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Cholecystectomy

Cholecystectomy

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Published by: Tom Bayubs-tucs on Jul 04, 2011
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Cholecystectomy is the surgical removal of the gallbladder.

The operation is done to remove gallstones or to remove an infected or inflamed gallbladder. Benefits and Risk Gallbladder removal will relieve pain, treat infection, and in most cases stop gallstones from coming back. The risks of not having surgery are the possibility of worsening symptoms, infection, or bursting of the gallbladder. Possible complications include bleeding, bile duct injury, fever, liver injury, infection, numbness, raised scars, hernia at the incision, anesthesia complications, puncture of the intestine, and death.

CHOLECYSTITIS WITH CHOLELITHIASIS Cholecystitis is an acute or chronic inflammation of the gallbladder, usually associated with gallstone(s) impacted in the cystic duct, causing distension of the gallbladder. Stones (calculi) are made up of cholesterol, calcium bilirubinate, or a mixture caused by changes in the bile composition. Gallstones can develop in the common bile duct, the cystic duct, hepatic duct, small bile duct, and pancreatic duct. Crystals can also form in the submucosa of

Firstly. The main duct is called the common bile duct. This latter duct joins with a duct from the pancreas on its way to the small intestine carrying pancreatic enzymes also used for digestion. (CCK) which in turn signals the relaxation of the valve at the end of the common bile duct (the sphincter of oddi) which lets the bile enter the small intestine. Without adequate bile you do not metabolize your fats well which can result in a deficiency of the fat- .(1) Some of it goes directly into the small intestine and some into the gallbladder. It hits up against the under surface of the liver. cholecystokinin. calcium. acids and waste materials among other things. WHAT IS THE GALLBLADDER The gallbladder is a small pear-shaped muscular sack that acts as a storage tank for bile. LOCATION OF GALLBLADDER The gallbladder is located behind the liver on the right side of the rib cage. to the pancreas as well. It also signals the contraction of the gallbladder which squirts the concentrated liquid bile into the small intestine where it helps with the emulsification or breakdown of fats in the meal. PICTURE OF GALLBLADDER LOCATION GALLBLADDER FUNCTION Bile is continually being made and secreted by the liver into bile ducts in varying amounts. It can consist of cholesterol. When the bile salts and cholesterol get out of balance with each other (to state it simply) gall stones can form. The gallbladder stores the bile to be squirted down the ducts into the small intestine to help to breakdown the fats when you eat a meal that contains fats. The ingestion of food and especially fats cause the release of a hormone. Bile moves in both directions into and out of the gallbladder through the cystic duct. yellow fluid.the gallbladder causing widespread inflammation. BILE FUNCTION The bile has two major functions in the body. gallbladder and farther down line. Acute cholecystitis with cholelithiasis is usually treated by surgery. it breaks down the fats that you eat so that your body can utilize them. bile salts. The bile is made in the liver by liver cells and is sent through tiny ducts or canals to the duodenum (small intestine) and to the gallbladder. The gallbladder stores the bile to have it available in larger quantities for secretion when a meal is eaten. lecithin. It is common to the liver. Bile is a bitter. There is a duct from the liver to the small intestine which is joined by a duct from and to the gallbladder. although several other treatment methods (fragmentation and dissolution of stones) are now being used. It also acts as a reservoir that uptakes excess bile when there is pressure in the bile ducts.

Secondly. or with a whole food beet product found in the GALLBLADDER STARTER KIT on this site. 3. drugs or other foreign substances the body doesn't want) and sends them out via the bile. peeling on the soles of your feet. The tube is then connected to a closed gravity drainage system. pour 50ml of cleaning solution into one basin and 50 ml of normal saline solution into the other basin. Assemble the equipment at the bedside Open all sterile equipment. The liver filters toxins (bacteria. 4. A healthy liver produces about a quart to a quart and a half of bile daily. Often the bile is thick and you can thin it out with The Beet Recipe which you can find here under gallbladder diet. Tape a small plastic bag on the table to use for refuse . The tube facilitates biliary drainage during healing. Amongst other symptoms you could have trouble utilizing calcium. Post-operatively it remains in place between 7 to 14 days. The pathway of departure is from the liver through the bile ducts and into the gallbladder or directly into the small intestine where it joins waste matter and leaves through the colon with the feces. D. May be placed in the common bile duct after cholecystectomy or choledochostomy.soluble vitamins (A. You may also have problems digesting the essential fatty acids. T-TUBE CARE y y y y y Also called a biliary draining tube. etc. bile is a very powerful antioxidant which helps to remove toxins from the liver. 2. Many people with sluggish gallbladders have a tendency towards constipation. The surgeon inserts the short end (crossbar) into the common bile duct and draws the long end through an incision in the skin. E and K). have dry skin. You might feel nauseous or experience gas and bloating. One way you can tell you have trouble digesting fats is if you have excessive burping that starts shortly after eating a meal that has fat in it. If you have gallbladder problems. which is made in the liver. viruses. you would do well to cleanse your liver and bowel also. Equipment Graduated collection container Small plastic bag Sterile gloves and clean gloves Clamp Sterile 4 x4 gauze pads Transparent dressings Rubber band Normal saline solution Sterile cleaning solution Two sterile basins Providone-iodine pads Sterile precut drain dressings Hyperallergenic paper tape Skin protectant Montgomery strips y y y y y y y y y y y y y y y Preparation of equipment 1. Place one sterile 4 x4 gauze pad in each sterile basin Using sterile technique.

