Nursing Care of the Patient with a

Disorder of the Gallbladder

What is the difference in the two disorders?

Who is at Risk?

Higher in women: multiparous, over 40 Sedentary lifestyle Familial tendency Obesity Treatment with estrogen therapy

Pathophysiology of Acute Cholecystitis

Obstruction of cystic duct blocks flow of bile backs up in the GB leading to ischemia of GB mucosa or wall

Inflammation may follow GB becomes edematous during acute attack, distended with bile or pus gangrenous

Clinical Manifestations of Acute Cholecystitis

Usually begins with a biliary colic attack Epigastric pain that radiates to the right

shoulder and scapula.

What precipitates a biliary colic attack?

What are additional signs and symptoms?

Pathophysiology of Cholelithiasis

Symptoms occur when one of the stones block the common bile duct.

Stones are made of: Cholesterol Pigments

Clinical Manifestations of Cholelithiasis

Sudden severe RUQ Pain biliary colic Symptoms related to bile obstruction such as:

• Jaundice• Dark orange and foamy urine• Steatorrhea and clay-colored stools• Pruritus

If the patient was displaying all the

symptoms of cholelithiasis,

which one is most important

to intervene?

Complications Gangrenous cholecystitis

Pancreatitis

Rupture of the gallbladder

Biliary Cirrhosis

Peritonitis

Diagnostic Studies

Ultrasound Must be NPO

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Additional Laboratory Tests

Laboratory tests * WBC count * Serum bilirubin

Treatment and Nursing Care Control Pain

Analgesics - Morphine Anticholinergic – Bentyl or Atropine

Maintain fluid and electrolyte balance IV fluids

Prevent GB stimulation NPO with NG suctionNPO with NG suction

Control of Infection Antibiotics

Treatment and Nursing Care

Relieve Pruritis Bile acid Sequestrants

Cholestyramine (Questran) and hydroxyzine (Atarax)

Treatment and Nursing CareNutrition

Once the acute attack is over – patient is placed on low fat diet Cooked fruits Lean meats Non-gas forming vegetables, mashed potatoes, rice

The patient should be taught to AVOID which foods?

Treatment and Nursing CareNonsurgical Approaches

Stone Removal Techniques: ERCP with sphincterotomy

Mechanical extracorporeal shock-wave lithotripsy

Treatment and Nursing CareMedical Dissolution Therapy

Used for patients who are a poor risk for surgery and mildly symptomatic

May take 6 months to 2 years Medications:

Chenodial Ursodiol (Actigall)

Cholesterol solvents Methyl tertiary terbutyl ether (MTBE)- infusion via tube

directly into the gallbladder

Treatment and Nursing CareSurgery

Laparoscopic cholecystectomy * treatment of choice

* gallbladder removed through four puncture holes

Treatment and Nursing CareSurgery

Incisional / Open cholecystectomy * Removal of GB through right subcostal incision * T tube inserted into CBD

Treatment and Nursing CarePost-op Care

Relieve post-op pain

Assess respiratory status

Wound care

Drains

Treatment and Nursing CarePost-op

Improve nutritional status – resume diet and fat back in diet in small increments.

Medications: Fat-soluble vitamins

Vitamins A,D,E,K

Bile salts

Post-op Teaching

When to call the doctor Severe pain Obstruction – stool and urine changes, jaundice,

pruritis Infection

Diet Activity Drains

How do you know they How do you know they are getting better? are getting better?

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