The document provides information on cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder). It discusses the anatomy and physiology of the gallbladder and biliary tract. It describes the epidemiology, etiological factors, pathophysiology, types, diagnostic evaluation and management of both cholelithiasis and cholecystitis. Key points include that gallstones are usually cholesterol stones and can cause biliary colic, cholecystitis occurs due to gallstone obstruction/infection, and laparoscopic cholecystectomy is the standard treatment. Complications like cholangitis and pancreatitis are also discussed.
The document discusses cholelithiasis (gallstones) and acute cholecystitis (inflammation of the gallbladder). It covers the prevalence and types of gallstones, risk factors, potential complications, clinical presentation, diagnosis and treatment options. For acute cholecystitis, conservative treatment with antibiotics and fluids is usually attempted first to resolve the inflammation before delayed cholecystectomy once symptoms subside.
This document discusses acute peritonitis, including:
- Peritonitis is defined as inflammation of the peritoneum and can be localized or generalized. It is usually caused by bacterial infection entering through the gastrointestinal tract or other sources.
- Symptoms depend on whether it is localized or diffuse. Localized peritonitis causes pain specific to the affected organ, while diffuse peritonitis causes generalized abdominal pain and tenderness.
- Treatment involves antibiotics, fluid resuscitation, and sometimes surgery to address the underlying cause and drain any abscesses. Outcomes depend on several factors but mortality is around 10% with prompt treatment. Complications can include shock, bowel obstruction, and residual infections.
gall stone disease, etiology , pathogenesis , risk factors ,types of gall stones,clinical feature, diagnosis , medical and surgical treatment of gall stones , prevention of gall stones
Choledocholithiasis refers to stones in the common bile duct. Stones can be primary, forming directly in the bile duct, or secondary, originating from the gallbladder. Clinical features include biliary colic, jaundice, fever, and complications like cholangitis. Investigations include ultrasound, MRCP, CT, and ERCP. Treatment involves ERCP with sphincterotomy and stone extraction, or open exploration during cholecystectomy. For retained stones, techniques include T-tube flushing or reoperation with transduodenal sphincteroplasty or choledochojejunostomy.
This document discusses cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder). It covers the anatomy of the gallbladder and biliary tree. Common causes of gallstones include altered gallbladder function and supersaturated bile. Gallstones can be asymptomatic, cause biliary colic, or lead to complications like cholecystitis, pancreatitis and obstruction. Acute calculous cholecystitis is usually caused by a gallstone obstructing the cystic duct. Clinical features include right upper quadrant pain and tenderness. Investigations include ultrasound and blood tests. Treatment is usually laparoscopic cholecystectomy.
This document discusses small bowel obstruction, including its pathophysiology, clinical presentation, diagnosis, management, and prevention. The pathophysiology section explains how obstruction leads to accumulation of gas and fluid in the bowel above the site of obstruction. The clinical presentation section outlines common symptoms like colicky abdominal pain and nausea/vomiting, as well as signs seen on examination. Diagnosis involves distinguishing mechanical obstruction from ileus, determining the etiology, and discriminating between partial and complete or simple versus strangulating obstruction, often using radiological exams. Management depends on whether the obstruction is simple or strangulated. With conservative treatment, the majority of patients with adhesive small bowel obstruction are readmitted in less than 20% of cases over 5
Diverticular disease is a common condition where pouches called diverticula bulge out from the colon wall, usually where blood vessels penetrate the colon. Diverticulosis is the presence of diverticula without inflammation, while diverticulitis occurs when diverticula become inflamed or infected, usually due to hard stool getting stuck in a diverticulum. Diverticulitis ranges from uncomplicated cases treated with antibiotics to complicated cases involving abscesses, fistulas, or perforation requiring surgery. Risk factors include low-fiber diet, aging, and high blood pressure.
The document discusses cholelithiasis (gallstones) and acute cholecystitis (inflammation of the gallbladder). It covers the prevalence and types of gallstones, risk factors, potential complications, clinical presentation, diagnosis and treatment options. For acute cholecystitis, conservative treatment with antibiotics and fluids is usually attempted first to resolve the inflammation before delayed cholecystectomy once symptoms subside.
This document discusses acute peritonitis, including:
- Peritonitis is defined as inflammation of the peritoneum and can be localized or generalized. It is usually caused by bacterial infection entering through the gastrointestinal tract or other sources.
- Symptoms depend on whether it is localized or diffuse. Localized peritonitis causes pain specific to the affected organ, while diffuse peritonitis causes generalized abdominal pain and tenderness.
- Treatment involves antibiotics, fluid resuscitation, and sometimes surgery to address the underlying cause and drain any abscesses. Outcomes depend on several factors but mortality is around 10% with prompt treatment. Complications can include shock, bowel obstruction, and residual infections.
gall stone disease, etiology , pathogenesis , risk factors ,types of gall stones,clinical feature, diagnosis , medical and surgical treatment of gall stones , prevention of gall stones
Choledocholithiasis refers to stones in the common bile duct. Stones can be primary, forming directly in the bile duct, or secondary, originating from the gallbladder. Clinical features include biliary colic, jaundice, fever, and complications like cholangitis. Investigations include ultrasound, MRCP, CT, and ERCP. Treatment involves ERCP with sphincterotomy and stone extraction, or open exploration during cholecystectomy. For retained stones, techniques include T-tube flushing or reoperation with transduodenal sphincteroplasty or choledochojejunostomy.
This document discusses cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder). It covers the anatomy of the gallbladder and biliary tree. Common causes of gallstones include altered gallbladder function and supersaturated bile. Gallstones can be asymptomatic, cause biliary colic, or lead to complications like cholecystitis, pancreatitis and obstruction. Acute calculous cholecystitis is usually caused by a gallstone obstructing the cystic duct. Clinical features include right upper quadrant pain and tenderness. Investigations include ultrasound and blood tests. Treatment is usually laparoscopic cholecystectomy.
