Gallbladder disorders include cholelithiasis, acute cholecystitis, and chronic cholecystitis. Cholelithiasis refers to gallstones, which form from bile constituents like cholesterol and pigment in the gallbladder or bile ducts. Risk factors include age, female sex, obesity, family history, and estrogen therapy. Acute cholecystitis is inflammation of the gallbladder due to gallstones obstructing the cystic duct or gallbladder neck. Symptoms include right upper quadrant pain, nausea, and fever. Chronic cholecystitis results from repeated inflammation and infection leading to gallbladder fibrosis. Treatment involves antibiotics, pain management, and cholecystectomy for severe or recurrent cases

1. GALLBLADDER DISORDERS
By
Y
.V
.V
anaja
Lecturer
Vijay Marie College of Nursing

2. Biliary tract disorders includes
▶ Cholelithiasis
▶ Acute cholecystitis
▶ Chronic cholecystitis

3. CHOLELITHIASIS/ GALLSTONES

4. DEFINITION
▶ 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.
▶ calculi or gallstones, usually form in the gallbladder from the solid
constituents of bile; they vary greatly in size, shape and composition.
“ Brunner’
’

5. INCIDENCE
▶ The incidence increases with age
▶ The incidence of cholelithiasis is higher in women, multiparous women
▶ Post menopausal women on estrogen therapy
▶ Oral contraceptive pills
▶ Familial tendency
▶ Obesity

6. TYPES OF GALLSTONES

7. Pigment stones: pigment stones probably form when when unconjugated pigments in the bile
precipitate to form stones
May be black colour
Cholesterol stones:
▶ In gall stone prone patients there is decreased bile acid synthesis and increased cholesterol synthesis
the liver resulting in bile supersaturated with cholesterol , which precipitate out of the bile to form bile
stones.
▶ Smooth & whitish yellow to tan colour
Mixed stones
▶ Combination of cholesterol and pigment stones or other substance
▶ Calcium carbonate, phosphate, bile salts, and palmitate

9. ETIOLOGY
▶ Change in bile composition-
▶ Gallbladder stasis
▶ supersaturation of bile with cholesterol
▶ Infection and tissue injury
▶ Genetics
▶ Cirrhosis
▶ Hemolysis and infections of the biliary tract

11. Pathophysiology
▶ In gallstone prone patients there is decreased bile acid synthesis and
increased cholesterol synthesis in the liver
▶ Super saturation of the bile with cholesterol or calcium
▶ Precipitation of solute from solvent to form solid crystal
▶ Crystals come together and fuse to form stones
▶ Venous and lymphatic drainage impaired
▶ Proliferation of bacteria occur

12. ▶ Localized cellular irritation & infiltration
▶ Ischemia and necrosis

14. ▶ Complaints of indigestion after
eating high fat foods.
▶ Localized pain in the right-
upper quadrant epigastric
region.
▶
fl
Anorexia, nausea, vomiting and
atulence

15. ▶ Increased heart and
respiratory rate – causing
patient to become
diaphoretic which in turn
makes them think they are
having a heart attack.

16. ▶ Abdominal distention
▶ Changes in the urine and stool color
▶ Vitamin deficiency
▶ 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.

17. 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.

18. ▶ Ultrasound of the gallbladder
▶ CT Scan
▶ MRI
▶ HIDA (hepato- iminodiacetic
acid)
▶ Cholangiography
▶ ERCP (endoscopic retrograde
cholangiopancreatography)
▶

20. MEDICAL MANAGEMENT
▶ MEDICAL MANAGEMENT GOALS-
▶ T
o resolve symptoms
▶ T
o remove stones
▶ T
o prevent complications
▶ PAIN MANAGEMENT
▶ Give analgesics
▶ Antacids,
▶ H2 blockers or proton pump inhibitors- to neutralize gastric acid
▶ For nausea and vomiting, Antiemetics given
▶ antibiotics

21. ▶ 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

22. ▶ Lithotripsy
▶ Extracorporeal shock wave
lithotripsy (ESWL)
▶ 1500 shock waves directed
at stones
▶ Used for fewer than 4
stones,
▶ each smaller than 3cm.

23. ▶ 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.

24. ▶ 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

25. ▶ Laproscopic cholecystectomy

26. CHOLECYSTITIS

27. TYPES OF CHOLECYTITIS
▶ Acute cholecystitis
▶ Chronic cholecystitis

28. ACUTE CHOLECYSTITIS
▶ DEFINITION;
▶ Acute cholecystitis refers to acute inflammation of the gallbladder wall.

29. TYPES OF ACUTE CHOLECYSTITIS
▶ Two types of acute cholecystitis can occur
▶ Calculous cholecystitis
▶ Acalculous cholecystitis
▶ 1) Calculous: -It is the obstructive cholecystitis due to gall stones having
the most common variety in which around 90% of people having gall
stones suffers.
▶ 2) Acalculous: -It is the non-obstructive type which is common in person
suffering from major illness like sever sepsis, burns, DM, dehydration,
multiple injury etc.

30. 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)

32. Pathophysiology
Gall stones
irritation and inflammmartion
Obstruct the cystic duct , gallbladder neck, or a common bile duct
When the gallbladder is inflamed trapped bile is reabsorbed and acts as a chemical irritant to the
gallbladder wall
reabsorbed bile, in combination with impaired circulation, edema, and distention of gallbladder, causes
ischemia and infection
The result is tissue sloughing with necrosis and gangrene
the gallbladder wall may eventually perforate peritonitis

33. 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.

34. ▶ - As acute cholecystitis progresses, the gallbladder begins to become
necrotic and gets a speckled appearance as the wall begins to die.

35. ▶ - Gallbladder undergoes gangrenous change and the wall becomes very
dark green or black. - This is the stage when perforation occurs.

36. ▶ SIGNS AND SYMPTOMS Complain of pain In right upper quadrant In
epigastric region In right subscapular Onset sudden Peak in 30min
▶ Nausea and vomiting Low grade fever Mild jaundice

37. ▶ CHRONIC CHOLECYSTITIS DEFINITION- Repeated inflammation and
infection of gallbladder

38. ▶ SIGNS AND SYMPTOMS Epigastric pain Indigestion Fat intolerance
Heart burn Fibrosis of gall tissues Inability to concentrate bile

39. ▶ MEDICAL MANAGEMENT GOAL- to treat symptomatic causes to
prevent complication

40. ▶ Antibiotic therapy- Ampicillin Ureidopenicillins – piperacillin or
mezlocillin Third generation cephalosporins- Ceftriaxone, cefixime,
Cefotaxime Aminoglycosides – Gentamicin, Amikacin, Neomycin

41. ▶ SURGICAL MANAGEMENT cholecystectomy

42. ▶ 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.

43. ▶ 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.