Nursing Care of the Patient with a Disorder of the Gallbladder

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Nursing Care of the Patient with a Disorder of
the Gallbladder
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Cholecystitis and Cholelithiasis
What is the difference in the two disorders?
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Who is at Risk?

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

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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

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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?

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Pathophysiology of
Cholelithiasis

• Symptoms occur when one of the stones block the
  common bile duct.
• Stones are made of
• Cholesterol
• Pigments

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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

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If the patient was displaying all the symptoms of
cholelithiasis,which one is most important to
intervene?
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Complications

• Gangrenous cholecystitis
• Pancreatitis
• Rupture of the gallbladder
• Biliary Cirrhosis
• Peritonitis

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Diagnostic Studies

• Ultrasound
• Must be NPO
• ERCP (Endoscopic Retrograde Cholangiopancreatograp
  hy)

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Additional Laboratory Tests

• Laboratory tests
• WBC count
• Serum bilirubin

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Treatment and Nursing Care
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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 suction
• Control of Infection
• Antibiotics

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Treatment and Nursing Care

• Relieve Pruritis
• Bile acid Sequestrants
• Cholestyramine (Questran) and hydroxyzine
  (Atarax)

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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?

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Treatment and Nursing CareNonsurgical Approaches

• Stone Removal Techniques
• ERCP with sphincterotomy
• Mechanical extracorporeal
• shock-wave lithotripsy

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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

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Treatment and Nursing CareSurgery

• Laparoscopic cholecystectomy
• treatment of choice
• gallbladder removed through four
• puncture holes

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Treatment and Nursing CareSurgery

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

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Treatment and Nursing CarePost-op Care

• Relieve post-op pain
• Assess respiratory status
• Wound care
• Drains

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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

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Post-op Teaching

• When to call the doctor
• Severe pain
• Obstruction stool and urine changes, jaundice,
  pruritis
• Infection
• Diet
• Activity
• Drains

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How do you know they are getting better?
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The End