Cholecystolithiasis

Cholecystolithiasis or Gallstones
Mass of crystallized substances that forms in the gallbladder. The most common type occurs when the liver secretes bile with too much cholesterol to stay in solution. Liver damage, chronic gallbladder disease, or biliary-tract cancer may predispose one to stone formation. In the gallbladder, stones may cause inflammation or produce no symptoms. A stone obstructing the bile duct causes severe pain (biliary colic).

Gallstones usually must be removed with the gallbladder or broken up with ultrasound. In some cases a stone can be treated by giving the patient bile salts, which help redissolve cholesterol. If the gallbladder must be removed, laparoscopy is the method of choice.

These studies have revealed a marked variation in overall gallstone prevalence between different ethnic populations. and Native American populations and lower rates in eastern European. As a general rule. African American. Hispanic. there appears to be higher rates of cholelithiasis in western Caucasian. and Japanese populations .EPIDEMIOLOGY Epidemiologic data are available from a number of large European and American populations.

The following prevalence rates were observed: .000 persons aged 20 to 74 in whom gallbladder disease was detected by the presence of gallstones or cholecystectomy on ultrasonography. the age standardized prevalence of gallbladder disease was estimated based upon a sample of more than 14.In the United States.

respectively 5.7 percent among Mexican American men and women.9 and 26. respectively 8.6 and 16.9 percent among non-Hispanic black men and women.6 percent among nonHispanic white men and women. respectively .3 percent and 13.8.

you should be aware of the initial symptoms of gallstone disease because you will need treatment quickly if you develop symptoms . Silent stones do not need to be treated since the first symptoms of gallstones are usually mild and there are risks involved in removing the gallbladder." Silent gallstones are often found on an ultrasound or CT scan done for other reasons. If you have silent gallstones. their stones remain "silent.GALLSTONE SYMPTOMS Silent gallstones ² The majority of people who have gallstones do not have symptoms.

This compresses the stones. Biliary colic usually happens when the gallbladder contracts in response to a fatty meal. also known as gallstone pain or biliary pain.Biliary colic ² Biliary colic. is the most common symptom of gallstones. Once you have a first attack of biliary colic. It causes attacks of abdominal pain. the pain subsides. often located in the right upper belly just under the lower ribs. blocking the opening. there is a good chance you will have more severe symptoms in the future. You may also feel nausea. . As the gallbladder relaxes several hours after the meal. and pain in the right shoulder or back. and vomiting.

which resolves within a few hours. and sometimes. Surgery to remove the gallbladder is usually recommended during the hospitalization or shortly thereafter. a life-threatening condition. caused by repeated episodes of biliary colic. Unlike biliary colic. pain medicine. Acute cholecystitis is a serious condition that requires immediate medical treatment in the hospital.Acute cholecystitis ² Acute cholecystitis refers to inflammation of the gallbladder. antibiotics. acute cholecystitis can lead to gallbladder rupture. pain is constant with acute cholecystitis and fever is common. It happens when there is a complete blockage of the gallbladder. . If not treated. Treatment includes IV fluids.

Serious complications are also rare. however. If they do occur. .Prognosis and Complications: Gallstones that do not cause symptoms rarely lead to problems. even from gallstones with symptoms. In most cases of obstruction. the stones block the cystic duct. Gallstones. or both. In such cases. is very rare. About 10% of patients with symptomatic gallstones also have stones that pass into and obstruct the common bile duct (choledocholithiasis). which leads from the gallbladder to the common bile duct. Death. This can cause pain (biliary colic). symptoms can develop. or after surgery. can cause obstruction at any point along the ducts that carry bile. infection and inflammation (acute cholecystitis). complications usually develop from stones in the bile duct.

Acute cholangitis is an infection of the bile ducts that causes pain.Complications of gallstones ² Complications can develop if gallstones move and block the area where bile exits (a condition known as choledocholithiasis). usually involving removal of the gallstone with a non-surgical procedure known as endoscopic retrograde cholangiopancreatography. leading to severe abdominal pain. or ERCP. chills. and fever. . This requires prompt treatment. (endoscopic retrograde cholangiopancreatography) Acute pancreatitis is sudden inflammation of the pancreas. Jaundice is a yellow discoloration of the skin and eyes.

NURSING CARE PLAN .

NURSING DIAGNOSIS ‡Acute Pain ‡Risk for infection .

changes in BP ( 80/60 mmHg to a 90/70 mmHg). reports of pain ( a pain scale of 7 out of 10).Hospital na ako kag indi ko na maag-wantahan ang sakitµ.NURSING DIAGNOSIS Acute pain related to biological injuring agents: inflammatory process as evidenced by: tenderness of the RUQ (abdomen) upon palpation. self-focusing and client verbalized ´ Nagpa. facial mask of pain. . guarding behaviour. grimace.

GOALS Ms. . R.S will be able to repot pain is relieved/controlled and demonstration use of relaxation skills and diversional activities as indicated for individual situation within 2 hours of nursing intervention.