This document discusses small bowel obstruction, including its pathophysiology, clinical presentation, diagnosis, management, and prevention. The pathophysiology section explains how obstruction leads to accumulation of gas and fluid in the bowel above the site of obstruction. The clinical presentation section outlines common symptoms like colicky abdominal pain and nausea/vomiting, as well as signs seen on examination. Diagnosis involves distinguishing mechanical obstruction from ileus, determining the etiology, and discriminating between partial and complete or simple versus strangulating obstruction, often using radiological exams. Management depends on whether the obstruction is simple or strangulated. With conservative treatment, the majority of patients with adhesive small bowel obstruction are readmitted in less than 20% of cases over 5
Diverticular disease is a common condition where pouches called diverticula bulge out from the colon wall, usually where blood vessels penetrate the colon. Diverticulosis is the presence of diverticula without inflammation, while diverticulitis occurs when diverticula become inflamed or infected, usually due to hard stool getting stuck in a diverticulum. Diverticulitis ranges from uncomplicated cases treated with antibiotics to complicated cases involving abscesses, fistulas, or perforation requiring surgery. Risk factors include low-fiber diet, aging, and high blood pressure.
This document defines various components of the biliary system including bile, bile salts, and bile acids. It describes bile acid metabolism and the enterohepatic circulation. It discusses cholestasis, approaches to diagnosing a patient with cholestasis, and various causes of cholestasis including gallstones. It describes the pathophysiology, risk factors, clinical features, diagnosis, and treatment of gallstone disease. It also discusses other biliary diseases and conditions such as primary sclerosing cholangitis, biliary strictures, and biliary dyskinesia.
Mr. B, a middle-aged man, experienced abdominal pain after eating fatty foods that radiated to his back and caused nausea. An examination and ultrasound were planned to evaluate for possible biliary diseases like cholelithiasis. Cholelithiasis, or gallstones, occur when bile contains too much cholesterol and not enough bile salts, causing stones to form in the gallbladder or ducts. Gallstones are often diagnosed by ultrasound and may be treated by laparoscopic cholecystectomy to remove the gallbladder.
This document defines and discusses diverticulosis, diverticulitis, segmental colitis associated with diverticula (SCAD), and symptomatic uncomplicated diverticular disease (SUDD). It covers the background, definitions, presentations, diagnoses, differential diagnoses, and treatments of these conditions. Diverticulosis is the presence of diverticula (sac-like protrusions of the colonic wall), while diverticulitis is inflammation of the diverticula that can be acute or chronic. SCAD involves chronic inflammation between diverticula, and SUDD includes abdominal pain associated with diverticulosis.
Liver abscesses are usually caused by bacteria, parasites or fungi entering through the biliary tract or portal vein. The most common type is a pyogenic abscess in the right lobe of the liver. Risk factors include chronic alcoholism. Entamoeba histolytica, the cause of amebic dysentery, can spread from the colon to the liver and cause an amoebic abscess. Symptoms include fever, right upper quadrant pain and tenderness. Diagnosis involves blood tests and imaging scans like ultrasound, CT or MRI. Treatment is with antibiotics and sometimes drainage of the abscess.
An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food. If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage.
The document discusses gallstones, including their pathogenesis, types (cholesterol, pigment, mixed), and complications such as cholecystitis, cholangitis, pancreatitis, and intestinal obstruction. It describes acute and chronic cholecystitis, noting that acute cholecystitis is usually associated with gallstones and presents with symptoms of pain, fever, jaundice. Treatment involves conservative measures followed by cholecystectomy. Chronic cholecystitis can be secondary or primary, presenting with vague symptoms, and is treated definitively with cholecystectomy.
This document discusses pancreatitis, including its anatomy, physiology, etiology, clinical presentation, diagnosis, prognosis, management, and complications. Pancreatitis is defined as inflammation of the pancreas and can be acute or chronic. Acute pancreatitis is commonly caused by gallstones or alcohol and may range from mild to severe, with severe cases involving pancreatic necrosis and multi-organ failure. Diagnosis involves blood tests measuring amylase and lipase along with imaging like CT. Management depends on severity but generally involves hospitalization, IV fluids, pain control, and monitoring for complications.
The document provides information on evaluating and diagnosing an acute abdomen. It describes how the causes of an acute abdomen vary by age and include appendicitis, biliary disease, bowel obstruction, and diverticulitis. A thorough history, physical exam, and lab tests are needed for diagnosis. The exam focuses on locating the pain and assessing for peritoneal irritation or inflammation. Common lab tests include complete blood count, electrolytes, and tests to check for conditions like pancreatitis or pregnancy. Imaging studies may also be used to diagnose the specific cause of the acute abdomen.
Acute cholangitis is an infection of the bile ducts caused by obstruction and bacterial overgrowth. It presents with fever, jaundice, and right upper quadrant pain (Charcot's triad). Obstruction leads to increased pressure and bacterial growth in the bile ducts. Diagnosis involves blood tests, imaging like ultrasound or CT, and testing bile if drained. Treatment is antibiotics, hydration, and relieving obstruction endoscopically or surgically. Antibiotics are continued until obstruction is fully resolved to prevent recurrence.
Intestinal obstruction occurs when the intestine is blocked partially or completely, preventing contents from passing through. It can be classified as dynamic, adynamic, small bowel, or large bowel obstruction.
Clinical presentation depends on the location and severity of the obstruction. Symptoms often include colicky abdominal pain, vomiting, distention, and constipation.
Common causes are adhesions, hernias, volvulus, intussusceptions, gallstones, and tumors. Strangulated obstruction with compromised blood flow is a surgical emergency.
Diagnosis involves blood tests, abdominal exams, imaging studies like abdominal x-rays and CT scans to detect air-
Mr. NBR, age 42, was admitted with symptoms of jaundice, abdominal pain, dark urine, and clay-colored stools. Investigations revealed multiple stones in the common bile duct. He underwent open cholecystectomy with exploration of the common bile duct and intraoperative cholangiography. Multiple impacted stones were found and removed from the common bile duct and intrahepatic ducts. The patient's postoperative recovery was uncomplicated and he was discharged on the 11th postoperative day after drain removal and suture removal.
This document discusses cholecystitis, inflammation of the gallbladder. It notes that gallstones are the most common cause of cholecystitis, occurring in 98% of cases, with obstruction of the cystic duct and inflammation due to gallstones being the typical pathogenesis. Ultrasound is identified as the initial diagnostic study of choice for gallbladder disease. Treatment involves IV fluids, analgesia, antibiotics, and cholecystectomy, with laparoscopic cholecystectomy being the gold standard procedure.
Intestinal obstruction is a blockage of the bowel that prevents contents from passing through. There are two main types: mechanical obstruction from pressure on the bowel wall, and functional obstruction where the bowel muscles cannot propel contents. Causes of small bowel obstruction include adhesions, intussusception, volvulus, and tumors. Causes of large bowel obstruction include carcinoma, diverticulitis, and inflammatory bowel disorders. Treatment involves decompressing the bowel, fluid replacement, and usually surgery to relieve the obstruction.
