CHOLECYSTECTOMY

ALYSSA JAMILLA Q. MARTINEZ

LIRIO CLAIRE T. AZUL
GALLBLADDER

Stores and concentrates bile and contracts to force bile into the
duodenum during the digestion of fats
The cystic duct joins the hepatic duct to form the common bile duct
The sphincter of Oddi is located at the entrance to the duodenum
The presence of fatty materials in the duodenum stimulates the
liberation of cholecystokinin, which causes contraction of the
gallbladder and relaxation of the sphincter of Oddi
500- 1000 ml of bile/day
Cholecystitis

Inflammation of the gallbladder that may occur as an acuteor chronic

process

Acute cholecystitis associated with gallstones (cholelithiasis)

Chronic cholecystitis results in inefficient bile emptying and gallbladder wall

disease cause a fibrotic and contracted gallbladder

Acalculous cholecystitis occurs in the absence of gallstones and is caused

by bacterial invasion via the lymphatic or vascular system
Assessment

N/V
Indigestion
Belching
Flatulence
Epigastric Pain (radiating to the scapula 2-4 hrs after eating fatty foods
and may persist 4-6 hrs)
Pain localized in RUQ
Guarding, rigidity and rebound tenderness
Mass palpated in RUQ
Assessment

MURPHYs SIGN ( cannot take a deep breath when the examiners

fingers are passed below the hepatic margin because of pain)
Increased Temp
Tachycardia
Signs of Dehydration
Fever
BILIARY OBSTRUCTION
-Jaundice
-Dark orange and foamy urine
-Steatorrhea and clay-colored feces
- Pruritus
Risk factors:

Women are more likely to get gallstones than men

Anyone older than 60
Pregnant or multigravidas
Women taking ERT or birth control pills
Obese
People who have lost weight rapidly
People who eat high-fat diet
Diagnostic/Lab test

Ultrasonography Gallstone

CT Scan

MRI

Oral cholecystography

Hepatobiliary Nuclear Scan

Endoscopic ultrasonography
Interventions

NPO when N/V

Administer Antiemetics, Analgesics
Administer Antispasmodic (anticholinergics) relax smooth muscles
Chronic Cholecystitis- eat small, low-fat meals
Avoid gas-forming foods
Surgical Interventions

CHOLECYSTECTOMY - removal of the gallbladder

CHOLEDOCHOLITHOTOMY incision in the common bile duct to

remove the stone
Pre-op

Obtain informed consent.

Reinforced to client and family the surgical procedure to be done, how

long it will take, possible complications and preventive measures.

Healt
Post- op Interventions

Monitor for respiratory complications caused by pain at the incision site

Encourage coughing and deep breathing

Encourage early ambulation

Instruct the client about splinting the abdomen to prevent discomfort

during coughing

Administer Antiemetics, analgesics

Post- op Interventions

Maintain NPO status and NGT suction as prescribed

Advanced diet from clear liquids to solids when prescribed and as

tolerated by the client

Maintain and monitor drainage from the T-tube, if present

Care for the T-tube

Place the client in Semi-fowlers position

Monitor the output, amount, color, consistency and odor of the drainage
Report sudden increase in bile output to the HCP
Monitor for inflammation and protect skin from irritation
Keep the drainage system below the level of the gallbladder
Monitor for foul odor and purulent drainage report to HCP
Avoid irrigation, aspiration, or clamping of the T-tube without HCP
prescription
As prescribed clamp the tube before a meal and observe for: abdl
discomfort distention, nausea, chills and fever; unclamp the
tube if N/V occurs