Cholecystitis • Cholecystitis Cholecystitis refers to a painful inflammation of the

gallbladder's wall.
4. Types • Acute cholecystitis is a sudden inflammation of the gallbladder that causes
severe abdominal pain. • Chronic Cholecystitis is long- standing swelling and
irritation of the gallbladder. • Calculous cholecystitis (90%) • Acalculous cholecystitis
(10%
5. Chronic Cholecystitis • The opened gall bladder contains about two dozen bright
yellow cholesterol rich gallstones • The remaining mucosa has a normal velvety
appearance • The cut edge of the gallbladder wall(arrow) is thickened indicative of
chronic inflammation (Image Contrib. by:UCHC) (Description by: Martin Nadel, M.D.)
6. • Gall stones cause stasis of bile (meaning bile is not moving (flowing)the way it
should through the bile ducts) and infection will take over. • Just like a small body of
water that is stagnant, (not flowing) bacteria will sit and multiply. Pathophysiology
7. Conti…. Although the exact mechanism of acalculous cholecystitis is unclear,
several theories exist. • Injury may be the result of retained concentrated bile, an
extremely noxious substance. • In the presence of prolonged fasting, the gallbladder
never receives a cholecystokinin (CCK) stimulus to empty thus, the concentrated bile
remains stagnant in the lumen.
8. Etiology Calculous cholecystitis is mainly caused by cholelithiasis and include the
following: • Female sex • Certain ethnic groups • Obesity or rapid weight loss •
Drugs (especially hormonal therapy in women) • Pregnancy • Increasing age
9. Conti… Acalculous cholecystitis is caused due to • Critical illness • Major surgery
or severe trauma/burns • Sepsis • Prolonged fasting • Sickle cell disease •
Salmonella infections • Diabetes mellitus
10. Sign and symptoms • Pain it may be colic or referred • Indigestion • Nausea •
Fever • Loss of appetite • Murphy’s sign is positive
11. Medical Diagnosis • Abdominal Ultrasound • History and Physical Exam •
Abdominal CT Scan • Blood Test
12. Treatments • Administration of Intravenous Fluids • Surgical Removal of
Gallbladder • Laparoscopic Cholecystectomy
13. Complications • Enlarged gallbladder. • Empyema • Death of gallbladder tissue. •
Perforation or rupture lead to peritonitis • Cholangitis (destruction of biliary ducts) •
Emphysema
14. Nursing diagnosis • Acute pain related to gallbladder inflammation or presence
of stones. • Impaired oral mucous membrane related to NPO status and possible NG
suction. • Ineffective breathing pattern related to pain from high abdominal incision.
• Risk for infection (postoperative) related to obstruction of external biliary drainage
tube. • Imbalanced nutrition less than body requirements related to altered lipid
metabolism and increased nutritional needs during healing.
15. Nursing intervention • Provide comfort measures and administer analgesics as
ordered • Monitor vital signs for signs of perforation. • Administer antibiotics for
infection as ordered. • Advice the patient to eat low fatty foods • Monitor
nutritional intake and weigh patient regularly. • Frequently turn the patient and
encourage deep breathing to prevent pulmonary complications, to protect skin, and
to promote comfort.
16. References • Huffman JL, Schenker S. Acute acalculous cholecystitis - a review.
Clin Gastroenterol Hepatol. Sep 9 2009;[Medline]. • Donovan JM. Physical and
metabolic factors in gallstone pathogenesis. Gastroenterol Clin North Am. Mar
1999;28(1):75- 97. [Medline]. • Sitzmann JV, Pitt HA, Steinborn PA, et al.
Cholecystokinin prevents parenteral nutrition induced biliary sludge in humans. Surg
Gynecol Obstet. Jan 1990;170(1):25-31. [Medline]. • Cullen JJ, Maes EB, Aggrawal S,
et al. Effect of endotoxin on opossum gallbladder motility: a model of acalculous
cholecystitis. Ann Surg. Aug 2000;232(2):202-7. [Medline]. • Forbes LE, Bajaj M,
McGinn T, et al. Perihepatic abscess formation in diabetes: a complication of silent
gallstones. Am J Gastroenterol. Apr 1996;91(4):786-8. [Medline].

