AMITY COLLEGE OF NURSING

AMITY UNIVERSITY, MANESAR, HARYANA

HEALTH TALK ON

CHOLELITHIASIS
Submitted to: Ms Sharmila Submitted By : Jyoti
Punia Tutor M.sc 4th Sem
ACON ACON
IDENTIFICATION DATA

 Name of the student teacher : Ms. Jyoti Punia

 Class : M.Sc Nursing IInd year

 Name of the subject : Medical Surgical Nursing

 Name of the topic : Cholelithiasis

 Name of the evaluator : MS. Sharmila

 Duration of teaching : 15-20min

 Method of teaching : Lecture cum discussion

 AV Aids : Chart and ppt

OBJECTIVES
 General objective -
 At the end of the Health education,the Patient will gain the knowledge about the ‘Cholelithiasis”.

 Specific objective
At the end of the teaching, the patient and his relative will be able to :
1. To Introduce about the topic.
2. To define Cholelithiasis.
3. To discuss the incidence of Cholelithiasis.
4. To explain the risk factors and causes.
5. To describe the sign and symptoms of Cholelithiasis.
6. To describe the complication of Cholelithiasis.
7. To discuss the Preventive measures of Cholelithiasis.
8. To summarize the topic.
9. To conclude the topic
S. TIME SPECIFIC CONTENT TEACHING A/V EVALUATION
No. OBJECTIVE LEARNING AIDS
ACTIVITY
1. 1min To introduce Self
yourself introduction:
Myself Jyoti
Punia ,student
of M.Sc.
Nursing IInd
year. Today my
topic of Health
education is
"Cholelithiasis.”
2. 1min To introduce Lecture cum ppt
about the topic Introduction discussion
Altered bile flow through the hepatic, cystic or common bile duct is a common method
problem. It often leads to inflammation and other complications. Gallstones are
the most common cause of obstructed flow. Tumours and abscesses also can
obstruct the bile flow.

3. 1min To define Lecture cum ppt

theCholelithiasis. Definition:-It is the formation of stones within the gallbladder or biliary duct discussion
system due to abnormal bile composition, biliary stasis and inflammation of method
the gallbladder.
4. 1 min To discuss the Incidence Lecture cum
incidence of discussion
Cholelithiasis. In developed countries, 10–15% of adults have gallstones. Rates in many parts
method
of Africa, however, are as low as 3%.Gallbladder and biliary related diseases
occurred in about 104 million people (1.6%) in 2013 and they resulted in
106,000 deaths.Women more commonly have stones than men and they occur
more commonly after the age of 40.Certain ethnic groups have gallstones more
often than others. For example, 48% of Native Americans have
gallstones.Once the gallbladder is removed, outcomes are generally good.

5 3 min To describe Clinical aspects of cholelithiasis Lecture Hand- Describe the

the clinical Asymptomatic/ silent cholelithiasis :-10 to 20% American develop the gallstones and 80% of cum outs clinical
aspects of them never experience biliary pain or complications such as acute cholecystitis, cholangitis or discussio aspects of
cholelithiasis. n method cholelithiasis
pancreatitis. The finding often occurs during abdomen ultrasound for another reason. People
?
with asymptomatic cholelithiasis may develop symptoms that require treatment about 2-3% per
year and 10% by 5 years.
The exception is patient with high risk for experiencing biliary complications :
 Large gallstones (> 3 cm)
 Sickle cell disease associated factor for development of pigment gallstones.
 Organ transplant like heart, lungs, kidney, pancreas and also stem cell transplant can
lead to cholelithiasis and biliary sludge formation.
 Abdominal surgery like bariatric surgery .

Symptomatic cholelithiasis:- gallstones associated pain seems to follow a certain pattern in

most patient. There is establish criteria for biliary pain relative to defined
characterstics : episodic, steady , sever pain located in the upper abdomen and last for 30
minutes.
Nocturnal onset : nausea and vomiting radiating through to the back.
These symptoms subside with cholecystectomy but in 10-30% pf people documented with
 gallstones pain doesn’t subside with the cholecystectomy.
Relationship between persistence of abdominal symptoms and successful outcome after
cholecystectomy.

Functional cholelithiasis:Biliary pain seemingly results from increased intraluminal pressure