The patient, a 57-year-old woman, presented with right upper quadrant pain and tenderness and was found to have gallstones. Gallstones form when bile in the gallbladder becomes supersaturated, causing cholesterol and other substances to precipitate out into stones. Risk factors include female gender, multiparity, obesity, and genetics. Ultrasound confirmed the presence of gallstones and showed a thick-walled gallbladder, indicating cholecystitis. Treatment options include dissolving the stones medically, surgical removal by cholecystectomy, or nonsurgical methods such as lithotripsy to break up the stones.
The document discusses various disorders of the gallbladder and bile ducts. It describes that over 95% of biliary tract diseases are due to cholelithiasis (gallstones), which can be either cholesterol stones or pigment stones. Cholecystitis, an inflammation of the gallbladder, can be acute or chronic and is usually caused by gallstones blocking the cystic duct. Other complications of gallbladder disorders include cholangitis, an inflammation of the bile ducts, and secondary biliary cirrhosis from long-term bile duct obstruction.
This document provides an overview of the management of acute pancreatitis. It defines acute pancreatitis as the inflammation of the pancreas often associated with pancreatic duct dilation. It discusses the epidemiology, etiology, pathogenesis, clinical forms, investigations, risk assessment, treatment and prognosis of acute pancreatitis. The management involves resuscitation, assessing severity, treating any underlying causes, and monitoring for complications which can include pancreatic necrosis, infection and multi-organ failure. Severity is assessed using scoring systems like Ranson's criteria or CT severity index to determine prognosis and guide management.
Liver tumours can be benign or malignant. Benign tumours include hepatic hemangiomas and hepatic adenomas. Hepatic hemangiomas are the most common benign liver tumour, often appearing as 4 cm growths, while hepatic adenomas have a risk of bleeding or transforming into cancer. Malignant liver tumours are usually metastases from other cancers but can also include hepatocellular carcinoma, the most common primary liver cancer associated with risk factors like hepatitis, alcoholism and cirrhosis. Symptoms of liver cancer include jaundice and weight loss. Treatment options depend on diagnosis and include surgery, transplantation or other therapies.
This document provides tips for using a PowerPoint presentation (PPT) on liver tumors:
1. The PPT can be freely downloaded, edited, and modified.
2. Many slides are blank except for the title to facilitate active learning sessions where students provide information before each slide is shown.
3. This approach allows for three revisions of content to reinforce learning.
4. The PPT is also useful for self-study with notes providing bibliographic references.
The gallbladder is a hollow organ located beneath the liver that stores and concentrates bile. Cholecystitis is inflammation of the gallbladder, usually caused by gallstones blocking the cystic duct. Symptoms include pain in the upper right abdomen and fever. Ultrasound is often used to diagnose cholecystitis by detecting gallstones or thickening of the gallbladder wall. Treatment typically involves surgical removal of the gallbladder via laparoscopy.
This document discusses gallstones, including their types, risk factors, pathogenesis, clinical presentations, investigations, and treatments. The main points are:
- Gallstones are typically cholesterol stones, pigment stones, or mixed. Their composition varies globally, with Asia having more pigment stones and Europe more cholesterol stones.
- Risk factors for gallstones include being female, over 40, fertile, or overweight, as well as pregnancy, oral contraceptive use, certain medical conditions, and hyperlipidemia.
- Gallstones can be asymptomatic or cause issues like biliary colic, cholecystitis, pancreatitis, jaundice, and cholangitis due to obstruction or inflammation in the biliary system
The liver produces bile which is stored and concentrated in the gallbladder before being released to aid in fat digestion. Gallstones form when bile contains too much cholesterol or bilirubin. Risk factors for gallstones include female sex, obesity, rapid weight loss, and family history. Gallbladder disorders in children can include cholecystitis, cholelithiasis, sludge, polyps, and septations. Symptoms include abdominal pain. Ultrasound can detect gallstones, wall thickening, sludge, and other abnormalities.
This document summarizes a seminar on cholecystitis and choledocholithiasis presented by Ms. Navaneeta Kusum. It discusses the topics of:
1) Cholecystitis, which is inflammation of the gallbladder often caused by gallstones blocking bile flow, and choledocholithiasis, which are stones in the common bile duct.
2) Risk factors, signs and symptoms, diagnostic evaluations and complications of both conditions.
3) Treatment options including conservative management, definitive surgery such as cholecystectomy and bile duct exploration, and nonsurgical options like oral dissolution therapy.
This document defines various components of the biliary system including bile, bile salts, and bile acids. It describes bile acid metabolism and the enterohepatic circulation. It discusses cholestasis, approaches to diagnosing a patient with cholestasis, and various causes of cholestasis including gallstones. It describes the pathophysiology, risk factors, clinical features, diagnosis, and treatment of gallstone disease. It also discusses other biliary diseases and conditions such as primary sclerosing cholangitis, biliary strictures, and biliary dyskinesia.
Mr. B, a middle-aged man, experienced abdominal pain after eating fatty foods that radiated to his back and caused nausea. An examination and ultrasound were planned to evaluate for possible biliary diseases like cholelithiasis. Cholelithiasis, or gallstones, occur when bile contains too much cholesterol and not enough bile salts, causing stones to form in the gallbladder or ducts. Gallstones are often diagnosed by ultrasound and may be treated by laparoscopic cholecystectomy to remove the gallbladder.
This document defines and discusses diverticulosis, diverticulitis, segmental colitis associated with diverticula (SCAD), and symptomatic uncomplicated diverticular disease (SUDD). It covers the background, definitions, presentations, diagnoses, differential diagnoses, and treatments of these conditions. Diverticulosis is the presence of diverticula (sac-like protrusions of the colonic wall), while diverticulitis is inflammation of the diverticula that can be acute or chronic. SCAD involves chronic inflammation between diverticula, and SUDD includes abdominal pain associated with diverticulosis.
Liver abscesses are usually caused by bacteria, parasites or fungi entering through the biliary tract or portal vein. The most common type is a pyogenic abscess in the right lobe of the liver. Risk factors include chronic alcoholism. Entamoeba histolytica, the cause of amebic dysentery, can spread from the colon to the liver and cause an amoebic abscess. Symptoms include fever, right upper quadrant pain and tenderness. Diagnosis involves blood tests and imaging scans like ultrasound, CT or MRI. Treatment is with antibiotics and sometimes drainage of the abscess.