DEFINITION The presence of stones in the gallbladder is referred to as cholelithiasis,

from the Greek chol- (bile) + lith- (stone) + -iasis (process). If gallstones migrate
into the ducts of the biliary tract, the condition is referred to as choledocholithiasis
form from the solid constitutes of the bile; they may vary greatly in size, shape, &
composition. Uncommon in children & young adults but become more prevalent
with increasing age.
7. INCIDENCE & PREVALENCE 2% in south-7 % in north. ↑ in women, especially
multiparous women & person ↑ 40 yr of age.
8. RISK FACTORS Women Mutiparity Birth control pills Pregnancy A family
history Obesity Diabetes Sedentary life style Liver disease Rapid weight loss.
9. TYPES OF GALLSTONES There are three types of gall stone-
10. CHOLESTEROL STONES Composed mainly of cholesterol (> 50% of stone
composition) & comprises multiple layers of cholesterol &mucin glycoproteins.
Pure cholesterol stones are not common; they comprise less than 10% of all stones.
Most other cholesterol stones contain variable amounts of bile pigments &
calcium.
11. If excessive cholesterol or insufficient bile acids are secreted, bile becomes
supersaturated with cholesterol which then precipitates out as cholesterol crystals &
stones. The incidence increase with age, & the prevalence higher in women. Stones
are usually smooth & whitish yellow to tan.
12. PIGMENT STONES It probably form when unconjugated pigments in the bile
precipitate to form stone. In these people bile contains an excess of unconjugated
bilirubin.
13. Pigment stone are dark due to the presence of calcium bilirubinate & are
usually formed secondary to hemolytic disorders such as sickle cell disease &
spherocytosis, & in those with cirrhosis. Two types are recognized, black & brown.
Pigment stone cannot be dissolved & must be removed surgically
14. Black pigment stones Most common Formed in gall bladder Common in
hemolytic disorders,cirrhosis Multiple , small & hard in consistence. bilirubinate,
phosphate, bicarbonate, calcium.
15. Brown stones- Rare Formed in bile duct usually after bacterial infection
caused by bile stasis. The bacteria responsible for the infection enzymatically
catalyze the conversion of bilirubin glucuronide to insoluble unconjugated bilirubin.
Major constituents are precipitated calcium bilirubinate & bacterial cell bodies.
16. MIXED STONES Most common type. It may be combination of cholesterol &
pigment stones or either of these with some other substances. Calcium carbonate,
phosphate, bile salts, & palmitate make up more common minor constituents.
17. CLINICAL MANIFESTATIONS May develop two types of symptoms: Due to
disease of the gallbladder itself Due to obstruction of the bile passages by a
gallstone. May be acute or chronic. Epigastric distress, such as fullness,
abdominal distention & vague pain in the right upper quadrant. May follow a meal
rich in fried or fatty foods.
18. PAIN & BILIARY COLIC Gallstone obstructs the cystic duct, becomes distended,
inflamed & eventually infected (acute cholecystitis). Develops a fever & may have a
palpable abdominal mass. May have biliary colic with excruciating upper right
abdominal pain that radiates to the back or right shoulder, is usually associated with
nausea & vomiting & is noticeable several hours after a heavy meal.
19. Moves about restlessly, unable to find a comfortable position ,the pain is
constant rather than colicky. Such a bout of biliary colic is caused by contraction of
the gallbladder, which cannot release bile because of obstruction by the stone.
When distended, the fundus of the gallbladder comes in contact with the abdominal
wall in the region of the right ninth & tenth costal cartilages. Produces marked
tenderness in the right upper quadrant on deep inspiration & prevents full
inspiratory excursion.
20. If dislodged & no longer obstructs the cystic duct, the gallbladder drains & the
inflammatory process subsides after a relatively short time. If continues to obstruct
the duct, abscess, necrosis & perforation with generalized peritonitis may result.
