2. Cholelithiasis
Definition:
• Cholelithiasis is derived from the Greek word chol means "bile" + lith
means "stone” .
• Acute or chronic inflammation of the gallbladder associated with
choleliathesis.
• Presence of stones in the gallbladder is referred to as cholelithiasis
The stones may be lodged in the neck of the gall bladder or in the cystic
duct.
4. Types
• Cholesterol stones: It vary in color from light-yellow to dark-green or brown
and are oval 2 to 3 cm in length, often having a tiny dark central spot.
• Pigment stones: The small, dark stones made of bilirubin, calcium salts and
20% cholesterol that are found in bile.
5. Types
• Mixed gallstones: It typically contain 20–80% cholesterol. Common
constituents are Calcium carbonate, phosphate, Bilirubin, and other
bile pigments.
6. Risk Factors
• Family history
• Most commonly in woman
• Age 40yrs above
• Obese
• A diet high in fat and cholesterol but low in fiber
• Don’t get much exercise
7.
8. Etiology
• Pregnancy :failure to empty bile appropriately by the gallbladder
• Biliary tract infections
• Drugs
• Heredity
9. Etiology
• Too much cholesterol in bile. Body needs bile for digestion. It usually
dissolves cholesterol. But it can’t do that, the extra cholesterol might
form stones.
• Too much bilirubin in bile. Conditions like cirrhosis, infections,
and blood disorders can cause liver to make too much bilirubin.
• Gallbladder doesn’t empty all the way. This can make bile very
concentrated.
10.
11. Signs & symptoms
• Gallstones may be asymptomatic, even for years, are called "silent stones"
and do not require treatment.
• It begin to appear once the stones reach a certain size (>8 mm).
• A characteristic symptom of gallstones is a "gallstone attack", intense pain in
the upper-right side of the abdomen. Often, attacks occur after a particularly
fatty meal.
12. Signs & symptoms
• Abdominal bloating
• Intolerance of fatty foods
• Gas
• Indigestion.
15. • Blood tests. These check for signs of infection or blockage, and rule
out other conditions.
• Ultrasound.
• CT scan. Specialized X-rays to see inside the gallbladder.
• Magnetic resonance cholangiopancreatography(MRCP). This test
uses a magnetic field and pulses of radio wave energy to make
pictures of the inside of liver and gallbladder.
16. • (HIDA scan). This test can check gallbladder squeezes correctly.
injects a harmless radioactive material and a technician can then
watch its movement.
• Endoscopic ultrasound. This test combines ultrasound and endoscopy
to look for gallstones.
17. Endoscopic retrograde cholangiopancreatography (ERCP).
• A tube called an endoscope through mouth down to small intestine.
They inject a dye so they can see bile ducts on a camera in the
endoscope.
• They can often take out any gallstones that have moved into the ducts
18. Medical Management
• Narcotics to relieve pain (Morphine)
• Antispasmodics and anticholinergics to relax smooth muscles and
decrease ductal tone and spasm.
• Nastro gastric tube also inserted and connected to intermittent, low-
pressure suction to relieve vomiting.
• Iv fluids
20. Non- Surgical Management
Dissolution therapy:
Tube or catheter is inserted into the gallbladder to dissolve stones.
Extracorporeal shock wave lithotripsy:
It is a technique that uses electric shock waves to dissolve gallstones.
22. Surgical Management
• Cholecystectomy
Surgical removal of the gall bladder.
• Cholecystostomy
Is a procedure a stoma is created in the gallbladder, can facilitate placement
of a tube for drainage.
23. COMPLICATIONS
• Gallbladder inflammation (acute cholecystitis).
• Blocked bile ducts cause fever, chills, and yellowing of skin
and eyes (jaundice).
• If a stone blocks the duct to pancreas, that organ may become
inflamed (pancreatitis).
24. PREVENTION
• Eat a healthy diet that's high in fiber and good fats, like fish oil and
olive oil. Avoid refined carbs, sugar, and unhealthy fats.
• Get regular exercise
25. Nursing Diagnosis
• Acute pain related to gallbladder stones.
• Ineffective breathing pattern related to pain secondary to disease.
• The risk of dehydration related to vomiting
• Imbalanced nutrition less than body requirements related to altered lipid
metabolism and increased nutritional needs during healing
• Risk for infection related to complications of disease.
26. Nursing Interventions
• Monitor and record vital signs.
• Administer medication as ordered.
• Administer analgesic as ordered
• Place the patient in low Fowler’s position to facilitates breathing.
• Provide intravenous fluids and nasogastric suction.
• Provide water and other fluids and soft diet.
• Observe for indications of infection, leakage of bile, or obstruction of bile drainage
