6Cholelithiasis—Manifestations May have no or minimal symptoms and may be acute or chronic.Epigastric distress: fullness, abdominal distention, vague upper right quadrant pain. Distress may occur after eating a fatty meal.Acute symptoms occur with obstruction and inflammation or infection: fever, palpable abdominal mass, severe right abdominal that radiates to the back or right shoulder, nausea and vomiting.Biliary colic is episodes of severe pain usually associated with nausea and vomiting, which usually occur several hours after a heavy meal.Jaundice may develop due to blockage of the common bile duct.
7Cholecystitis Cholecystitis is inflammation of the gallbladder. Acute cholecystitis is caused primarily by gallstone obstruction of the cystic duct with edema, inflammation, and bacterial invasion. It may also occur in the absence of stones, as a result of major surgical procedures, severe trauma, or burns.Chronic cholecystitis results from repeated attacks of cholecystitis, presence of stones, or chronic irritation. The gallbladder becomes thickened, rigid, fibrotic, and functions poorly.
8Cholecytitis- manifestations SymptomsThe main symptom is pain in the upper right side or upper middle of the abdomen. The pain may:Be sharp, cramping, or dullBe steadySpread to the back or below the right shoulder bladeOther symptoms that may occur include:Clay-colored stoolsFeverNausea and vomitingYellowing of skin and whites of the eyes (jaundice)
9Diagnositics Exams and Tests A physical exam will show that your abdomen is tender to the touch.Your doctor may order the following blood tests:Amylase and lipaseBilirubinComplete blood count -- may show a higher than normal white blood cell countLiver function testsImaging tests that can show gallstones or inflammation include: Abdominal CT/US/ X-RayOral cholecystogramGallbladder radionuclide scan
10QuestionIs the following statement True or False? Cholecystitis is when a patient has calculi in the gallbladder.
11AnswerFalseCholelithiasis is when a patient has calculi in the gallbladder. Cholecystitis is inflammation of the gallbladder.
12Medical Management of Cholelithiasis CholecystectomyLaparoscopic cholecystectomyDietary managementMedications: ursodeoxycholic acid and chenodeoxycholic acidNonsurgical removalBy instrumentationIntracorporeal or extracorporeal lithotripsy
16Nursing Process: The Care of the Patient Undergoing Surgery for Gallbladder Disease—Assessment Patient historyKnowledge and teaching needsRespiratory status and risk factors for respiratory complications postoperativeNutritional statusMonitor for potential bleedingGastrointestinal symptoms: after laparoscopic surgery asses for loss of appetite, vomiting, pain, distention, fever—potential infection or disruption of GI tract
17Nursing Process: The Care of the Patient Undergoing Surgery for Gallbladder Disease—Diagnoses Acute painImpaired gas exchangeImpaired skin integrityImbalanced nutritionDeficient knowledge
18Collaborative Problems/Potential Complications BleedingGastrointestinal symptomsComplications as related to surgery in general: atelectasis, thrombophlebitis
19Nursing Process: The Care of the Patient Undergoing Surgery for Gallbladder Disease—Planning Goals may include relief of pain, adequate ventilation, intact skin, improved biliary drainage, optimal nutritional intake, absence of complications, and understanding of self-care routines.
20Postoperative Care Interventions Low Fowler’s positionMay have NGNPO until bowel sounds return, then a soft, low-fat, high-carbohydrate diet postoperativelyCare of biliary drainage systemAdminister analgesics as ordered and medicate to promote/permit ambulation and activities, including deep breathingTurn, and encourage coughing and deep breathing, splinting to reduce painAmbulation
21Patient Teaching—See Chart 40-3 MedicationsDiet: at discharge, maintain a nutritious diet and avoid excess fat. Fat restriction is usually lifted in 4–6 weeks.Instruct in wound care, dressing changes, care of T- tubeActivityInstruct patient and family to report signs of gastrointestinal complications, changes in color of stool or urine, fever, unrelieved or increased pain, nausea, vomiting, and redness/edema/signs of infection at incision site