as the gallbladder contracts against an obstructed outlet.
In functional gallbladder disease (also termed; acalculous gallbladder disease, gallbladder
dyskinesia or biliary dyskinesia), the pain mechanism may be obstruction located at the
gallbladder outlet, incoordination between gallbladder contraction and sphincter of Oddi
relaxation, or visceral hypersensitivity.
6. 3 min To describe Cause and risk factor Lecture Chart Describe the
the cause and Non-modifiable factors cum cause and risk
risk factor of discussio factor of
 Age- The frequency of gallstones increases with age, escalating markedly after age 40
cholelithiasis n method cholelithiasis
to become 4 to 10 times more likely in older individuals ?
 Gender- More in female than men especially during fertile years. Women are almost
twice as likely as men to form stones; the gap narrows following menopause after
which men begin to catch up.
 Family- Familial studies reveal an increased frequency: a nearly 5 times elevated risk
in the relatives of gallstone patients. These rate are even higher in monozygotic twins at
12% and dizygotic twins at 6%
 Genetics - Cholelithiasis most likely is a polygenetic disease entity. Several genes have
been associated with gallstone disease.
Modifiable factors
 Obesity- Females with obesity have an even increased risk of stones formation.
Women with severe obesity.
 Rapid weight loss:-Low caloric diets and bariatric surgery with rapid weight loss are
associated with gallstones developing in 30% to 71% of such individuals.
 Sedentary life style and diet :-
- Reduced physical activity heightens the risk of gallstone disease whereas increased
physical activity helps prevent cholelithiasis, independent of its role in weight loss.
- Diets specifically high in cholesterol,fatty acids, carbohydratesor legumesseem to
increase the risk of Cholelithiasis
 Other risk factors for biliary sluge are:-
Drugs
 Octreotide-Octreotide, a long-acting analogue of somatostatin that inhibits
cholecystokinin release, results in decreased gallbladder motility and stasis.
 Ceftriaxone-Ceftriaxone, a third generation cephalosporin antibiotic, is secreted
unmetabolized into bile, achieving high concentrations.
 Thiazide diuretics-Thiazide treatment may increase biliary cholesterol saturation
leading to gallstones developing.
Diseases-( liver cirrhosis, chronic haemolysis, Crohn’s diseases)
7 2 min To explain Symptoms Lecture hando Explain the
the symptoms cum ut symptoms of
of discussio cholelithiasis
cholelithiasis. Some patients with gallstones may not have any symptoms at all. The gallstones are discovered ?
n method
during routine medical procedures such as x-ray, abdominal surgery etc.

 In case of choledocholithiasis, cramping pain is present in the center to the right upper
abdomen where a large stone blocks either the cystic duct or common bile duct producing
a condition known as biliary colic.
 The pain subsides when the stone passes into the duodenum, which is the first part of the
small intestine.
 Pain in the right upper or middle upper abdomen which may be dull, constant, sharp or
cramping in nature.
 The pain may radiate to the back or below the right shoulder blade.
 Fever.
 Jaundice.
 Clay-colored stools.
 Nausea and vomiting.
6 1 min To Complications: Most people with gallstones never have a serious complication. However, Lecture Describe the
describethe gallstones can sometimes cause complications, such as: cum complication
complication discussio ofcholelithias
ofcholelithiasi  inflammation of the gallbladder (cholecystitis); n method is?
s.  inflammation of the bile duct (cholangitis);
 inflammation of the pancreas (biliary pancreatitis); and
 obstruction of the intestine (gallstone ileus).
8 5 min To discuss the Preventive Measures Lecture Discuss the
Preventive cum Preventive
measuresof Lifestyle and Diet modification :-modifiable risk factors include obesity , hyperlipidemia, discussio measures
cholelithiasis. extremely low calorie diets and diets high in cholesterol. n method ofcholelithias
 Encourage client who are obese to increase their activity level is?
 Follow a low carbohydrate, low fat, low cholesterol diet to promote weight loss and
reduce the risk for developing gallstones.
 Discuss the danger of yo-yo dieting with cycles of weight loss followed by weight gain
and extremely low calorie diet.
 Following cholecystectomy a low fat diet recommended.

Medications
 Educate client about the importance of treatment, action of drug, frequency, duration
and side effects of the drugs.
 Educate the patient about the laboratory tests that are required with the treatment so as
to rule out any hepatotoxic effects like chenodiol.

Follow up:
 Advice the client to come for follow up.
 Instruct the client to come for consultation if any complication arises such as post
operative haemorrhage, vomiting or other abdominal discomfort.
13 1 To summarize Summarization Summary Today
min the topic.  Introduction of Cholelithiasis. we discussed
 Definition aboutcholelithiasis.
 Risk factors & causes
 Clinical manifestation
 Complication
 management
 Health education
14 1 To conclude Conclusion:Cholelithiasis develop inside the gallbladder and are hard, pebble-like deposits
min the topic. that develop inside the gallbladder. They can be as small as a sand grain or as big as a golf
ball. Complications include: Acute and chronic cholecystitis, cholangitis, choledocholithiasis,
and pancreatitis. Surgery is required if the patient is symptomatic.
References

 Suddarth& Brunner’s, Wolters Kluwer (2010), New Delhi (India). Textbook of Medical Surgical Nursing (12th ed). Nursing care of the client
having Gastro-intestinal disorder, 941- 960.
 LeMone Priscilla & Burke Karen, DorlinKindersely (2008), New Delhi (India). Medical Surgical nursing (4th ed). Nursing care of the client with
Gastro-ntestinal disorder 657--669.
 Black M. Joyce, Elsevier (2009), New Delhi (India). Medical Surgical nursing (8th ed). Gastro-intestinal disorders, 560-578.
 Wilson & Ross, Elsevier (2007), New Delhi (India). Anatomy and Physiology in health and illness (12th ed). Anatomy and physiology stomach,
297-301.
 https://www.kenhub.com/en/library/anatomy/the-small-intestine
 www.wikipedia.com
 www.nurselab.com
 www.webmed.com
 www.pubmed.com