Nursing Interventions 1. and amount of drainage. 6. How does a Jackson Pratt drain work? The JP drain removes fluids by creating suction (pulling) in the tube. The other end sticks out of your body through a small incision (cut). 4. and is connected to the squeeze bulb. empty the bag s contents completely into the container and reseal the outlet valve. check the bile drainage amounts regularly. 7. it stimulates the release of cytokines resulting to pain. or JP drain. 2. areas where surgery has been done. it contracts and there is spasm. 3. which may indicate obstruction. valve. 3. Put on glean gloves Place the graduated collection container under the outlet valve of the drainage bag. Verify the patient s identity using two patient identifiers. Monitor all urine and stools for color changes. As the JP drain bulb fills with fluid. thus it cannot adequately release bile due to the stone. Monitor tube patency and the condition of the site hourly for the first 8 hours. Without contaminating the clamp. drainage reflux. it goes back to its round shape. Protect the skin edges and avoid excessive taping. Why do I need a Jackson Pratt drain? When fluid builds up in a body area. 2. 5. This pulls fluid out from the area where the drain was placed and into the rubber tubing. 2. Provide privacy and reinforce the explanation of the procedure to the patient Wash hands Emptying drainage 1. Monitor for bile leakage. Reinforce with the patient that the bile stains clothing and is irritating to the skin. 9. The JP drain is made up of a thin rubber tube and a soft round squeeze bulb. When the bladder releases bile. Unwanted fluid can collect in areas of infection. 3. or in other body areas. Too much fluid in a body area may also cause pain and swelling. Discard gloves Clamping the T-tube 1. blood tinged bile in the first 24 hours after surgery. occlude the tube lightly with a clamp or wrap a rubber band around the end. Carefully measure and record the character. the bulb is pressed flat and is connected to the tube sticking out of your body. To produce suction. Suction is created as the bulb sucks in air from the tube going into your body. 3. The JP drain also . Provide meticulous skin care and frequent dressing changes since bile is irritating to the skin. 2. Bile will flow into the bag only when biliary pressure increases. Complications Obstructed bile flow. Using a JP drain after surgery may help you heal faster and decrease your risk of getting an infection. tube dislodgement. The T-tube usually drains 300 to 500 ml of thin. y y y What is a Jackson Pratt drain? Jackson Pratt Drain Care Care Guide A Jackson Pratt drain. Remind the patient about signs and symptoms of T-tube and biliary obstruction and to report them to physicians. 8. To prevent excessive bile loss over 500ml in the first 24 hours or backflow contamination. Clamping the tube 1 hour before and after meals diverts the bile back to the duodenum to aid digestion. such as the patient s name and identification number. and infection. 11. As ordered. color. is used to remove fluids that build up in areas of your body. Teach the patient how to care for the tube at home. skin excoriation or breakdown. the area may not heal as fast as it should. Reinforce with the patient that loose bowel occur commonly the first few weeks after surgery. or an infection may start. To ensure the comfort and safety. or outlet valve. Acute Pain Cholecystectomy Nursing Care Plan The flow of bile in the gall bladder is obstructed due to the presence of stones. 4.Procedure 1. The fluid then travels through the tubing and into the bulb of the JP drain. One end of the rubber tube is placed in the area where body fluids may build up. Monitor the patient s response to clamping. 10.

