1. Nursing Care of the Patient with a Disorder of the Gallbladder

2. What is the difference in the two disorders?

3. Who is at Risk?   Higher in women: multiparous, over 40   Sedentary lifestyle   Familial tendency   Obesity   Treatment with estrogen therapy

4. 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

5. 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?

6. Pathophysiology of Cholelithiasis   Symptoms occur when one of the stones block the common bile duct.   Stones are made of:   Cholesterol   Pigments

7. 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

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

9. Complications n n Gangrenous cholecystitis n n Pancreatitis n n Rupture of the gallbladder n n Biliary Cirrhosis n n Peritonitis

10. Diagnostic Studies n n Ultrasound n n Must be NPO   ERCP (Endoscopic Retrograde Cholangiopancreatography)

11. Additional Laboratory Tests n n Laboratory tests * WBC count * Serum bilirubin

13. 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

14. Treatment and Nursing Care n n Relieve Pruritis n n Bile acid Sequestrants n n Cholestyramine (Questran) and hydroxyzine (Atarax)

15. 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?

16. Treatment and Nursing Care Nonsurgical Approaches   Stone Removal Techniques:   ERCP with sphincterotomy   Mechanical extracorporeal shock-wave lithotripsy

17. 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

18. Treatment and Nursing Care Surgery n n Laparoscopic cholecystectomy * treatment of choice * gallbladder removed through four puncture holes

19. Treatment and Nursing Care Surgery n n Incisional / Open cholecystectomy * Removal of GB through right subcostal incision * T tube inserted into CBD

20. 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

21. 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

22. 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

23. How do you know they are getting better?

24. The End The End