An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food. If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage.
The document discusses gallstones, including their pathogenesis, types (cholesterol, pigment, mixed), and complications such as cholecystitis, cholangitis, pancreatitis, and intestinal obstruction. It describes acute and chronic cholecystitis, noting that acute cholecystitis is usually associated with gallstones and presents with symptoms of pain, fever, jaundice. Treatment involves conservative measures followed by cholecystectomy. Chronic cholecystitis can be secondary or primary, presenting with vague symptoms, and is treated definitively with cholecystectomy.
This document discusses pancreatitis, including its anatomy, physiology, etiology, clinical presentation, diagnosis, prognosis, management, and complications. Pancreatitis is defined as inflammation of the pancreas and can be acute or chronic. Acute pancreatitis is commonly caused by gallstones or alcohol and may range from mild to severe, with severe cases involving pancreatic necrosis and multi-organ failure. Diagnosis involves blood tests measuring amylase and lipase along with imaging like CT. Management depends on severity but generally involves hospitalization, IV fluids, pain control, and monitoring for complications.
The document provides information on evaluating and diagnosing an acute abdomen. It describes how the causes of an acute abdomen vary by age and include appendicitis, biliary disease, bowel obstruction, and diverticulitis. A thorough history, physical exam, and lab tests are needed for diagnosis. The exam focuses on locating the pain and assessing for peritoneal irritation or inflammation. Common lab tests include complete blood count, electrolytes, and tests to check for conditions like pancreatitis or pregnancy. Imaging studies may also be used to diagnose the specific cause of the acute abdomen.
Acute cholangitis is an infection of the bile ducts caused by obstruction and bacterial overgrowth. It presents with fever, jaundice, and right upper quadrant pain (Charcot's triad). Obstruction leads to increased pressure and bacterial growth in the bile ducts. Diagnosis involves blood tests, imaging like ultrasound or CT, and testing bile if drained. Treatment is antibiotics, hydration, and relieving obstruction endoscopically or surgically. Antibiotics are continued until obstruction is fully resolved to prevent recurrence.
Intestinal obstruction occurs when the intestine is blocked partially or completely, preventing contents from passing through. It can be classified as dynamic, adynamic, small bowel, or large bowel obstruction.
Clinical presentation depends on the location and severity of the obstruction. Symptoms often include colicky abdominal pain, vomiting, distention, and constipation.
Common causes are adhesions, hernias, volvulus, intussusceptions, gallstones, and tumors. Strangulated obstruction with compromised blood flow is a surgical emergency.
Diagnosis involves blood tests, abdominal exams, imaging studies like abdominal x-rays and CT scans to detect air-
Mr. NBR, age 42, was admitted with symptoms of jaundice, abdominal pain, dark urine, and clay-colored stools. Investigations revealed multiple stones in the common bile duct. He underwent open cholecystectomy with exploration of the common bile duct and intraoperative cholangiography. Multiple impacted stones were found and removed from the common bile duct and intrahepatic ducts. The patient's postoperative recovery was uncomplicated and he was discharged on the 11th postoperative day after drain removal and suture removal.
This document discusses cholecystitis, inflammation of the gallbladder. It notes that gallstones are the most common cause of cholecystitis, occurring in 98% of cases, with obstruction of the cystic duct and inflammation due to gallstones being the typical pathogenesis. Ultrasound is identified as the initial diagnostic study of choice for gallbladder disease. Treatment involves IV fluids, analgesia, antibiotics, and cholecystectomy, with laparoscopic cholecystectomy being the gold standard procedure.
Intestinal obstruction is a blockage of the bowel that prevents contents from passing through. There are two main types: mechanical obstruction from pressure on the bowel wall, and functional obstruction where the bowel muscles cannot propel contents. Causes of small bowel obstruction include adhesions, intussusception, volvulus, and tumors. Causes of large bowel obstruction include carcinoma, diverticulitis, and inflammatory bowel disorders. Treatment involves decompressing the bowel, fluid replacement, and usually surgery to relieve the obstruction.
The patient, a 57-year-old woman, presented with right upper quadrant pain and tenderness and was found to have gallstones. Gallstones form when bile in the gallbladder becomes supersaturated, causing cholesterol and other substances to precipitate out into stones. Risk factors include female gender, multiparity, obesity, and genetics. Ultrasound confirmed the presence of gallstones and showed a thick-walled gallbladder, indicating cholecystitis. Treatment options include dissolving the stones medically, surgical removal by cholecystectomy, or nonsurgical methods such as lithotripsy to break up the stones.
The document discusses various disorders of the gallbladder and bile ducts. It describes that over 95% of biliary tract diseases are due to cholelithiasis (gallstones), which can be either cholesterol stones or pigment stones. Cholecystitis, an inflammation of the gallbladder, can be acute or chronic and is usually caused by gallstones blocking the cystic duct. Other complications of gallbladder disorders include cholangitis, an inflammation of the bile ducts, and secondary biliary cirrhosis from long-term bile duct obstruction.
This document provides an overview of the management of acute pancreatitis. It defines acute pancreatitis as the inflammation of the pancreas often associated with pancreatic duct dilation. It discusses the epidemiology, etiology, pathogenesis, clinical forms, investigations, risk assessment, treatment and prognosis of acute pancreatitis. The management involves resuscitation, assessing severity, treating any underlying causes, and monitoring for complications which can include pancreatic necrosis, infection and multi-organ failure. Severity is assessed using scoring systems like Ranson's criteria or CT severity index to determine prognosis and guide management.
Liver tumours can be benign or malignant. Benign tumours include hepatic hemangiomas and hepatic adenomas. Hepatic hemangiomas are the most common benign liver tumour, often appearing as 4 cm growths, while hepatic adenomas have a risk of bleeding or transforming into cancer. Malignant liver tumours are usually metastases from other cancers but can also include hepatocellular carcinoma, the most common primary liver cancer associated with risk factors like hepatitis, alcoholism and cirrhosis. Symptoms of liver cancer include jaundice and weight loss. Treatment options depend on diagnosis and include surgery, transplantation or other therapies.
This document provides tips for using a PowerPoint presentation (PPT) on liver tumors:
1. The PPT can be freely downloaded, edited, and modified.
2. Many slides are blank except for the title to facilitate active learning sessions where students provide information before each slide is shown.