21. JAUNDICE Occurs in a few patients & usually occurs with obstruction of the
CBD. The bile, which is no longer carried to the duodenum, is absorbed by the
blood & gives the skin & mucous membrane a yellow color. frequently
accompanied by marked itching of the skin.
22. CHANGES IN URINE & STOOL COLOR The excretion of the bile pigments by the
kidneys gives the urine a very dark color. The feces, no longer colored with bile
pigments, are grayish, like putty, & usually described as clay- colored.
23. VITAMIN DEFICIENCY Obstruction of bile flow also interferes with absorption of
the fat soluble vitamins A, D, E, & K. May exhibit deficiencies of these vitamins. If
biliary obstruction has been prolonged (eg, bleeding caused by vitamin K deficiency,
which interferes with normal blood clotting)
24. Research input Leptin levels & lipoprotein profiles in patients with cholelithiasis.
Saraç S, Atamer A, Atamer Y, Can AS, Bilici A, Taçyildiz İ, Koçyiğit Y, Yenice N
OBJECTIVE: To determine the relationships between serum leptin & levels of
lipoprotein(a) [Lp(a)], apolipoprotein A-1 (ApoA-1) & apolipoprotein B (ApoB) in
patients with cholelithiasis.
25. RESULTS: A total of 90 patients & 50 controls were included. S.levels of leptin,
Lp(a), T. cholesterol, triglyceride & ApoB were significantly ↑ed, & levels of ApoA-1
& HDL-C were ↓ed, in patient with cholelithiasis compared with controls. S. leptin in
patients with cholelithiasis were vely correlated with Lp(a) & ApoB & vely
correlated with ApoA-1. CONCLUSIONS: Patients with cholelithiasis have ↑ leptin
levels & an altered lipoprotein profile compared with controls, with ↑ ed leptin
levels being associated with ↑ ed Lp(a) & ApoB levels, & ↓ ed ApoA-1 levels, in
those with cholelithiasis.
26. ASSESSMENT & DIAGNOSTIC FINDINGS Abdominal ultrasound
Ultrasonography Radionuclide imaging or cholescintigraphy Cholecystography
Endoscopic retrograde cholangiopancreatography Percutaneous transhepatic
cholangiography
27. ABDOMINAL ULTRASOUND If gall bladder stone is suspected, an abdominal x-
ray may be obtained to exclude other causes of symptoms. However, only 10 to 15%
gall stone are calcified sufficiently to be visible on such x - ray studies.
28. ULTRA SONOGRAPHY Replaced cholecystography as the diagnostic procedure
of choice Does not expose patients to ionizing radiation. Most accurate if the
patients fasts overnight so that the gall bladder is distended. Detect calculi in the
gall bladder or a dilated common bile duct with 90% accuracy. Obesity, ascites &
distended bowel may be difficult to examine satisfactorily with an ultrasound.
29. Stones are acoustically dense & produce an acoustic shadow. Stones also move
with changes in position. Polyps may be calcified & reflect shadows, but do not
move with change in posture. Thickened gallbladder wall & local tenderness
indicate cholecystitis. When a stone obstructs the neck of the gallbladder, the
gallbladder may become very large, but thin walled. A contracted, thick-walled
gallbladder indicates chronic cholecystitis .
30. RADIONUCLIDE IMAGING CHOLESCINTIGRAPHY used successfully in the
diagnosis of acute cholecystitis or blockage of a bile duct. Radioactive agent is
administered IV Taken up by the hepatocytes & excreted rapidly through the biliary
tract. Then scanned & image of the gall bladder & biliary tract are obtained.
31. More expensive than USG Takes longer to perform Expose the patient to
radiation Often used when ultrasonography is not conclusive such as acalculous
cholecystitis.
32. CHOLECYSTOGRAPHY Has been replaced by ultrasonography as the test of
choice Oral cholangiography may be performed to detect gallstones & to assess
the ability of the gallbladder to fill, concentrate its contents, contract & empty.
