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Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Cholelithiasis is the presence of stones in the gallbladder or bile ducts: chole- means "bile", lithia means "stone", and -sis means "process". Most gallstones result from supersaturation of cholesterol in the bile, which acts as an irritant, producing inflammation in the gallbladder, and which precipitates out of bile, causing stones. Risk factors include gender (women four times as like to develop cholesterol stones as men), age (older than age 40), multiple parity, obesity, use of estrogen and cholesterol-lowering drugs, bile acid malabsorption with GI disease, genetic predisposition, rapid weight loss. Pigment stones occur when free bilirubin combines with calcium. These stones occur primarily in patients with cirrhosis, hemolysis, and biliary infections.
Pigment gallstones Most commonly seen in the developing world. they can often be visualized radiographically. however. incomplete and infrequent . Pseudoliths Also known as "Fake stones. Their brownish to greenish color suggest they are cholesterol calculi. and/or bilirubinate. They contain less than 20% of cholesterol. On the basis of their contents. Those classified as mixed. dark stones made of bilirubin and calcium salts that are found in bile. Pigment stones are small." they are sludge-like gallbladder secretions that act like a stone. People with erythropoietic protoporphyria (EPP) are at increased risk to develop gallstones. Conditions causing hemolytic anemia can cause pigment gallstones.Gallstones have different appearance. and perhaps diet. Cholesterol gallstones Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. The proportions of these different types of stone found varies between samples and is thought to be affected by the age and ethnic or regional origin of the patients. two other factors seem to be important in causing gallstones. body weight. contain between 30% and 70% of cholesterol. gallstones can be subdivided into the two following types: y y Cholesterol stones are usually green. They are made primarily of cholesterol. Besides a high concentration of cholesterol. and biliary tract infections. gallbladder motility (movement). the proportion required for classification as a cholesterol stone being either 70% (Japanese classification system) or 80% (US system). but are sometimes white or yellow in color. Risk factors for pigment stones include hemolytic anemia (such as sickle cell anemia and hereditary spherocytosis). cirrhosis. including inherited body chemistry. Mixed stones Gall bladder opened to show numerous gallstones. Causes Researchers believe that gallstones may be caused by a combination of factors. The first is how often and how well the gallbladder contracts. All stones are of mixed content to some extent. In most cases the other majority constituent is calcium salts such as calcium carbonate. depending on their contents. palmitate phosphate. Because of their calcium content.
Nausea and vomiting may occur. as melatonin both inhibits cholesterol secretion from the gallbladder. These attacks are sharp and intensely painful. highcholesterol diets and diets high in starchy foods have been suggested as contributing to gallstone formation. constipation. nearer to the pelvis. . yellowing of the skin or eyes and/or clay-colored stool. They do not need treatment. The common mnemonic for gallstone risk factors refer to the "four Fs": fat (i. No clear relationship has been proven between diet and gallstone formation. attacks occur after a particularly fatty meal and almost always happen at night. eating fewer meals per day. If the gallbladder is inflamed. a doctor should be consulted immediately. They start developing symptoms once the stones reach a certain size (>8 mm). The absence of these risk factors does not. also known as biliary colic. increased levels of the hormone estrogen as a result of pregnancy. In addition. and is an antioxidant. however. may increase cholesterol levels in bile and also decrease gallbladder movement. or the use of combined (estrogen-containing) forms of hormonal contraception. and low intakes of the nutrients folate. but this is less common. capable of reducing oxidative stress to the gallbladder. A patient may also experience pain in the back. On the other hand. and vitamin C. and fertile (pre-menopausal). the pain develops in the lower region of the abdomen. wine and whole grain bread may decrease the risk of gallstones. Patients characteristically exhibit a positive Murphy's sign. Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. resulting in a positive Murphy's sign. enhances the conversion of cholesterol to bile. If the above symptoms coincide with chills. In some cases. Interestingly. Other nutritional factors that may increase risk of gallstones include rapid weight loss. female. magnesium. Other symptoms include abdominal bloating. overweight). A main symptom of gallstones is commonly referred to as a gallstone "attack".emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation. belching.e. a fifth F.. (the patient is instructed to breathe in while the gallbladder is deeply palpated). however. low-fiber. the patient will abruptly stop inhaling due to the pain. The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones. ordinarily between the shoulder blades. calcium. a lack of melatonin could significantly contribute to gallbladder stones. These gallstones are called "silent stones" and do not affect the gallbladder or other internal organs. Often. similar to that of a kidney stone attack. intolerance of fatty foods. forty (an age near or above 40). low-grade fever. in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately 30 minutes to several hours. hormone therapy. Symptoms Gallstones usually remain asymptomatic initially. resulting in gallstone formation. or pain under the right shoulder. fair is sometimes added to indicate that the condition is more prevalent in Caucasians. eating less fish. gas and indigestion. preclude the formation of gallstones.
Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP). This approach will not eliminate the gallstones or improve the patient's condition in the long term. However. Laparoscopic cholecystectomy patients can generally resume normal diet and light activity a week after release. followed by a few days of home rest and pain medication. there is a significant portion of the population ² between 5 and 40% ² who develop a condition called postcholecystectomy syndrome which may cause gastrointestinal distress and persistent pain in the upper right abdomen. Gallstones may recur however. . They are then passed safely in the feces. but it may be required that the patient takes this medication for up to two years. Only symptomatic patients must be indicated to surgery. with a return to normal diet a week after release and normal activity several weeks after release. Temporary Relief Some patients have anecdotally reported that symptoms can be temporarily reduced by drinking several glasses of water when experiencing gallstone pain. However. This is a method of concentrating ultrasonic shock waves onto the stones to break them into tiny pieces. Surgical options Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. with some decreased energy level and minor residual pain continuing for a month or two. There are two surgical options for cholecystectomy: y y Open cholecystectomy: This procedure is performed via an incision into the abdomen (laparotomy) below the right lower ribs. Laparoscopic cholecystectomy: This procedure. The lack of a gall bladder may have no negative consequences in many people. Post-operative care typically includes a same-day release or a one night hospital stay. introduced in the 1980s. once the drug is stopped. In addition.Treatment Medical options Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. this form of treatment is only suitable when there are a small number of gallstones. Studies have shown that they can all be removed. as many as 20% of patients develop chronic diarrhea. is performed via three to four small puncture holes for a camera and instruments. Recovery typically consists of 3±5 days of hospitalization. Gallstones can be broken up using a procedure called lithotripsy (extracorporeal shock wave lithotripsy).
Benefits of Oxygen Therapy: Additional Benefits of Oxygen Therapy: y y y y Increased clarity Relieves nausea Can prevent heart failure in people with severe lung disease Allows the bodies organs to carry out normal functions Long-Term Benefits of Oxygen Therapy: y y y y Prolongs life by reducing heart strain Decreases shortness of breath Makes exercise more tolerable Results in fewer days of hospitalization .Oxygen therapy ± is the administration of oxygen as a therapeutic modality. and liter flow per minute. who specifies the concentration. It is prescribed by the physician. method of delivery.
Types of Face Masks: 1.Delivers oxygen concentrations from 40% to 60% at liter flows of 5 to 8 liters per minute. Partial Rebreather Mask ± Delivers oxygen concentration of 60% to 90% at liter flows of 6 to 10 liters per minute. It delivers a relatively low concentration of oxygen which is 24% to 45% at flow rates of 2 to 6 liters per minute. It is easy to apply and does not interfere with the client¶s ability to eat or talk. 2. . Venturi Mask ± Delivers oxygen concentrations varying from 24% to 40% or 50% at liter flows of 4 to 10 liters per minute. Simple Face Mask . 3. 2. Nasal Cannula y y y y Also called nasal prongs. 4. Face Mask y y It covers the client¶s nose and mouth may be used for oxygen inhalation. Non Rebreather Mask ± Delivers the highest oxygen concentration possible 95% to 100% ± by means other than intubation or mechanical ventilation.Oxygen Delivery Systems 1. Is the most common inexpensive device used to administer oxygen. Exhalation ports on the sides of the mask allow exhaled carbon dioxide to escape. at liter flows of 10 to 15 liters per minute. respectively. respectively.
and on the oxygen equipment. 7. at the foot or head of the bed. 6. suction machines and portable diagnostic machines.3. and hearing pads) are in good working order to prevent the occurrence of short-circuit sparks. flammable materials such as oils. Face Tent y y It can replace oxygen masks when masks are poorly tolerated by clients. The client requires less oxygen (0. Cotton blankets should be used . 3. Oxygen Therapy Safety Precautions: 1. near clients receiving oxygen. radios.5 to 2 liters per minute) because all of the low delivered enters the lungs. and client and caregivers should be advised to wear cotton fabrics.g. Avoids materials that generate static electricity. alcohol. Place cautionary signs reading ³No Smoking: Oxygen in use´ on the clients door. Ground electric monitoring equipment. nail polish remover). Transtracheal Oxygen Delivery y y It may be used for oxygen-dependent clients. and acetone (e. 4. Instruct the client and visitors about the hazard of smoking with oxygen use. televisions. ether. Make sure that electric devices (such as razors. teach family members and roommates to smoke only outside or in provided smoking rooms away from the client. Make known the location of the fire extinguishers. 8. hearing aids. and make sure personnel are trained in their use. such as woolen blankets and synthetic fabrics. greases. 4. For home oxygen use or when the facility permits smoking. . It provides varying concentrations of oxygen such as 30% to 50% concentration of oxygen at 4 to 8 liters per minute. 2. Avoid the use of volatile. 5.
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