3. This approach allows for three revisions of content to reinforce learning.
4. The PPT is also useful for self-study with notes providing bibliographic references.
The gallbladder is a hollow organ located beneath the liver that stores and concentrates bile. Cholecystitis is inflammation of the gallbladder, usually caused by gallstones blocking the cystic duct. Symptoms include pain in the upper right abdomen and fever. Ultrasound is often used to diagnose cholecystitis by detecting gallstones or thickening of the gallbladder wall. Treatment typically involves surgical removal of the gallbladder via laparoscopy.
This document discusses gallstones, including their types, risk factors, pathogenesis, clinical presentations, investigations, and treatments. The main points are:
- Gallstones are typically cholesterol stones, pigment stones, or mixed. Their composition varies globally, with Asia having more pigment stones and Europe more cholesterol stones.
- Risk factors for gallstones include being female, over 40, fertile, or overweight, as well as pregnancy, oral contraceptive use, certain medical conditions, and hyperlipidemia.
- Gallstones can be asymptomatic or cause issues like biliary colic, cholecystitis, pancreatitis, jaundice, and cholangitis due to obstruction or inflammation in the biliary system
The liver produces bile which is stored and concentrated in the gallbladder before being released to aid in fat digestion. Gallstones form when bile contains too much cholesterol or bilirubin. Risk factors for gallstones include female sex, obesity, rapid weight loss, and family history. Gallbladder disorders in children can include cholecystitis, cholelithiasis, sludge, polyps, and septations. Symptoms include abdominal pain. Ultrasound can detect gallstones, wall thickening, sludge, and other abnormalities.
This document summarizes a seminar on cholecystitis and choledocholithiasis presented by Ms. Navaneeta Kusum. It discusses the topics of:
1) Cholecystitis, which is inflammation of the gallbladder often caused by gallstones blocking bile flow, and choledocholithiasis, which are stones in the common bile duct.
2) Risk factors, signs and symptoms, diagnostic evaluations and complications of both conditions.
3) Treatment options including conservative management, definitive surgery such as cholecystectomy and bile duct exploration, and nonsurgical options like oral dissolution therapy.
Cholelithiasis, or the presence of gallstones, is a common condition where stones form in the gallbladder. Risk factors include female gender, multiple pregnancies, oral contraceptive use, obesity, diabetes, and family history. Gallstones can be asymptomatic or cause pain, most commonly in the right upper quadrant of the abdomen. Diagnosis involves imaging tests like ultrasound or CT. Treatment options include pain management for symptomatic stones or surgical removal of the gallbladder (cholecystectomy) which is now most often performed laparoscopically.
The document discusses diseases of the gallbladder and biliary tree. It describes the anatomy and physiology of the gallbladder and discusses conditions like gallstones, acute cholecystitis, and obstructive jaundice. Gallstones are the most common pathology of the biliary tract and can cause complications within the gallbladder or bile ducts. Acute cholecystitis is an inflammation of the gallbladder usually due to a gallstone obstructing the cystic duct. Obstructive jaundice is caused by an obstruction of the biliary tree above the entry of the pancreatic duct and results in a yellowish discoloration of skin and eyes.
This document provides an overview of gallbladder disease in children. It discusses gallbladder physiology, bile formation, and the pathophysiology of gallbladder disease including cholecystitis and cholelithiasis. Risk factors for gallbladder disease in children include prolonged parenteral nutrition, obesity, rapid weight loss, and certain medical conditions or medications. Gallbladder abnormalities that may be seen in children include sludge, polyps, septation, and changes in size or wall thickness. The document also presents data on 211 children evaluated for changes in BMI and fatty liver disease who were subsequently found to have gallbladder abnormalities.
Cholecystitis And Cholelithiasis slidesharePatelVedanti
Cholecystitis: It is defined as the inflammation of the Gall Bladder.
Cholelithiasis: Stones in the Gall Bladder specially seen in the neck of the Gall Bladder or the cystic duct.
Most important for in GI system.
Common bile duct stones are found in 5-15% of patients undergoing cholecystectomy. They can cause obstruction, pain, jaundice, and cholangitis. Clinical features range from incidental findings to Charcot's triad of pain, fever, and jaundice. Endoscopic retrograde cholangiopancreatography with sphincterotomy is the primary treatment for common bile duct stones.
Bile is produced by the liver and stored and concentrated in the gallbladder before being released to aid digestion. The biliary tree consists of intrahepatic and extrahepatic ducts that drain bile from the liver to the gallbladder and duodenum. Developmental variations in branching patterns can occur and need to be recognized to avoid complications during surgery or imaging studies. Biliary disorders in children may be developmental, such as biliary atresia or choledochal cysts, or acquired, like inspissated bile plug syndrome. Gallbladder diseases include cholecystitis, porcelain gallbladder, and adenomyomatosis.
This document discusses gallstones, including their anatomy, physiology, risk factors, types, and imaging modalities. It provides detailed information on bile secretion and flow, the regulation of gallbladder emptying by cholecystokinin, and factors that affect relaxation of the sphincter of Oddi. It describes the main types of gallstones as cholesterol stones and pigment stones. Imaging modalities covered include abdominal x-ray, oral cholecystography, ultrasonography, and computerized tomography.
The gallbladder is a pear-shaped organ located on the inferior surface of the liver. It concentrates and stores bile produced by the liver. Bile contains water, electrolytes, bile salts, proteins, lipids, and bile pigments. Bile flows from the liver through the hepatic ducts and common bile duct into the duodenum. The sphincter of Oddi regulates bile and pancreatic juice flow. Ultrasonography is the initial test for gallbladder diseases and can detect gallstones. CT and HIDA scans provide additional information about the biliary tree and surrounding structures.
Laparoscopic cholecystectomy is a surgical procedure to remove the gallbladder through several small incisions in the abdomen. During the procedure, an instrument called a laparoscope is inserted to illuminate and provide video of the surgical area. The cystic duct and artery are clipped and cut to remove the gallbladder. This minimally invasive surgery has benefits over traditional open cholecystectomy such as fewer complications, shorter hospital stay, and quicker recovery. Risks are low but can include bleeding, infection, or injury to nearby bile ducts or blood vessels.