Iodide-containing contrast agent excreted by the liver & concentrated in the
gallbladder is administered to the patient. Normal gallbladder fills with this
radiopaque substance. Appear as shadows on the x-ray film.
33. Contrast agents include iopanoic acid (Telepaque), iodipamide meglumine
(Cholografin) & sodium ipodate (Oragrafin). Administered orally 10 to 12 hours
before the x-ray study. To prevent contraction & emptying of the gallbladder, the
patient is NPO after the contrast agent is administered. Asked about allergies to
iodine or seafood. An x-ray of the right upper abdomen is obtained. If the
gallbladder is found to fill & empty normally & to contain no stones, gallbladder
disease is ruled out.
34. ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Permits direct
visualization of structures that could once be seen only during laparotomy.
Examination of the hepatobiliary system is carried out via a side-viewing flexible
fiberoptic endoscope inserted into the esophagus to the descending duodenum.
Multiple position changes are required during the procedure, beginning in the left
semiprone position to pass the endoscope. Fluoroscopy & multiple x-rays are used.
35. PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY Involves the injection of
dye directly into the biliary tract. can be carried out even in the presence of liver
dysfunction & jaundice. useful for distinguishing jaundice caused by liver disease
from that caused by biliary obstruction for investigating the g.i symptoms of a
patient whose gallbladder has been removed, for locating stones within the bile
ducts, & for diagnosing cancer involving the biliary system.
36. Performed under moderate sedation on a patient who has been fasting; the
patient receives local anesthesia & IV sedation. Coagulation parameters & platelet
count should be normal . Broad-spectrum antibiotics are administered flexible
needle is inserted into the liver from the right side in the midclavicular line
immediately beneath the right costal margin. Successful entry of a duct is noted
when bile is aspirated or upon the injection of a contrast agent. Ultrasound
guidance can be used.
37. Bile is aspirated & samples are sent for bacteriology & cytology. A
water-soluble contrast agent is injected to fill the biliary system. The fluoroscopy
table is tilted & the patient repositioned to allow x-rays to be taken in multiple
projections Note Murphy sign- It is indicator of gall bladder inflammation (acute
pancreatitis). Pain on deep breath when the finger on under the liver border at the
bottom of the rib cage. The inspiration causes the gallbladder to descend onto the
fingers.
38. MANAGEMENT Nutritional & supportive therapy Pharmacologic therapy
Nonsurgical removal Surgical management Nursing management
39. NUTRITIONAL & SUPPORTIVE THERAPY The diet immediately after an episode is
usually limited to low-fat liquids. Include powdered supplements ↑ protein &
carbohydrate into skim milk. Cooked fruits, rice or tapioca, lean meats, mashed
potatoes, non–gas-forming veg, bread, coffee or tea may be added as tolerated.
Avoid eggs, cream, pork, fried foods, cheese, gas- forming vegetables & alcohol.
40. Fatty foods may bring on an episode. Dietary management may be the major
mode of therapy in patients who have had only dietary intolerance to fatty foods &
vague g.i. symptoms
41. PHARMACOLOGIC THERAPY Ursodeoxycholic acid (UDCA) , chenodeoxycholic
acid (chenodiol or CDCA). Acts by inhibiting the synthesis & secretion of cholesterol,
thereby desaturating bile. Existing stones can be reduced in size, small ones
dissolved & new stones prevented from forming.
42. 6 to 12 months of therapy are required. The effective dose of medication
depends on body weight. This method of treatment is generally indicated for
patients who refuse surgery or for whom surgery is considered too risky. Patients
with significant, frequent symptoms, cystic duct occlusion, or pigment stones are not
candidates for this therapy. Symptomatic patients with acceptable operative risk
are more appropriate for laparoscopic or open cholecystectomy.
