ppt of cholelithiasis

1. Presented by:
M.Abuzar
70127133
6th (B)
CHOLELITHIASIS

2. Cholelithiasis or gallstones are hardened deposits of digestive
fluid that can form in your gallbladder. Your gall bladder is a
small, pear-shaped organ of your abdomen, just beneath your
liver. The gallbladder holds a digestive fluid called bile that’s
released in your small intestine.
Gallstones range is size from as small as grain to as large as
a golf ball. Some people develop just one gallstone, while
others develop many gallstones at the same time.
INTRODUCTION

4. Gallstones are stones or lump that develop in the gallbladder
or bile duct when certain substances harden. The gallbladder
is a small sac located on the right-hand side of the body, on
the underside of the liver.
DEFINITION

5. Factors that may increase your risk of gallstones include:
 Being female
 Being age 40 or older
 Being overweight or obese
 Being sedentary
 Being pregnant
 Eating a high cholesterol diet
 Having diabetes
 Having a family history of gallstones
 Taking medications that contain estrogen, such as oral
contraceptives or hormone therapy drugs
RISK FACTORS

6.  Too much cholesterol. Normally, your bile contains enough
chemicals to dissolve the cholesterol excreted by your bile. But if
your liver excretes more cholesterol than your bile can dissolve, the
excess cholesterol may form into crystals and eventually into
stones.
Bile contains too much bilirubin. Bilirubin is a chemical that’s
produced when your body breaks down red blood cells. Certain
conditions cause your liver too much bilirubin, including liver
cirrhosis, biliary tract infections and certain blood disorders. The
excess bilirubin contributes to gallstone formation.
Gallbladder doesn’t empty correctly. If gallbladder doesn’t
empty completely or often enough, bile may become very
concentrated, contributing to the formation of gallstones.
CAUSES

7. Types of gallstones that can form in the gallbladder include:
Cholesterol gallstones. The most common type of gall stone,
called a cholesterol gallstone, often appears yellow in color. These
gallstones are composed mainly of undissolved cholesterol, but may
contain other components.
Pigment gallstones. These dark brown or black stones form when
your bile contains too much bilirubin.
TYPES OF GALLSTONES

8. Sudden and rapidly intensifying pain in the upper right portion
of your abdomen.
Sudden and rapidly intensifying pain in the center of your
abdomen, just below your breastbone.
Back pain between your shoulder blades.
Pain in your right shoulder.
Nausea or vomiting.
SIGNS AND SYMPTOMS

9. Physical examination.
History collection.
Abdominal ultrasound. This test is the most commonly used to
look for signs of gallstones. Abdominal ultrasound involves moving
a device (transducer) back and forth across tour stomach area.
Endoscopic ultrasound. This procedure can help identify smaller
stones that may be missed on an abdominal ultrasound. During EUS
your doctor passes a thin, flexible tube (endoscope) through your
mouth and through your digestive tract.
Blood test. Blood test may reveal infection, jaundice, pancreatitis
or other complications caused by gallstones.
DIAGNOSTIC EVALUATION

10. Don’t skip meals.
Lose weight slowly.
Eat more higher-fiber foods.
Maintain a healthy weight.
PREVENTION

11.  Lifestyle modifications: Dietary changes, including a low-fat diet,
can help manage symptoms and reduce the risk of gallstone formation .
Weight management and gradual weight loss may be recommended for
overweight individuals.
 Medications : Medications can be prescribed to dissolve certain types
of cholesterol gallstones over time. It is most effective for small stones
and may take several months to work.
 Extracorporeal Shock Wave Lithotripsy (ESWL): ESWL uses shock
waves to break gallstones into smaller pieces, making them easier to
pass. This method is typically used for patients who are not suitable
candidates for surgery.
 Cholecystectomy: This minimally invasive surgery is the most
common and effective treatment for cholelithiasis. It involves removing
the gallbladder through small incisions.
 Postoperative care: Following surgery, patients are advised on diet
modifications to prevent discomfort and digestive issues. Early
mobilization and light physical activity are encouraged to aid recovery.
.
TREATMENT

12.  A 42-year-old office manager, seeks medical attention for
severe right upper abdominal pain, accompanied by nausea
and vomiting. Her medical history reveals occasional
indigestion, but she has never experienced pain of this
intensity. The clinical examination and diagnostic
investigations point towards cholelithiasis, highlighting the
need for a comprehensive approach to manage her condition.
CASE SCENARIO

13. • Name: Sara Alam
• Age: 42
• Gender: Female
• Occupation: Office manager
• Diagnosis: Cholelithiasis
DEMOGRAPHICS

14. Pulse rate Blood pressure Temperature Respiratory rate
90 beats/min 130/80 mmHg 98 F 18 breaths/min
60-100 beats/min 120/80 mmHg 98.6 F 12-20 breaths/min
OBJECTIVE HISTORY

15. Presenting
complain
History of
presenting illness
Past medical
history
Past family history
The patient presents
with severe right
upper abdominal pain
that started a few
hours ago. The pain is
sharp and
intermittent, radiating
to her back. She also
complains of nausea
and has vomited
once. She denies any
fever, chills, or recent
dietary changes.
She mentions that
she had a fatty meal
at a restaurant the
night before. The pain
started as a dull ache
but gradually
intensified, leading
her to seek medical
attention. She recalls
similar but less
severe episodes in
the past, which
resolved
spontaneously.
No significant prior
medical conditions,
occasional episodes
of indigestion.
Non significant
SUBJECTIVE HISTORY

16.  Abdominal examination reveals tenderness and guarding over
the right upper quadrant.
 Murphy's sign is positive, causing Sara pain when pressure is
applied to the right subcostal area during inspiration.
ASSESSMENT

17.  Abdominal Ultrasound: Confirms the presence of gallstones in the
gallbladder and identifies signs of inflammation, such as thickening
of the gallbladder wall and pericholecystic fluid.
 Blood Tests: Elevated levels of ALT and alkaline phosphatase,
indicating possible biliary obstruction.
EXAMINATION

18. Sara is diagnosed with acute cholecystitis secondary to
cholelithiasis, which is the formation of gallstones in the
gallbladder.
DIAGNOSIS

19. Medical treatment Surgical treatment Physiotherapy treatment
(post operative)
• NSAIDs
• Antibiotics
• Intravenous Fluids (fluid
replacement is crucial to
maintain hydration,
especially if there has
been fluid loss due to
vomiting.)
• Cholecystectomy(This
surgery eliminates the
source of gallstones and
reduces the risk of
recurrent cholelithiasis.)
• Breathing exercises
• Early ambulation
• Core strengthening
PLAN OF CARE

20. THANK YOU!