Gallbladder Disease

Gallbladder Disease

INFLAMMATION: Gallbladder Disease HINKLE, CHAPTER 50, 1389-1401 A&P Review: Liver, Biliary System, and Pancreas Cholelithiasis Pathophysiology

Pigment stones Cholesterol stones Risk factors Obesity Drugs Rapid Weight Loss Dehydration Increased triglycerides Fatty Diet

CHOLECYSTITIS Cholecystitis is inflammation of the gallbladder. Acute cholecystitis is caused primarily by gallstone obstruction of the cystic duct with edema, inflammation, and bacterial invasion. Chronic cholecystitis results from repeated attacks of cholecystitis, presence of stones, or chronic irritation. The gallbladder becomes thickened, rigid,

fibrotic, and functions poorly. CHOLECYSTITIS/CHOLELITHIASISMANIFESTATIONS Can be caused by inflammation/infection alone or by inflammation/infection with stones. --Sharp, cramping, or dull pain in RUQ --May be constant or intermittent --May refer to mid-back or right scapula --+Murphys sign

--Clay-colored stools --Fever --Nausea and vomiting --Jaundice of skin and sclera DIAGNOSTICS --PE --Elevated WBC, bilirubin, amylase

and lipase, LFTs (AST, ALT) --+Abdominal CT or US --+Oral cholecystogram --+Gallbladder scan Medical Management of Cholelithiasis Cholecystectomyopen or lap. Can range from elective to emergency. Lithotripsy

Basket extraction (see next slide) Low fat diet Medications: oral ursodeoxycholic acid and chenodeoxycholic acid to dissolve stones in poor surgical candidates. May take several months. Nonsurgical Techniques for Removing Gallstones

Laparoscopic Cholecystectomy Cholesterol Gallstones and Pigment Gallstones Nursing Management: Preop Assessment Patient history: Pain characteristics

GI sx Obstructive sx Current meds (Rx and OTC) Comorbidities Risk factors for complications Preop knowledge and teaching needs (hint: any postop abdominal surgery!) Nutritional status

Nursing Diagnoses Acute pain Impaired gas exchange Impaired skin integrity Imbalanced nutrition Deficient knowledge Risk for infection

Collaborative Problems/Potential Complications Bleeding Gastrointestinal symptoms Complications as related to surgery in general: atelectasis, thrombophlebitis

Nursing Management: Planning and Outcomes

Relief of pain Adequate ventilation Intact incision Improved biliary drainage Optimal nutritional intake, Absence of complications Understanding of postop self-care

Postoperative Care Interventions Low Fowlers position Care of drainage tubes: NG, JP, biliary Care of IV and IV meds Dressings NPO until bowel sounds return, then a soft, low-fat, high-carbohydrate diet postoperatively Analgesics as ordered and medicate to promote ambulation and activities, including deep breathing

Turn, and encourage coughing and deep breathing, IS, splinting to reduce pain Ambulation Patient TeachingChart 50-2 Medications Nutritious diet and avoid excess fat. Fat restriction is usually lifted in 46 weeks. Wound care, dressing changes, tube care

Activity Instruct 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

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