Gall bladder nestled under the liver

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)

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.

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

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

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

Causes Gallstones Injury Infection tumor

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

complications Gallbladder distention Infection Tissue death perforation

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?

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)

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

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

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

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

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

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.

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.

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

Surgical interventions Laproscopic cholecystectomy Cholecystectomy Cholecystectomy with T-tube placement

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

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