If you have a drain after skin flap or skin graft surgery. 5 to 6 new cotton swabs. the drain will need to stay in place until less than 30 milliliters (about two tablespoons) of fluid are draining from it in a day. Dry your hands and put on clean gloves. and he will tell you when the drain will be taken out. Look for any new redness. . Make sure the stitches that attach the JP drain to your skin are tight. y y y y y y Loosen the tape and gently remove the old bandage. you will need to keep track of the amount of fluid that you are emptying from the drain. When is a Jackson Pratt drain removed? The amount of fluid that comes out of the surgery or wound area and into the JP drain will decrease as the area heals. swelling. Your caregiver will tell you if you need to do this more often. Dip a cotton swab in the solution once. Gently clean the skin around the drain. Attach the bulb to your clothing using a safety pin. the bulb cannot correctly suction fluids. If the drain is placed after certain types of surgery. it may allow germs to enter your body and cause an infection. Your caregiver will keep track of how much fluid is draining into the JP drain. put a new bandage around the JP tube entry site. moving away from the insertion site. In most cases. and your wound will heal more slowly. Follow these steps to care for your skin around the JP drain entry site: y Wash your hands with soap and water. Surgical tape. When the area is dry. Collect the following items and place them where they can be reached easily: y y y y y y y y Two pairs of clean medical gloves. The end of the tubing inside your body may get blocked with blood or other materials. Tell caregivers if you see any of these changes. Plastic trash bag. If this happens. A JP drain may be used after surgery on your spine to check if spinal fluid is leaking. you may get an infection if it stays in your body longer than it is needed. moving in circles. Saline solution or soap and water. or it may not heal at all. or pus at the place where the drain enters your skin. Wash your hands after you are finished. Tape the tubing down to the bandages. Clean your skin 3 to 4 times. using a new swab each time. You may develop a fistula (unwanted tunnel). and collect it. What are the risks of having a Jackson Pratt drain? If a JP drain is not taken care of correctly. New gauze pads. How do I take care of the skin around my Jackson Pratt drain entry site? Change bandages at the JP drain entry site every day to keep it clean and dry. Start from the place where the drain enters your skin and clean outward in circles. Let the skin dry. you may have more pain and swelling. JP drains may also be used after skin flap surgery and skin grafting. or the drain may make a hole in your intestine. Tell caregivers if they are loose or missing. A clean container. Take your gloves off and put on a clean pair. Check for a foul (bad) smell coming from the area. If you are caring for your JP drain at home. Pour a small amount of saline solution or clean water into a container.helps clear away pus and may help infections heal faster. Throw all used supplies in the trash bag along with your gloves. Use surgical tape to hold it down against your skin. the tissue may not heal. Throw the old bandage into a plastic trash bag. If you get an infection. Place a waterproof pad or towel under the JP drain to soak up any spills. Waterproof pad or bath towel.

especially after eating fatty or greasy foods. When the gallbladder is removed. In Asia. However. bile may undergo a change in composition. (1) Frequent bouts of indigestion. radishes. sometimes with X rays. by emulsifying fat into smaller droplets to increase access for the enzymes. Digestion of fat occurs mainly in the small intestine. and emulsifying fat. age over 60. The presence of gallstones in the gallbladder is called cholelithiasis. (2) Nausea and bloating (3) Attacks of sharp pains in the upper right part of the abdomen. Diet-Very low calorie diets. The only treatment that cures gallbladder disease is surgical removal of the gallbladder. although recent studies have shown an increase in cholesterol stones in the Far East. hormone replacement therapy. rapid weight loss. until it is needed in the digestive process. This pain occurs when a gallstone causes a blockage that prevents the gallbladder from emptying (usually by obstructing the cystic duct). which leads into the intestine blocking the flow of bile from both the gallbladder and the liver. rid the body of surpluses and metabolic wastes Cholesterol and Bilirubin. Obesity. Enable intake of fat. and remove any stones that may be lodged there. A common digestive disorder worldwide. gallbladder stasis may lead to bile stasis. are at particularly high risk for gallstone formation. Gallstones are crystalline structures formed by concretion (hardening) or accretion (adherence of particles. or the use of birth control pills. which can usually be controlled with a special diet and medication The function of the gallbladder is to store bile. Most patients experience no further symptoms after cholecystectomy. Generally.Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. preventing putrefaction. or when the gallbladder is infected and inflamed. Cholelithiasis is the pathologic state of stones or calculi within the gallbladder lumen. Risk factors associated with development of gallstones include heredity. through diet or surgery. The purpose of bile is to. infection may predispose a person to stone formation. or certain vegetables such as cabbage. D. by pancreatic enzymes called lipases. or pickles. Others. accumulation) of normal or abnormal bile constituents. removal of the organ is usually necessary. and low-fiber/high. The gallbladder. called cholecystectomy. prolonged fasting. the duct that connects the gallbladder to the hepatic duct. E. female gender-gallbladder disease is more common in women than in men. help the Lipases to Work. the surgeon may examine the bile ducts.cholesterol/high-starch diets all may contribute to gallstone formation. Fourth. and approximately 10-25% of gallstones are bilirubinate of either black or brown pigment. secreted by the liver and transmitted from that organ via the cystic and hepatic ducts. empties through the biliary ducts into the duodenum to aid digestion by promoting peristalsis and absorption. when functioning normally. there are four possible explanations for stone formation. where 75-80% of gallstones are of the cholesterol type. as a result of pregnancy. however. Second. Cholecystitis is usually caused by a gallstone in the cystic duct. This is a serious complication and usually requires immediate treatment. when stones are present and causing symptoms. Third. including fat-soluble vitamins: Vitamin A. Native American or Mexican American racial makeup. According to various theories. pigmented stones predominate. Sometimes. (4) Jaundice (yellowing of the skin) may occur if a gallstone becomes stuck in the common bile duct. will eventually develop one or more of the following symptoms. genetics and demography can affect stone formation. The ducts are not removed so that the liver can continue to secrete bile into the intestine. the annual overall cost of cholelithiasis is approximately $5 billion in the United States. Women with high estrogen levels. and K. . mild residual symptoms can occur. First. persons with gallbladder disease have few or no symptoms.

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