The document provides an overview of cholelithiasis, detailing its definition, etiology, risk factors, clinical manifestations, and management strategies. It emphasizes the significance of gallstones as a common health issue in India, alongside the diagnostic evaluation and potential complications arising from the condition. The text also outlines nursing assessments and health education pertinent to patients with cholelithiasis.

1. CHOLELITHIASIS
DEPARTMENT OF
MEDICAL SURGICAL
NURSING

2. At the end of the class students will be
able to:---
1. Define cholelithiasis
2. Enlist the etiology and risk factors of
cholelithiasis
3. Discuss the clinical manifestations and
diagnostic evaluation of cholelithiasis
Learning objectives

3. 4.Explain the management of cholelithiasis.
5.Discuss the complications &
health education of cholelithiasis.
Ct- Learning objectives

4. Cholelithiasis is the stones in the
gallbladder.
Definition

6. Incidence
• The gallbladder disease is a common health
problem in India, particularly North India
• The prevalence of gall stones in India ranges
from 2% in South India up to 7%in North India

7. Age
Gender
Malabsorption of bile salts with GI disease
Bile fistula
Carcinoma of the gallbladder.
Obesity
Multiple pregnancies
Diabetes mellitus
Risk Factors

8. Rapid weight loss (leads to rapid
development of gallstones and high risk of
symptomatic disease)
Treatment with high-dose estrogen (ie, in
prostate cancer).
Cystic fibrosis
Risk Factors

10. Types

11. Type of gall stones
• Cholesterol stones : radiating crystal like
appearance
• Mixed stone : most common type of stone,
contains cholestrol, calcium salts of
phosphates and carbonates, protein
• Pigment stone : small, black or greenish black,
multiple and often sludge like

12. Pigmented stones
Black pigment stones Brown pigment stones
Most common Rarely form in gall bladder
Formed in gall bladder Formed in bile duct
Made of calcium, bilirubinate, phosphate,
bicarbonate
Related to bile stasis & infected bile
Common in hemolytic disorder, cirrhosis e. coli, bacteroides
Multiple, small & hard in consistency

13. Pathophysiology
Decrease bile acid synthesis
Increased cholesterol synthesis in the liver
Super saturation of bile with cholesterol
Formation of precipitates

14. Gall stones
Inflammatory changes (cholecystitis)

15. Gallstones that remain in the gallbladder are
usually asymptomatic.
Biliary colic can be caused by gallstones.
(Steady, severe, aching pain to right
hypocondrium & epigastserium, radiating to
chest, back & shoulder.)
Clinical Manifestations

16. Sensation of pressure in the— Epigastrium or
Right upper quadrant, begins suddenly and
persists for 1 to 3 hours until the stone falls
back into the gallbladder.
Vomiting
Fever
Increased WBCs
Murphy’s sign

18. 1. Cholecystography
2. Ultrasonography
3. Radionuclide imaging or cholescintigraphy
4. ERCP or PTC to visualize location of
stones & extension of obstruction).
Diagnostic Evaluation

19. Nutrition & Supportive management
• Adequate bed rest
• Low fat and liquid diet
• Give - Cooked vegitable/fruits, rice, lean meat,
bread etc.
• avoid- fried food, pork, cream, cheese, other fats
and alcohol
Management

20. Pharmacological therapy
• Ursodeoxycholic acid
• Chenodeoxycholic acid
To decrease the size of existing gall stone and
stop formation of new stone
6-12 month therapy are required

21. • Non surgical removal of stone
• Dissolving gallstone
• Stone removed by instrumentation (ERCP)
• Extracorporeal shock wave lithotripsy
• Intracorporeal lithotripsy

22. Cholecystectomy.
Choledochostomy
Surgical management

23. 1. Cholangitis.
2. Necrosis, empyema, or perforation of the
gallbladder.
3. Biliary fistula through the duodenum.
4. Adenocarcinoma of the gallbladder.
Complications

24. 1. Obtain history and demographic data that
may indicate risk factors for biliary disease.
2. Assess patient's pain for location,
description, intensity, relieving and
exacerbating factors.
Nursing Assessment

25. 3. Assess for signs of dehydration: dry
mucous membranes, poor skin turgor, low
urine output with elevated specific gravity.
4. Assess sclera and skin for jaundice.
5. Monitor temperature and white blood
count for indications of infection.
Nursing Assessment

26. 1.Acute Pain related to biliary colic or stone
obstruction.
Assess pain location, severity, and
characteristics.
Administer medications or monitor patient-
controlled analgesia to control pain.
Assist in attaining position of comfort.
Ct--Nursing Assessment

27. 2.Deficient Fluid Volume related to nausea and
vomiting and decreased intake.
Administer I.V. fluids and electrolytes as
prescribed.
Administer antiemetic as prescribed to decrease
nausea and vomiting.
Maintain NG decompression, if needed.
Ct--Nursing Assessment

28. Begin food and fluids as tolerated, after
acute symptoms subside or postoperatively.
Observe and record amount of biliary tube
drainage, if applicable.
Ct--Nursing Assessment

29. • Impaired gas exchange related to the high
abdominal surgical incision
• Impaired digestion related to altered biliary
drainage
• Impaired nutrition less than body requirement
related to altered bile secretion

30. Instruct patient in care of tubes or catheters
that may be in place at discharge.
Review discharge instructions for activity,
diet, medications, and postoperative follow-
up.
Encourage follow-up as indicated.
Health Education

31. Definition of cholelithiasis
Etiology and risk factors of cholelithiasis
Clinical manifestations and diagnostic
evaluation of cholelithiasis.
Management of cholelithiasis.
Complications &
Health education of cholelithiasis.
SUMMARY

32. BIBLIOGRAPHY
• Black, J.M. & Hawks, J.H. (2009). Medical-Surgical
Nursing: Clinical Management for Positive Outcomes
(8th ed.). Philadelphia: Elsevier/Saunders.
• Porth, C.M. (2009). Pathophysiology: Concepts of
Altered Health States (8th ed.). Philadelphia:
Lippincott Williams & Wilkins.
• Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever,
K.H. (2010). Brunner & Suddarth’s Textbook of
Medical-Surgical Nursing (12th ed.). Philadelphia:
Lippincott Williams & Wilkins.

33. THANK
YOU
!