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 document provides an overview of cholecystitis, including what it is, its causes, types (acute and chronic), signs and symptoms, and treatment approaches from medical, surgical, and nursing perspectives. It defines cholecystitis as inflammation of the gallbladder, which holds digestive fluid released into the small intestine. Acute cholecystitis occurs when gallstones block the cystic duct, trapping bile and causing swelling and potential infection. Chronic cholecystitis develops over time from repeated acute attacks or gallstones. The document outlines signs, conservative treatment, surgical interventions like cholecystectomy, and the nursing role in management and addressing patient needs. It also notes elderly are more susceptible to cholecystitis due
Gall bladder & bile ducts with narration drchris5252
The document discusses the anatomy and diseases of the gallbladder and bile ducts. It provides details on:
1. The anatomy of the gallbladder, cystic duct, common bile duct, and sphincter of Oddi.
2. Common gallbladder and bile duct diseases including gallstones, cholecystitis, cholangitis, strictures, cancers, and more.
3. The symptoms, signs, investigations, and treatments for various diseases like acute cholecystitis, chronic cholecystitis, and bile duct stones.
Cholecystectomy is often the treatment for gallbladder diseases while bile duct diseases may require other interventions. A thorough understanding of the anatomy and diseases is
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.
Dr.Saad Gall Bladder and Biliary Tract2022.pptxGgdcddede
This document provides an overview of the surgical anatomy, physiology, investigations, congenital anomalies, diseases, and procedures related to the gallbladder and biliary system. It discusses the anatomy of the gallbladder, cystic duct, common hepatic duct, and common bile duct. It also summarizes the arterial supply, lymphatic drainage, and functions of the gallbladder. Various congenital anomalies, diseases like gallstones, calculus cholecystitis, and tumors are described. Surgical procedures for conditions like cholecystectomy, bile duct obstruction, and strictures are outlined.
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Cholelithiasis and cholecystitis, sunita kharel
1. Cholelithiasis & Cholecystitis
Presented By
Ms. Sunita Kharel
Medical Surgical Nursing Batch 2019
Supervised By
Prof. Pushpa Parajuli
Medical Surgical Nursing Department
2. Content
Relevant Anatomy
Physiology of gall
bladder
Cholelithiasis
o Introduction
o Epidemiology
o Etiological factors
o Pathophysiology
o Types of stones
o Diagnostic
evaluation
o Management
Cholecystitis
o Introduction
o Epidemiology
o Etiological factors
o Pathophysiology
o Diagnostic
evaluation
o Management
Nursing
Management
Potential
Complications
Summary
10/8/2021 Ms. Sunita Kharel 2
4. A small pouch that sits just under the liver
Stores bile produced by the liver.
After meals, the gallbladder is empty and flat, like
a deflated balloon.
The biliary tract is composed of the gallbladder,
bile ducts, and cystic duct.
The cystic duct (from the gall bladder) joins with
the hepatic duct (from the liver) to form a
common bile duct.
Relevant Anatomy…
10/8/2021 Ms. Sunita Kharel 4
5. Bile Juice
Normal adult human produce about 400-800ml bile
per day.
Produced by liver and stored at gallbladder.
Ph : 7.4, colour is golden yellow
Components: bile salts, bile pigments and
cholesterol
Helps in digestion and absorption of lipids and fats.
Also neutralizes any excess stomach before
entering ileum
Helps in absorption and other substances like fat
soluble vitamins, iron, calcium etc.
Increases peristalsis and thereby help in
defecation.
10/8/2021 Ms. Sunita Kharel 5
6. Physiology of Gall Bladder
Acts as a storage depot for bile.
During storage, a large portion of the water in
bile is absorbed through the walls, bile is 5-10
times more concentrated than that originally
secreted by the liver.
When food enters the duodenum, the
gallbladder contracts & the sphincter of Oddi
relaxes, allowing the bile to enter the intestine.
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8. Introduction
The presence of gallstones in the gallbladder.
A gallstone is a crystalline concentration
formed within the gallbladder by accretion of
the bile components.
These calculi are formed in the gallbladder,
but may pass distally into other parts of the
biliary tract such as cystic duct, common bile
duct, pancreatic duct, or the ampulla of vater.
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9. Introduction
If gallstones migrate into the ducts of the
biliary tract, the condition is referred to as
choledocholithiasis.
Gallstones can vary in size and shape from as
small as a grain of sand to as large as a golf
ball.
The gallbladder may contain a single large
stones or many smaller ones.
10/8/2021 Ms. Sunita Kharel 9
10. Epidemiology
It is uncommon in children and young adults, but
become increasingly prevalent after 40 years of age.
The incidents of cholelithiasis increase thereafter to such
an extent that up to 50% of those over 80 will develop
stones in the bile tract.
10/8/2021 Ms. Sunita Kharel 10
In the United States, about 20 millions people (10-20%
of adults) have gallstones.
11. Contributing Factors
Five Fs
Low fiber, high cholesterol and diets high in starchy
foods
Hereditary: Mutation of ABCG5/G8 (ATP Binding
Cassette Sub family G member 5 and G member 8)
Rapid weight loss
Low intakes of the nutrients,
Deficiency of folate, magnesium, calcium and
vitamin C
Immobility, pregnancy and inflammatory or
obstructive lesions
Hormonal factors during pregnancy cause delayed
emptying of the gallbladder
10/8/2021 Ms. Sunita Kharel 11
16. Gall Stones
A high percentage of gallstones are precipitated
of cholesterol.
Other components of bile that precipitate into
stones are bile salts, bilirubin, calcium and
protein.
The stones sometimes have a mixed consistency.
Stasis of bile leads to progression of super
saturation and changes in the chemical
composition of the bile.
10/8/2021 Ms. Sunita Kharel 16
18. Cholesterol stone
Most common type
Incidence
increases with age
Female> Male
Smooth & whitish
yellow to tan
colour.
10/8/2021 Ms. Sunita Kharel 18
19. Pigmented Stones
Excess of
unconjugated
bilirubin
May be black color
(associated with
hemolysis and
cirrhosis) or earthy
calcium bilirubinate
(associated with
infection)
10/8/2021 Ms. Sunita Kharel 19
20. Mixed Stones
Combination of cholesterol and
pigment stones or other substance
Consists of Calcium salts, phosphate ,
bile salts and palmitate.
10/8/2021 Ms. Sunita Kharel 20
22. Increased heart and
respiratory rate causing
patient to become
diaphoretic which in
turn makes them think
they are having a heart
attack.
Biliary Colic: Pain as
stone pass through the
ducts, and they may
lodge in the duct and
produce an obstruction.
Sign and Symptoms
10/8/2021 Ms. Sunita Kharel 22
23. Low grade fever
Elevated leukocyte count
Mild jaundice
Steatorrhea
Palpable Abdominal Mass
Clay colored stools caused by a lack of bile in
the intestinal tract.
