Gallbladder and biliary tract disorders are common, affecting around 20 million people in the US each year. The most common conditions are gallstones and cholecystitis. Gallstones form when bile contains too much cholesterol, bilirubin, or calcium salts. Cholecystitis is inflammation of the gallbladder which can be acute or chronic. Surgical removal of the gallbladder (cholecystectomy) is often required to treat symptomatic gallbladder disease or prevent complications like infection or gallstone obstruction. Nursing care focuses on managing pain, monitoring for complications, and educating patients on signs of issues after surgery.
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
Cholelithiasis (calculi or gallstones) usually form in the gallbladder from the solid constituents of bile and vary greatly in size, shape and composition.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
Gastrointestinal bleeding (GI bleed), also known as gastrointestinal hemorrhage, is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool.
Cholelithiasis (calculi or gallstones) usually form in the gallbladder from the solid constituents of bile and vary greatly in size, shape and composition.
Formation of hard, pebble and stone like structure mainly made up of cholesterol in gall bladder is called cholelithiasis.
Know more about cholelithiasis
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
These presentation is related to biliary disorders. it is simple and concise presentation and provide all information about the biliary disease. i hope this presentation fulfill your requirements and should be useful.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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3. EPIDEMIOLOGY
In the united states alone, it is estimated
that 20 million people have gall stones
with approximately 1 million new cases
developing each year.
The most common conditions are gall
stones and associated cholecystitis.
4. About 98% of clients who present with
symptomatic gall bladder disease have
gall stones.
Malignancies and congenital anomalies
are very rare.
5. ANATOMY OF GALL BLADDER
Pear shape sac
7-10 cm long
Average capacity 30-
50 ml
When obstructed 300
ml
6. PHYSIOLOGY OF GALL BLADDER
The smooth muscles in the gallbladder
wall contract, leading to the bile
being secreted into the duodenum to
rid the body of waste stored in the bile as
well as aid in the absorption of
dietary fat by solubilising them using bile
acids.
7. BILE COMPOSITION
Bile consists of water, electrolytes, bile
acids, cholesterol, phospholipids and
conjugated bilirubin
Bile is secreted by the liver into small
ducts that join to form the common hepatic
duct and get stored in gall bladder.
9. CHOLELITHIASIS/ GALLSTONES
Gallstones are collections of cholesterol,
bile pigment or a combination of the two,
which can form in the gallbladder or within
the bile ducts of the liver.
10. Gallstones . .
The presence of
gallstones in the
gallbladder is called
cholelithiasis.
11. INCIDENCE
Common duct stones are found in about
10% tom15% of client with cholelithiasis.
The incidence increases with age, and the
frequency of gallstones it the common
duct in the older population may be as
high as 25%.
12. ETIOLOGY
Change in bile composition-
Gallbladder stasis
supersaturation of bile with cholesterol
Infection and tissue injury
Genetics
13. 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
18. Pigment stones
Excess of
unconjugated bilirubin
May be black
colour(associated
with hemolysis and
cirrhosis) or earthy
calcium bilirubinate
(associated with
infection)
20. 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.
22. 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.
23. DIAGNOSTICS TEST
History of patient
Physical examination
Laboratory test for-
Elevated conjugated bilirubin.
Elevated alkaline phosphate
Serum amylase and lipase
Elevated WBC count
Fecal studies.
30. Gall stone dissolution
Oral administration of agents-
chenodeoxycholic acid (CDCA) or
chenodal
ursodeoxycholic acid (UDCA) or ursodiol
Action- reduces the amount of cholesterol
in bile
32. Medical Management.
If stones are present in the
common bile duct, an
endoscopic sphincterotomy
must be performed to remove
them BEFORE a
cholecystectomy is done.
A number of various
instruments are inserted
through the endoscope in
order to "cut" or stretch the
sphincter.
Once this is done, additional
instruments are passed that
enable the removal of stones
and the stretching of
narrowed regions of the
ducts.
Drains (stents) can also be
used to prevent a narrowed
area from rapidly returning to
its previously narrowed state.
36. NURSING DIAGNOSIS
Acute pain related to surgical procedure.
Impaired skin integrity Invasion of body
structure
Ineffective breathing pattern Pain
Risk for deficient fluid volume related to
surgical procedure
37. NURSING INTERVENTION
1. Acute pain related to surgery
Monitor and record vital signs.
administer medication as ordered.
assess the severity,frequency, and
characteristic of pain.
Provide divertional activities such as
reading newspapers.
38. 2. Impaired skin integrity
Observe the color and character of the
drainage.
Change dressings as often as necessary.
Place patient in low- or semi-Fowler’s
position.
Monitor puncture sites (3–5) if endoscopic
procedure is done.
39. 3. Ineffective breathing pattern
Observe respiratory rate, depth.
Auscultate breath sounds.
Assist patient to turn, cough, and deep
breathe periodically.
Show patient how to splint incision.
Instruct in effective breathing techniques.
Elevate head of bed, maintain low-
Fowler’s position.
40. 4. Risk for deficient fluid volume
Monitor vital signs. Assess mucous
membranes, skin turgor, peripheral
pulses, and capillary refill.
Monitor I&O, including drainage from NG
tube ,T-tube, and wound. Weigh patient
periodically.
Observe for signs of bleeding:
hematemesis, melena, petechiae,
ecchymosis.
Administer IV fluids, blood products, as
indicated
41. What is it cholecystitis?
By definition,
cholecystitis is an
inflammation of the
gallbladder wall and
nearby abdominal
lining.
Abdominal wall
Gallbladder
44. ETIOLOGY
Gall stone in cystic duct
Obstruction in cystic duct
Bacterial infection (gram positive and
gram negative aerobes and anaerobes:-
E. Coli, klebsiella, Clostredium and
streptococcus)
47. PROGRESSION OF ACUTE
CHOLECYSTITIS.
- Gallbladder has a
grayish appearance & is
edematous.
-There is an obstruction
of the cystic duct and
the gallbladder begins
to swell.
- It no longer has the
"robin egg blue"
appearance of a normal
gallbladder.
58. 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.
59. 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.
60. CONCLUSION
Biliary disorders are extremely common
but diverse in nature.
Incidence rate of the disease is increasing
day by day.
Teaching and awareness is vital in
prevention and management of the
disease.
61. EVALUATION
A 45 yr old obese lady, complaining of
epigastric pain, right sided subscapular
pain which last for 3-4 hrs associated with
nausea and vomiting. She has mild icterus
and bilirubin is 3.3mg/dl.
Guess what could be the diagnosis of
patient?