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 n n Sudden severe RUQ Pain biliary colic n n 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 n n Gangrenous cholecystitis n n Pancreatitis n n Rupture of the gallbladder n n Biliary Cirrhosis n n Peritonitis
Diagnostic Studies n n Ultrasound n n Must be NPO ERCP (Endoscopic Retrograde Cholangiopancreatography)
Additional Laboratory Tests n n Laboratory tests * WBC count * Serum bilirubin
Treatment and Nursing Care n n Control Pain n n Analgesics - Morphine n n Anticholinergic – Bentyl or Atropine n n Maintain fluid and electrolyte balance n n IV fluids n n Prevent GB stimulation n NPO with NG suction n n Control of Infection n n Antibiotics
Treatment and Nursing Care n n Relieve Pruritis n n Bile acid Sequestrants n n Cholestyramine (Questran) and hydroxyzine (Atarax)
Treatment and Nursing Care Nutrition n n Once the acute attack is over – patient is placed on low fat diet n n Cooked fruits n n Lean meats n n Non-gas forming vegetables, mashed potatoes, rice n n The patient should be taught to AVOID which foods?
Treatment and Nursing Care Nonsurgical Approaches Stone Removal Techniques: ERCP with sphincterotomy Mechanical extracorporeal shock-wave lithotripsy
Treatment and Nursing Care Medical Dissolution Therapy n n Used for patients who are a poor risk for surgery and mildly symptomatic n n May take 6 months to 2 years n n Medications: n n Chenodial n n Ursodiol (Actigall) Cholesterol solvents Methyl tertiary terbutyl ether (MTBE)- infusion via tube directly into the gallbladder
Treatment and Nursing Care Surgery n n Laparoscopic cholecystectomy * treatment of choice * gallbladder removed through four puncture holes
Treatment and Nursing Care Surgery n n Incisional / Open cholecystectomy * Removal of GB through right subcostal incision * T tube inserted into CBD
Treatment and Nursing Care Post-op Care n n Relieve post-op pain n n Assess respiratory status n n Wound care n n Drains
Treatment and Nursing Care Post-op n n Improve nutritional status – resume diet and fat back in diet in small increments. Medications: n n Fat-soluble vitamins n n Vitamins A,D,E,K n n Bile salts
Post-op Teaching n n When to call the doctor n n Severe pain n n Obstruction – stool and urine changes, jaundice, pruritis n n Infection n n Diet n n Activity n n Drains