A hardened deposit within the fluid in the gallbladder, a small organ under the liver.

1. Mr.Jagdish Sambad
M.Sc.N-MSN
Cholelithiasis

2. Introduction
 Calculous disease of the biliary tract is the general
term applied to diseases of
the gallbladder and biliary tree that are a direct
result of gallstones. Gallstone disease is the most
common disorder affecting the biliary system. The
true prevalence rate is difficult to determine
because calculous disease may often
be asymptomatic.

3. Definition
 “Cholelithiasis is the presence of stones in the
gallbladder - chole- means "gall bladder", lithia
meaning "stone", and -sis means "process".
 Cholelithiasis is the formation of gallstones, which
are composed of cholesterol, calcium salts, and
bile pigments.

9. Causes & Risk Factors
 Fair, fat, female, fertile of course.
 High fat diet
 Obesity
 Rapid weight loss
 Increases with age
 alcoholism.
 Diabetics have more complications
 Lack of Physical Activity
 Family History of Gallstones

11. signs and symptoms
 There are three stages of gallstones: asymptomatic,
symptomatic, and with complications. Sixty to 80% of
gallstones are asymptomatic, meaning that they cause
no symptoms.
If gallstones become symptomatic, the person may
have the following symptoms:
 a feeling of abdominal bloating and excessive gas
 nausea and sometimes vomiting
 pain that is usually in the upper right or middle part of
the abdomen
 radiation of the pain through to the back or into the
shoulder
 worsening of the pain after a heavy or fatty meal

12. signs and symptoms
If complications occur, the individual may
develop further symptoms:
 · abnormally light-colored stools
 · blockage of the bowels
 · dark-colored urine
 · fever
 · itching
 · jaundice, or yellowing of the eyes and skin
 · severe, constant abdominal pain

13. Diagnosis
 History Taking
 Abdominal Examination
 Ultrasound - Ultrasounds are used to view internal
organs of the abdomen such as the liver spleen, and
kidneys and to assess blood flow through various
vessels.
 cholangiography - x-ray examination of the bile ducts
using an intravenous (IV) dye (contrast).
 percutaneous transhepatic cholangiography (PTC) -
a needle is introduced through the skin and into the liver
where the dye (contrast) is deposited and the bile duct
structures can be viewed by x-ray.

14. Diagnosis
 Computed tomography scan - A CT scan shows
detailed images of any part of the body, including the
bones, muscles, fat, and organs. CT scans are more
detailed than general x-rays.
 endoscopic retrograde cholangiopancreatography
(ERCP) - a procedure that allows the physician to
diagnose and treat problems in the liver, gallbladder, bile
ducts, and pancreas. The procedure combines x-ray
and the use of an endoscope - a long, flexible, lighted
tube. The scope is guided through the patient's mouth
and throat, then through the esophagus, stomach, and
duodenum.

15. Treatment
 Surgery is the treatment of choice for gallbladder
and biliary tract diseases and may include open
or laparoscopic cholecystectomy,
cholecystectomy with operative cholangiography
and, possibly, exploration of the common bile
duct.
 Stone dissolution: For patients who decline
surgery or who are at high surgical risk (eg,
because of concomitant medical disorders or
advanced age), gallbladder stones can
sometimes be dissolved by ingesting bile acids
orally for many months.

16. Treatment
 Other treatments such as low-fat diet to prevent attacks
and vitamin K for itching, jaundice, and bleeding
tendendes due to vitamin K deficiency.
 Treatment during an acute attack such as insertion of a
nasogastric tube and an I.V.line and, possibly, antibiotic
and analgesic administration.
 Another treatment for this disease is non surgical, it
involves placement of a catheter through the
percutaneous transhepatic cholangiographic route.
Guided by fluoroscopy, the catheter is directed toward the
stone. A basket is threaded through the catheter,opened,
twirled to entrap the stone, closed, and withdrawn. This
procedure can be performed endoscopically.

17. Laparoscopic Cholecystectomy

18. Complications
 Cholangitis, sepsis
 Pancreatitis
 Perforation (10%)
 Hepatitis
 Choledocholithiasis (Stone in Common Bile
Duct)

19. Nursing Management
 Assessment
 Subjective Data
 Objective Data

20. Nursing Diagnosis
 Preoperative
 Knowledge deficit regarding cholecystectomy.
 Anxiety related to surgery.

21. Nursing Diagnosis
 Post-operative
 Acute pain and discomfort related to surgical
incision.
 Impaired skin integrity related to altered biliary
drainage after surgical intervention.
 Imbalance nutrition, less than body requirements
related to inadequate bile secretion.
 Knowledge deficit about self-care activities
related to incision care and follow up.

22. Lifestyle and Gallstone Disease
Sandeep Sachdeva, Indian J Community Med. 2011 Oct-Dec; 36(4): 263–267.
 Females had a higher prevalence of gallstone disease than
males (P < 0.01). Among males, the geriatric age group (<60
years) was relatively more susceptible (28%). Prepubertal age
group was least afflicted (3.3%). Univariate analysis revealed
multiparity, high fat, refined sugar, and low fiber intakes to be
significantly associated with gallstones. Sedentary habits,
recent stress, and hypertension were also among the
significant lifestyle-related factors. High body mass index and
waist hip ratios, again representing unhealthy lifestyles, were
the significant anthropometric covariates.