Lect 28 Cholecystitis-Cholelithiasis.ppt

CHOLECYSTITIS & CHOLELITHIASIS
Prepared by
Maira Shaheen

Learning Objectives
By the end of the session learners will be able to:
• Discuss the Causes, pathophysiology and
manifestation of the Cholecystitis & Cholelithiasis
• Discuss the diagnostic test , medical, Surgical and
Nursing management of the Cholecystitis &
Cholelithiasis
2

Cholecystitis
Cholecystitis is an
inflammation of the
gallbladder wall and
nearby abdominal
lining.
Abdominal
wall
Gallbladder 3

ETIOLOGY / PATHOPHYSIOLOGY
Can be caused by an obstruction, gallstone or a
tumor.
 90% of all cases caused by gallstones.
 The exact cause of gallstone formation is
unknown.
When there is an obstruction, gallstone or tumor it
prevents bile from leaving the gallbladder.
 Bile gets trapped and acts as an irritant
which causes cellular infiltration within 3 – 4
days.
4

 This infiltration causes an
inflammatory process – the
gallbladder becomes enlarged
and edematous.
Eventually this occlusion
along with bile stasis causes
the mucosal lining of the
gallbladder to become
necrotic.
Bacterial growth occurs due
to ischemia.
Necrotic Gallbladder
5

 Rupture of the gallbladder becomes a danger,
along with spread of infection of the hepatic
duct and liver.
 If the disease is severe and interferes with the
blood supply it can cause the gallbladder to
become gangrenous.
Gangrenous
gallbladder
Gallstones
6

GALLSTONES
The presence of gallstones in the gallbladder is
called Cholelithiasis.
7

Common locations of gallstones
8

Those who are most at risk.
These are all adjectives to describe the person most
at risk of developing symptomatic gallstones.
FAIR FAT FORTY FEMALE
9

Something to think about.
Disorders of the biliary system are COMMON
in the U.S.
They are responsible for the hospitalization of
more than half a million people each year.
The two most common conditions are
cholecystitis & cholelithiasis.
10

Signs and Symptoms
Complaints of indigestion
after eating high fat foods.
Localized pain in the
right-upper quadrant
epigastric region.
Anorexia, nausea,
vomiting and flatulence.
Increased heart and respiratory rate
– causing patient to become
diaphoretic which in turn makes
them think they are having a heart
attack.
12

SIGNS AND SYMPTOMS
 Low grade fever.
 Elevated leukocyte count.
 Mild jaundice.
 Stools that contain fat – steatorrhea.
 Clay colored stools caused by a lack of bile in
the intestinal tract.
 Urine may be dark amber- to tea-colored.
13

DIAGNOSTICS TEST
Fecal studies.
Serum bilirubin tests.
Ultrasound of the
gallbladder.
15

ASSESSMENT AND DIAGNOSTIC
METHODS
Cholecystogram,
cholangiogram
Laparoscopy
Cholesterol levels
gamma-glutamyl
transpeptidase
(GGTP), LDH
CT scans and MRI;
ERCP
Serum alkaline
phosphatase;
gamma-glutamyl
(GGT),
16

MEDICAL MANAGEMENT.
ERCP
 for patients with
only a few stones
With other
pathological disease
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.
18

Dissolving gallstones, they can be removed by
instrumentation T-tube placement in the common
bile duct
19

SURGICAL MANAGEMENT
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.
20

Laparoscopic vs Open Cholestectomy
21

Cholendoscopic removal of gallstones
22

Nursing Interventions
Post Op - Cholesystectomy
1. Administer oral analgesics to facilitate movement
and deep breathing – and to stay ahead of pts pain.
2. Observe dressings frequently for exudate and hemorrhage.
3. Vitals are routinely checked.
4. Patient teaching:
-Must understand how to splint the abd. before
coughing.
-Report any abnormalities such as,
severe pain, tenderness in RUQ, increase in
pulse, etc . .
-Instructed that they usually can return to work in 3
days & can resume full activity in 1 week.
5. Fluid balance is maintained IV –
potassium added to compensate
for loss from surgery.
23

Nursing Interventions
1. Urine and stool should be observed for alterations
in the presence of bilirubin.
2. NG tube must be monitored for amount, color & consistency
of output.
Also, tube must be on LOW suction and nasal area should
be monitored for irritation and necrosis.
3. Anti-emetics may be administered if nausea persists.
4. I & O are measured and described carefully.
5. Pt. must understand how to splint the abdomen
for post op coughing, turning and deep breathing.
Interventions center on keeping patient comfortable by
carefully administering meds and watching for reactions.
24

Will you survive?
 Prognosis is usually excellent with prompt
treatment.
 Laparoscopic surgery has decreased the
number of complications.
 Prognosis is NOT favorable for those who
develop pancreatitis. 
25

REFERENCE
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., &
Cheever, K. H. (2010). Brunner and Suddarth’s
textbook of medical-surgical nursing (12th ed.).
Philadelphia:Lippincott Williams & Wilkins.
27

Lect 28 Cholecystitis-Cholelithiasis.ppt

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