43. NONSURGICAL REMOVAL OF GALLSTONES Dissolving Gallstones Stone
Removal by Instrumentation Extracorporeal Shock-Wave Lithotripsy
Intracorporeal Lithotripsy
44. DISSOLVING GALLSTONES By infusion of a solvent (mono-octanoin or methyl
tertiary butyl ether [MTBE]) into the gallbladder. Can be infused through a tube or
catheter inserted percutaneously directly into the gallbladder; a tube or drain
inserted through a T-tube tract to dissolve stones not removed at the time of surgery;
an ERCP endoscope; or a transnasal biliary catheter.
45. In the latter procedure, the catheter is introduced through the mouth &
inserted into the CBD. The upper end of the tube is then rerouted from the mouth to
the nose & left in place. This enables the patient to eat & drink normally while
passage of stones is monitored or chemical solvents are infused to dissolve the
stones. This method of dissolution of stones is not widely used in patients with
gallstone disease. Method used when the size of stone not more than 20 mm in
diameter.
46. STONE REMOVAL BY INSTRUMENTATION used to remove stones that were not
removed at the time of cholecystectomy or have become lodged in the CBD. A
catheter & instrument with a basket attached are threaded through the T-tube tract
or fistula formed at the time of T-tube insertion; the basket is used to retrieve &
remove the stones lodged in the common bile duct. A second procedure involves
the use of the ERCP endoscope .After the endoscope is inserted, a cutting instrument
is passed through the endoscope into the ampulla of Vater of CBD.
47. Another instrument with a small basket or balloon at its tip may be inserted
through the endoscope to retrieve the stones. The patient is closely observed for
bleeding, perforation & the development of pancreatitis or sepsis. The ERCP
procedure is particularly useful in the diagnosis & treatment of patients who have
symptoms after biliary tract surgery, for patients with intact gallbladders, & for
patients in whom surgery is particularly hazardous.
48. EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY Used for nonsurgical
fragmentation of gallstones. Derived from lithos, meaning stone & tripsis, meaning
rubbing or friction. Uses repeated shock waves directed at the gallstones in the
gallbladder or CBD to fragment the stones. The energy is transmitted to the body
through a fluid-filled bag, or it may be transmitted while the patient is immersed in a
water bath.
49. Converging shock waves are directed to the stones to be fragmented. After
the stones are gradually broken up, the stone fragments pass from the gallbladder or
CBD spontaneously are removed by endoscopy, or dissolved with oral bile acid or
solvent. Requires no incision & no hospitalization, patients are usually treated as
OPD , but several sessions are generally necessary.
50. INTRACORPOREAL LITHOTRIPSY Fragmented by means of laser pulse
technology. A laser pulse is directed under fluoroscopic guidance with the use of
devices that can distinguish between stones & tissue. Produces rapid expansion &
disintegration of plasma on the stone surface, resulting in a mechanical shock wave.
Electro- hydraulic lithotripsy uses a probe with two electrodes that deliver electric
sparks in rapid pulses, creating expansion of the liquid environment surrounding the
gallstones.
51. This results in pressure waves that cause stones to fragment. Can be
employed percutaneously with the use of a basket or balloon catheter system or by
direct visualization through an endoscope. Repeated procedures may be necessary
due to stone size, local anatomy, bleeding, or technical difficulty. A nasobiliary
tube can be inserted to allow for biliary decompression & prevent stone impaction in
the CBD. This approach allows time for improvement in the patient’s clinical
condition until gallstones are cleared endoscopically, percutaneously, or surgically.
52. SURGICAL MANAGEMENT
53. LAPAROSCOPIC CHOLECYSTECTOMY If the CBD is thought to be obstructed by a
gallstone, an ERCP with sphincterotomy may be performed Performed through a
small incision or puncture made through the abdominal wall in the umbilicus.
54. CHOLECYSTECTOMY Gallbladder is removed through an abdominal incision
(usually right subcostal) after the cystic duct & artery are ligated. Performed for
acute & chronic cholecystitis. Drain may be placed close to the gallbladder bed &
brought out through a puncture wound if there is a bile leak. Drain type is chosen
based on the physician’s preference.
