic acid to dissolve cholesterol
(8 to 10 mg/kg/day Po dissolves 80% of tiny
stones )
• Lithotripsy( using shock wave to disintegrate
the stones)
• Endoscopic retrograde
cholangiopancreatography
 NURSING MANAGEMENT

• Give information about the disease process,

diagnostic and therapuetic procedures and their
expected out comes.
• Provide diet restriction (review of food high in
fat) keep client NPO and IV fluid as ordered.
• Provide comfort measures, pain free
• Encourage obese individual to lose weight.
PRE -OPERATIVE CARE
• Maintaning hydration with
appropriate fluid.
• Prevent injury & give vitamin K
may be given before surgery.
• Prepare blood for transfusion.
POST OPERATIVE NURSING CARE
• Monitor vital signs.
• Keep wound incision clean and dry.
• Maintain pattent IV and
Administration of IV antibiotic
• Control pain (give analgesics prior to
post operative exercise.
• Keep client comfortable to promote
deep breathing, coughing and
turning position to prevent
pulmonary infection.
• Place fowler’s position to clients
with T- tube placement.
• Assess bile drainage and record the
amount.
• Assess the skin for inflammation
secondary to bile likage.
 COMPLICATIONS
• Cholangitis,
• sepsis
• Pancreatitis
• Perforation (10%)
• Hepatitis
• Choledocholithiasis