1. Gall bladder nestled under the liver

2. Gall Bladder Location: under the liver
Description: a sac-like organ located on the inferior surface of the liver
Mucosa of the GB wall absorbs water and electrolytes resulting in a high concentration of bile salts, bile pigments and cholesterol.
Primary purpose of the GB is to store and concentrate bile (90 mL)

3. The path of bile
The cystic duct connects the gallbladder to the hepatic duct and they merge to form the common bile duct.
The sphincter of Oddi is at the distal end of the common bile duct and controls the flow of bile into the duodenum.
The bile secretions that empty from the common bile duct into the duodenum are necessary for digestion.

4. Cholecystitis An inflammation of the gallbladder.
Remember back to inflammation and what happens within the body when that occurs.

5. Inflammatory response
“The body’s celllular response to injury, infection or irritation. A protective vascular reaction that delivers fluid, blood products and nutrients to an area of injury. The process neutralizes and eliminates pathogens or dead (necrotic) tissues and establishes a means of repairing body cells and tissues.”
Perry and Potter, p. 646

6. Signs and symptoms
Severe and steady pain in the upper right part of your abdomen.
Pain worsens when you inhale deeply. (Murphy’s sign)
Pain that radiates from your abdomen to your right shoulder or back.
Tenderness over your abdomen when touched
Sweating
N/V
Anorexia
Fever, chills, abdominal bloating

7. Causes
Gallstones
Injury
Infection
tumor

8. Risk factors Gallstones Long labor Traumatic injury Diabetes
Cholesterol stones
Pigmented stones
Long labor
Traumatic injury
Diabetes

9. complications Gallbladder distention Infection Tissue death
perforation

10. Questions to ask When did you first begin experiencing symptoms?
Have you had bouts of pain similar to this before?
Do you have a fever?
Have your symptoms been continuous or occasional?
What improves your symptoms?
What makes them worse?

11. Tests and diagnosis Blood tests Imaging tests
CBC
Hyperbilirubinemia
Elevated Erythrocyte sedimentation rate (ESR)
E-lytes
Alkaline phosphatase
Liver Function Tests (LFTs)
Imaging tests
Hepatobiliary iminodiacetic acid (HIDA) scan (aka cholescintigraphy, hepatobiliary scan)

12. Therapeutic Management
Oral dissolution therapy with ursodeoxycholic acid
Extracorporeal shock wave lithotripsy
ERCP = Endoscopic retrograde cholangiopancreatography
Laparoscopic cholecystectomy
Cholecystectomy

13. Priority Nursing diagnoses
Acute pain
Risk for impaired gas exchange related to pain and ineffective inspiratory effort
Imbalanced nutrition: less than body requirements related to nausea, vomiting and anorexia
Anxiety related to lack of knowledge about disease process and treatment measures

14. Interventions Implement comfort measures
Provide education regarding diagnostic tests and disease process
Maintain NPO and Institute IV therapy as ordered
Nutrition counseling
Weight loss (3 Fs)
Monitor fluids and e-lytes

15. Medication Therapy
Symptomatic treatment of pain and nausea with analgesics and antiemetics
Meperidine (Demerol) is the preferred opioid analgesic because Morphine can cause spasms.
Cholestyramine (Questran) is used for severe cases of pruritus: Binds the bile salts to hasten excretion through the feces.
Chenodeoxycholic acid (CDCA) and urodoxycholic acid (UDCA) are oral dissolution medications

16. cholecystitis
Description: an acute or chronic disorder, most often caused by gallstones obstructing the cystic duct resulting in distention and inflammation of the gallbladder.

17. Etiology
Most commonly caused by gallstones blocking the cystic or common bile duct.
A small percentage of clients develop acalculous cholecystitis precipitated by trauma, prolonged hyperalimentation, fasting or surgery.

18. Assessment
Clinical manifestations include all those identified with cholelithiasis
Fever leukocytosis, elevation of serum bilirubin(possible jaundice), elevation of alkaline phosphatase, and elevation of amylase if pancreatic ducts are involved.
Abdominal guarding, rigidity, and rebound tenderness suggest peritoneal involvement.

19. Therapeutic management
NPO
IV hydration
Opioids for pain control
IV antibiotics
Surgical intervention is postponed until the acute infectious process has subsided.

20. Surgical interventions
Laproscopic cholecystectomy
Cholecystectomy
Cholecystectomy with T-tube placement

21. Postoperative care Prevent infection Control pain
Prevent pulmonary complications
Maintain T-tube is needed
Below the incision
Assess drainage and record amount
Assess skin at insertion site
Report bile drainage in excess of 500 mL after 3 days
T-tube is removed when drainage has subsided and stools have returned to a normal color

22. Postoperative care Maintain NPO status as ordered
Advance diet slowly; low fat diet
Monitor bowel sounds
Encourage ambulation to promote peristalsis
Prevent DVTs
Provide general postoperative instructions:
Wound care
Analgesia
Diet
Signs of infection