55. SMALL INCISION CHOLECYSTECTOMY Gallbladder is removed through a small
incision. If needed, the surgical incision is extended to remove large gallbladder
stones. Drains may or may not be used. The cost savings resulting from the
shorter hospital stay have been identified as a major reason for pursuing this type of
procedure. The procedure is controversial because it limits exposure to all the
involved biliary structures.
56. CHOLEDOCHOSTOMY An incision into the common duct, usually for removal of
stones. After the stones have been evacuated, a tube usually is inserted into the
duct for drainage of bile until edema subsides. This tube is connected to gravity
drainage tubing, the patient is monitored closely. A laproscopic cholecystectomy is
planned for a future date after acute inflammation has resolved.
57. SURGICAL CHOLECYSTOSTOMY Performed when the patient’s condition
prevents more extensive surgery or when an acute inflammatory reaction is severe.
The gallbladder is surgically opened, the stones & the bile or the purulent drainage
are removed & a drainage tube is secured with a purse-string suture. The drainage
tube is connected to a drainage system to prevent bile from leaking around the tube
or escaping into the peritoneal cavity.
58. PERCUTANEOUS CHOLECYSTOSTOMY Used in the treatment & diagnosis of
acute cholecystitis in patients who are poor risks for any surgical procedure or for
general anesthesia. Under local anesthesia, a fine needle is inserted through the
abdominal wall & liver edge into the gallbladder under the guidance of ultrasound or
computed tomography. Bile is aspirated to ensure adequate placement of the
needle & a catheter is inserted into the gallbladder to decompress the biliary tract.
59. Research input: Cost-effective treatment of patients with symptomatic
cholelithiasis & possible common bile duct stones. Brown LM, Rogers SJ, Cello JP,
Brasel KJ, Inadomi JM
60. RESULTS: Across the CBD stone probability range of 4% to 100%, LC with IOC ±
ERCP was the most cost- effective. If the probability was 0%, LC alone was the most
cost-effective. Our model was sensitive to 1 health input: specificity of IOC, & 3 costs:
cost of hospitalization for LC with CBDE, cost of hospitalization for LC without CBDE,
& cost of LC with IOC. CONCLUSIONS: The most cost-effective treatment strategy for
the majority of patients with symptomatic cholelithiasis is LC with routine IOC. If
stones are detected, CBDE should be forgone & the patient referred for ERCP.
61. NURSING MANAGEMENT
62. ASSESSMENT
63. NURSING DIAGNOSIS Acute pain & discomfort r/t surgical incision. Impaired
gas exchange r/t the high abdominal surgical incision Impaired skin integrity r/t
altered biliary drainage after surgical intervention Imbalanced nutrition, less than
body requirements, r/t inadequate bile secretion Deficient knowledge about
self-care activities r/t incision care, dietary modifications (if needed), medications,
reportable signs or symptoms (eg, fever, bleeding, vomiting)
64. PLANNING & GOALS Relief of pain Adequate ventilation. Intact skin &
improved biliary drainage. Optimal nutritional intake. Absence of complications.
Understanding of self-care routines.
65. RELIEVING PAIN Observe & document location, severity (0–10 scale) &
character of pain (steady, intermittent, colicky). Splint the affected site & to take
shallow breaths to prevent pain. Gradually increased activity . Administer
analgesic agents as prescribed. Helping the patient to turn, cough, breathe deeply
& ambulate as indicated. Use of a pillow or binder over the incision.
66. Control environmental temperature. Encourage use of relaxation techniques.
Provide diversional activities. Make time to listen to and maintain frequent
contact with patient.
67. IMPROVING RESPIRATORY STATUS Reminds patients to take deep breaths &
cough every hour to expand the lungs fully & prevent atelectasis. The early &
consistent use of incentive spirometry. Early ambulation prevents pulmonary
complications as well as other complications, such as thrombophlebitis.