Urine may be dark amber to tea colored
Anorexia, Nausea, Vomiting, and flatulence is
noticeable several hours after a heavy meal.
Sign and Symptoms…
10/8/2021 Ms. Sunita Kharel 23
24. Often attacks occur after a particularly fatty
meals and almost always happen at night.
Vitamin Deficiency
A positive Murphy’s sign is a common finding
on physical examination.
Sign and Symptoms…
10/8/2021 Ms. Sunita Kharel 24
28. Management
Goal
To resolve symptoms
To remove stones
To prevent complications
10/8/2021 Ms. Sunita Kharel 28
29. Management
Medical Management
Pain Management
Give analgesics
Antacids, H2 blockers or proton pump inhibitors
– to neutralize gastric acid.
Maintain fluid and electrolyte balance
IV Fluids
Prevent GB stimulation
NPO with NG suction
For Nausea and vomiting
Antiemetics given
10/8/2021 Ms. Sunita Kharel 29
30. Gall Stone dissolution
• Oral ursodeoxycholic acid
• a naturally occurring bile acid which is taken as
either a tablet or liquid
• It works by dissolving the cholesterol that makes
gallstones and inhibiting production of cholesterol in
the liver and absorption in the intestines, which
helps to decrease the formation of gallstones.
• Necessary for the patient to take this medication for
upto two years. Gallstones may recur , however once
the drug is stopped.
10/8/2021 Ms. Sunita Kharel 30
31. Endoscopic retrograde sphincterotomy (ERS)
Dissolving the gallstones by infusion of solvent
(mono-octanonin) into the gall bladder through
percutaenously insertion of catheter into the GB.
A tube or drain inserted through T-tube, during
the ERCP endoscope or transmural biliary
catheter.
10/8/2021 Ms. Sunita Kharel 31
32. Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL)
Non surgical fragmentation of gallstones
Uses repeated shock waves directed at the
gallstones in GB or CBD to fragment the stones.
1500 shock waves directed at stones
Used for fewer than 4 stones, each smaller than
3 cm.
10/8/2021 Ms. Sunita Kharel 32
33. Surgical management
laparoscopic Cholecystectomy
Removal of the gall bladder
This is the treatment of choice.
The gallbladder along with the cystic duct, vein and
artery are ligated.
It has a 99% chance of eliminating the recurrence
of cholelithiasis.
Surgery is only indicated in symptomatic patients.
10/8/2021 Ms. Sunita Kharel 33
34. laparoscopic Cholecystectomy
Post cholecystectomy syndrome
Develops in between 10 and 15%
population.
Cause gastrointestinal distress and
persistent pain in the upper right
abdomen,
10% has chance of developing chronic
diarrhea.
10/8/2021 Ms. Sunita Kharel 34
35. Related Research Article
Laparoscopic cholecystectomy: an experience of
university hospital in eastern Nepal
Bajracharya A. et al. BPKIHS
Results: A total of 346 laparoscopic cholecystectomy
over a six months period, male to female ratio 1:4.
The most common indication for surgery was biliary
colic/dyspepsia (51%), cholecystitis (chronic- 49.4%,
acute-12%), pancreatitis, gallbladder polyp, history of
recurrent attacks16.5%,obesity 19.1%.
Despite limited resources, laparoscopic
cholecystectomy is feasible and procedurally safe for
gallstones disease even in developing country like
Nepal
10/8/2021 Ms. Sunita Kharel 35
36. Potential Complications
Acute Cholecystitis
Cholangitis (infection or inflammation
of CBD)
Choledocholithiasis ( gallstones in
CBD)
Pancreatitis
10/8/2021 Ms. Sunita Kharel 36
40. ACUTE CHOLECYSTITIS
Acute inflammation of the gallbladder wall.
Increased incidence in clients who are overweight,
especially those with sedentary life styles.
ACUTE ACALCULOUS CHOLECYSTITIS
Acute Acalculous (absence of stones) Cholecystitis
accounts for approximately 4% to 8% of all cases of
acute cholecystitis.
Occurs after or in association with other conditions,
especially major trauma, burns or surgery;
Other preceding conditions include Bacterial Sepsis,
Postpartum Period, Tuberculosis, and Cardiovascular
disease.
10/8/2021 Ms. Sunita Kharel 40
41. Etiology
Gall stone in cystic duct
Obstruction in cystic duct
Bacterial infection (gram positive and gram
negative aerobes and anaerobes: E.coli,
Klebsiella, Clostridium and streptococcus)
Sedentary lifestyle
Obesity
10/8/2021 Ms. Sunita Kharel 41
43. Sign 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
10/8/2021 Ms. Sunita Kharel 43
44. CHRONIC CHOLECYSTITIS
Repeated inflammation and infection of
gallbladder
Arises as a sequela to acute cholecystitis.
In addition, it is almost always associated
with gallstones.
Chronic cholecystitis principally affects
middle-aged and older obese women.
The female to male ratio is 3:1.
10/8/2021 Ms. Sunita Kharel 44
45. Progression of
Chronic Cholecystitis
There is an obstruction of the
cystic duct and the gallbladder
begins to swell.
It no longer has the "robin’s
egg blue" appearance of a
normal gallbladder.
Gallbladder undergoes
gangrenous change and the
wall becomes very dark green
or black. - 10/8/2021 Ms. Sunita Kharel 45
46. Sign and Symptoms
Epigastric pain; less severe
Indigestion
Fever
Leucocytes count lower
Dyspepsia
Fat intolerance
Heart burn
Fibrosis of gall tissues
Inability to concentrate bile
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47. Diagnostic Investigations
Ultrasonography- 90% to 95% accurate in
detecting stones.
ERCP
Percutaneous Trans hepatic Cholangiography
Laboratory Investigations
Bile Culture
WBC Count:-Increased WBC count as a result of
inflammation
Alkaline Phosphatase , ALT, AST, Bilirubin (direct),
Serum amylase-Increased if Pancreatic Involvement
10/8/2021 Ms. Sunita Kharel 47
48. If patients come within 3 days of onset of
symptoms Immediate Cholecystectomy
If patients come after 3 days of onset of
symptoms do conservative treatment to
cool down the inflammation first and do
elective Cholecystectomy after 45 days.
