Cholelithiasis & Cholecystitis

Presence of stones in the gallbladder The most common disorder of the biliary

system.

The actual cause of cholelithiasis is unknown

Bilary sludge ( calcium, cholesterol & mucin) develops during gallbladder stasis as occurs during pregnancy or when receiving TPN. Sludge is asymptomatic. The sludge can evolve into stones.

Caused by the inflammation of the gallbladder.

May be acute or chronic, these conditions usually occur together.

Cholecystitis is most commonly associated with obstruction caused by gallstones or biliary sludge.

Affect about 20% of population The incidence is higher in women,

multiparous women, and people over 40 years of age.

Obesity High cholesterol Race or ethnicity(Native American/Northern

European heritage. Disorders : cirrhosis, small intestine

disorders, sickle cell anemia

Can vary from indigestion to moderate to severe pain, fever and jaundice.

Can get tenderness in the right upper quadrant, which may be referred to the right shoulder and scapula.

Accompanied by nausea and vomiting, restlessness and diaphoresis.

Ultrasonography to detect the stones and it is useful for people who have jaundice, because it does not rely on liver function.

ERCP(Endoscopic Retrograde Cholangiopancreatography) allows for visualization of the gallbladder, cystic duct, common hepatic duct and common bile duct. Sent for culture and sensitivity.

Laboratory tests will show and increase white blood cell count.

Bilirubin levels are elevated Serum enzymes such ALT, and AST may be

elevated

Acute pain related to obstruction of bile flow, inflammation in gallbladder.

Intolerance to certain kinds of foods, related to gallbladder or bile ducts disease

Anxiety related to the symptoms of disease and fear of the unknown

Increased risk of dehydration and electrolytes and metabolic disturbances due to inflammation, related to gallbladder or bile ducts diseases.

Treatmentso Symptomatico MTBE (methyl tertiary terbutyl ether)

dissolves stones MedicationsoUrsodeoxycholic acido Indomethacin(anti-inflammatory agent)

Diet◦ Monitor fluids and output closely◦ Decreased cholesterol and weight ◦ Avoid dairy products

Surgery - laparoscopic cholecystectomy - minimal

invasion less than 24 hours hospitalization. - incisional cholecystectomy - incision inside

the abdomen and NG tube in place post-op and several days hospitalized.

Health teaching- learning needs of client and family/caregiver include pain control, deep breathing, mobilization, incisional care and nutritional/fluids needs.

Laparoscopic Cholecystectomy Procedure

  Burke, K., LeMone, P., Mohn-Brown, L. (2006). Medical surgical

nursing care (2nd ed.). Upper Saddle River, NJ: Prentice Hall.

  Lewis, S.M., Heitkemper, M., Dirksen, S., Goldsworthy, S.,

Barry, M. (2006). Medical surgical nursing in Canada. (1st Cdn ed.). St. Louis, MO: Elsevier/Mosby.

  Med for all. (producer).(December 21, 2007) Laparoscopic

Cholecystectomy Procedure. Retrieved November 2, 2008 from http://www.youtube.com/watch?v=7tTGfYCqH5w

  Mosby’s medical nursing and allied health dictionary (7th ed.).

(2006). Toronto: Elsevier Mosby