68. PROMOTING SKIN CARE & BILIARY DRAINAGE Drainage tubes must be
connected immediately to a drainage receptacle. Fasten tubing to the dressings or
to the patient’s gown. Observe for indications of infection, leakage of bile into the
peritoneal cavity, & obstruction of bile drainage. Note & report right upper
quadrant abdominal pain, nausea & vomiting, bile drainage around any drainage
tube, clay-colored stools, & a change in vital signs.
69. To prevent total loss of bile, the drainage tube or collection receptacle is
elevated above the level of the abdomen. Every 24 hours, measure the bile
collected & records the amount, color, & character of the drainage. After several
days of drainage, the tube may be clamped for an hour before & after each meal to
deliver bile to the duodenum to aid in digestion. Within 7 to 14 days, the drainage
tube is removed. The patient who goes home with a drainage tube in place
requires instruction & reassurance about its function & care of the tube.
70. Observes the stools daily & notes their color. Specimens of both urine & stool
may be sent for examination for bile pigments. In this way, it is possible to
determine whether the bile pigment is disappearing from the blood & is draining
again into the duodenum. Maintaining a careful record of fluid intake & output is
important.
71. IMPROVING NUTRITIONAL STATUS Encourage the patient to eat a diet ↓ in fats
& ↑ in carbohydrates & proteins immediately after surgery. Fat restriction usually
is lifted in 4 to 6 weeks This is in contrast to before surgery, when fats may not be
digested completely or adequately, & flatulence may occur.
72. COMPLICATIONS GALL STONES Chronic cholecystitis Acute cholecystitis
Choledocholithiasis Cholangitis, Gallstone pancreatitis, Gallstone ileus,
Perforation of the gallbladder Gallbladder carcinoma
73. MANAGING COMPLICATIONS Bleeding Postop, monitor vital signs & inspects
the surgical incisions & drains for bleeding. Assess the patient for ↑ tenderness &
rigidity of the abdomen. Report to the surgeon. Instruct to report any change in
the color of stools. After lap.cholecystectomy, assess for loss of appetite, vomiting,
pain, distention of the abdomen, & temperature elevation.
74. PATIENT EDUCATION Managing Pain Sitting upright in bed or a chair or walking
may ease the discomfort. Analgesic medications as needed & as prescribed
Report to surgeon if pain is unrelieved even with analgesic use.
75. Resuming Activity- Light exercise (walking) immediately. Shower or bath after
1 or 2 days. Drive a car after 3 or 4 days. Avoid lifting objects exceeding 5 pounds
after surgery, usually for1 week. Caring for the Wound Check puncture site daily
for signs of infection. Wash puncture site with mild soap & water. Allow special
adhesive strips on the puncture site to fall off. Do not pull them off.
76. Resuming Eating Resume normal diet. If you had fat intolerance before
surgery, gradually add fat back into your diet in small increments. Follow-Up Care
Report any sign & symptoms of infection at or around the puncture site: redness,
tenderness, swelling, heat, or drainage. Fever of 37.7°C (100°F) or more for 2
consecutive days. Nausea, vomiting, or abdominal pain
77. SUMMARY Anatomy & physiology Definition Incidence & prevalence Risk
factors Pathophysiology Clinical manifestations Diagnostic test Management
78. CONCLUSION The presence of stones in the gallbladder is referred to as
cholelithiasis with three types – cholesterol, pigment & mixed. Mostly detected
incidentally during surgery or evaluation for unrelated problems. Nursing care &
patient education is of utmost importance for preventing gall stones & related
complications
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81. What are the types of gall stones. a) Red & green stones b) Calcium & uric acid
stone c) Pink & green stones d) Cholesterol & pigment stones Ans- d
82. High estrogen level are associated with gall stones. a) True b) False Ans - a
83. Which are the risk factors for cholelithiasis a) Obesity b) Sudden weight loss c)
Sudden weight gain d) Women e) Men f) North indian Ans- a,b,d,f
84. False about black pigment stone a) Most common b) Formed in bile duct after
bacterial infection c) Common in hemolytic disorders,cirrhosis d) Multiple , small &
hard in consistence. Ans - b