10/8/2021 Ms. Sunita Kharel 48
Management
49. Conservative Management
A Nutritional and Supportive
therapy
Dietary counselling on
Low fat liquids
Weight reduction
Fat soluble vitamins and bile salts to enhance
absorptions and aid digestion
High protein, high carbohydrate
Cooked fruits, non gas forming vegetables,
bread, coffee or tea as tolerated
Smaller amounts and more frequent meals
Avoids eggs, cream, fried foods, cheese, gas
forming vegetables and alcohol
10/8/2021 Ms. Sunita Kharel 49
50. B Pharmacologic Therapy
Dissoultion of Gallstone
Ursodeoxycholic acid (UDCA)
Chenodeoxycholic acid
It works by dissolving the cholesterol that makes
gallstones and inhibiting production of cholesterol in
the liver and absorption in the intestines, which helps
to decrease the formation of gallstones.
Six to Twelve months of therapy are required in many
patients to dissolve stones, and monitoring of the
patient is required during this time.
10/8/2021 Ms. Sunita Kharel 50
52. SURGICAL MANAGEMENT
Surgical treatment of gallbladder disease
and gallstones is carried out to relieve
persistent symptoms, to remove the cause
of biliary colic, and to treat acute
cholecystitis.
Surgery may be performed as an
emergency procedure if the patient’s
condition necessitates it.
10/8/2021 Ms. Sunita Kharel 52
53. Surgical Cholecystotomy
Cholecystotomy is performed when the patient’s
condition prevents more extensive surgery or
when an acute inflammatory reaction is severe.
The gallbladder is surgically opened, the stones
and the bile or the purulent drainage are removed,
and a drainage tube is secure with a purse string
suture.
The drainage tube is connected to a drainage
system to prevent bile from leaking around the
tube or escaping into the peritoneal cavity.
10/8/2021 Ms. Sunita Kharel 53
54. PREOPERATIVE- MEASURES
A chest X-ray, ECG and liver function test may be
performed in addition to X-ray studies of the gallbladder.
Vitamin K may be administered, if the Prothombin level is
low.
Blood component therapy may be administered before
surgery.
Preparation for gallbladder surgery is similar to that for
any upper abdominal surgery like laparotomy or
laparoscopy.
Instructions and explanations are given before surgery with
regard to deep breathing. 10/8/2021 Ms. Sunita Kharel 54
55. POTENTIAL COMPLICATIONS
Empyema of gallbladder
Pancreatitis
Bleeding
Gastrointestinal symptoms ( may be
related to biliary leakage)
Peritonitis
10/8/2021 Ms. Sunita Kharel 55
56. NURSING MANAGEMENT
ASSESSMENT
Note a history of smoking, previous respiratory
problems a persistent or ineffective cough etc.
Onset of pain, severity, duration.
Alleviating measures and aggravating factors.
Evaluation of nutritional status.
10/8/2021 Ms. Sunita Kharel 56
57. POST- OPERATIVE NURSING
INTERVENTIONS
After recovery from anesthesia, the nurse
places the patient in the low fowler’s
position.
Intravenous fluids may be instituted to
relieve abdominal distention.
Water and other fluids are given in about
24 hours.
Soft diet started when bowel sounds
return.
10/8/2021 Ms. Sunita Kharel 57
58. Nursing Interventions
Acute pain and discomfort related to surgical
incision
Relieving Pain
Comfortable position
Administer analgesic agent as prescribed to
relieve the pain and to promote well-being in
addition to helping the patient turn, cough,
breathe deeply and ambulate as indicated.
Use of pillow or binder over the incision may
reduce pain during maneuvers.
Relaxation therapy
10/8/2021 Ms. Sunita Kharel 58
59. Impaired gas exchange related to the high
abdominal surgical incision.
Improving Respiratory status
Reminds the patient to take deep breaths and
coughs every hour to expand the lungs fully
and prevent atelectasis.
Early ambulation prevents pulmonary
complications as well as other complications,
such as thrombophlebitis.
10/8/2021 Ms. Sunita Kharel 59
Nursing Interventions
60. Impaired skin integrity related to altered biliary
drainage after surgical intervention.
Promoting Skin Care and Biliary Drainage
The drainage tube must be connected to a drainage
receptacle.
The drainage bag may be placed below the waist or
common duct level.
Bile may continue to drain from the drainage tract in
considerable quantities for a time, necessitating
frequent changes of the outer dressings and protection
of the skin from irritation because bile is corrosive to
the skin.
Maintaining a careful record of fluid intake and output
is important.
10/8/2021 Ms. Sunita Kharel 60
Nursing Interventions
61. Imbalanced nutrition, less than body
requirements, related to inadequate bile
secretion.
Improving Nutritional Status
Encourages the patient to eat a diet low in
fats and high in carbohydrates and
proteins immediately after surgery.
10/8/2021 Ms. Sunita Kharel 61
Nursing Interventions
62. Teaching Patients Self Care
Instruct the patient about the medications that
are prescribed (vitamins, antispasmodics etc.)
and their action.
Inform patient and family about symptoms that
should be reported to the doctor, including
jaundice, dark urine, pale colored stools,
Pruritus, pain or fever.
Instruct them in proper care of the drainage tube
and the importance of reporting to the physician
promptly any changes in the amount or
characteristic of drainage.
10/8/2021 Ms. Sunita Kharel 62
Nursing Interventions
63. Continuity Care
Asses the patient for adequacy of pain
relief, and pulmonary exercise.
Asses for signs of infections.
Emphasize the importance of keeping
follow up appointments.
10/8/2021 Ms. Sunita Kharel 63
Nursing Interventions
65. References
Black, J.M., & Hawks J. H. (2009) Medical Surgical
nursing. (8th ed.). St. Louis, Missouri.
Nettina, S.M., (1998). The lipponcott manual of nursing
practice. (6th ed.). Lippincott Raven Publishers,
Washinton squares, Philadelphia
Smeltzer, S. C., Bare B.G., Hinkle J.L., Cheever K.H.
(2008). Textbook of medical-surgical nursing. (11th ed.).
Lippincott Williams & Wilkins, Lippincott Company.
Potter, P.A., Perry A.G. (2005). Fundamentals of
Nursing. (6th ed.). Noinda, U.P, India.
Lobel, S., Spartto, G. (2003). The nurses drug
handbook. (3rd ed.). Whiley Medical New York, USA.
https://www.researchgate.net/publication/229810965_L
aparoscopic_cholecystectomy_an_experience_of_unive
rsity_hospital_in_eastern_Nepal [accessed Apr 11
2021].
10/8/2021 Ms. Sunita Kharel 65