RATIONALE .To provide baseline data and note progression. -Information provides baseline data to evaluate need for effectiveness intervention. Determine pain history or verbal rating scale and relief measures used.NURSING INTERVENTION INDEPENDENT: 1. Assess vital signs such as temperature. . Accepts client·s description of pain. pulse rate. 3. respiratory rate and blood pressure. 2. -Pain is a subjective feeling and can·t be felt by others.

and in less pain.NURSING INTERVENTION RATIONALE 4.To prevent ulcer formation. stress. fears.Provide nonpharmacologic comfort measures and diversional activities such as: a) Sounds and Songs (Music) b) Humor c) Repositioning by turning to sides or in sitting position . .Provides a medium of expression thoughts and emotions. promotes relaxation and helps refocus attention. Use of humor makes people feel better. It is one way to relieve tensions. .Humor elevates endogenous opiods or endorphins. . more relaxed. and anger of an individual.

relieve pain and provide comfort. It also diminishes the source of pain.NURSING INTERVENTION RATIONALE 5. Encourage use of stress management skills/complementary therapies such as: a) Therapeutic touch b) Rhythmic breathing c) Guided imagery -Touch reduces anxiety and stress. -Helps client distracts themselves from their pain. . -This method focuses the client·s attention away from the pain and on the breathing and the rhythm. It produces a relaxation response that helps produce muscle relaxation and relieve pain.

-It aid in pain management by decreasing abdominal tension.NURSING INTERVENTION RATIONALE 6. . -Cold further reduces perfusion to ischemic tissues. Encourage deep breathing exercises. Provide cutaneous stimulation by applying cold compress. 7.

perfusion. and water for hydration.A good source of electrolytes. . which is essential for adequate tissue the physician. a) Mainline: D5LR 1L x 125cc/hr regulated at 31-32 gtts/min. Has analgesic and anti-inflammatory effect. . Celecoxib 200mg/cap 1 cap BID (8am-6pm) RATIONALE . Administer Intravenous Fluids: -Intravenous fluids help maintain PNNS/ D5LR 1L as prescribed by vascular volume.Inhibits the enzyme COX-2.NURSING INTERVENTION DEPENDENT: Administer medication as prescribed 1. 2. calories.

.EVALUATION Goal partially met as pain felt by the client was somehow controlled ( pain scale of 6 out of 10) she was able to relax and her BP remains of 90/70 mmHg.

.NURSING DIAGNOSIS Risk for infection related to inadequate primary defenses: traumatized tissue and altered peristalsis as evidenced by hasn·t passed flatus after the surgery for the first 24 hours haven·t defecated and has tenderness at the RUQ during palpation and the pain scale of 7 out of 10.

R. .GOALS Ms.S will be able to achieve timely wound healing and develop to regain a normal peristalsis movement within 6 days of Nursing Intervention.

RATIONALE .To prevent infection.NURSING INTERVENTION INDEPENDENT: 1. Adhere to keep the wound from infection. . pulse rate. and output of patient. -Information provides baseline data to evaluate need for effectiveness intervention. -Oliguria develops as a result of 3. respiratory rate and blood pressure. Assess vital signs such as temperature. Monitor urine input decrease renal perfusion. 4. Observe drainage from wounds. -Provide information about status of infection. 2.

NURSING INTERVENTION RATIONALE 5. Apply sterile dressings. .Prevent environmental contamination of fresh wounds. .

Identifies hypoxemia. 3.Laboratory results will give examinations such as baseline data for further prompt hematology. . and evaluates effectiveness of therapy or need for another therapy. Monitor ABG·s/ pulse oximetry. Submit patient to laboratory .To evaluate gastric bleeding prompt intervention.NURSING INTERVENTION DEPENDENT: RATIONALE 1. . intervention. 2. Submit patient to fecalysis .

.EVALUATION Goal partially met as client may able to identify risk factors but it greatly depends on the health care provider and able to achieve healing process. Pain scale of 6 out of 10.

ANATOMY & PHYSIOLOGY .

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unlike the small intestine they are not there to increase surface area for absorption. causing it to unfold. to denature protein. and thus increasing the area that pepsins can attack . Numerous pores are seen. The rugae of the stomach are folds in the mucosa seen in the fasting state.Food enters the stomach from the esophagus at the at the cardia and passes into the stomach. This highly acidic environment serves two purposes . but the presence of food causes it to expand. In the fasting state the stomach is kept in a state of contraction.to provide an environment hostile to bacteria and other pathogens. The Hydrochloric Acid produces a pH of about 2. the openings to the gastric glands which secrete enzyme persinogen and Hydrocloric Acid as well as mucous.

and the Ilium. The surface for absorption is increased in many ways: the mucosa of the small intestine is thrown into folds called rugae. . In is the area of the intestine where most of the absorption takes place. hence the term brush border. the duodenum. the jejunum. this later gives the appearance of a 'brush' on light microscopy. and the epithelial cells are also covered with numerous projections called microvilli.Small Intestine The small intestine is divided into three sections. the mucosa itself has numerous finger like projections called villi.

ascending. and feces are formed. These are propelled forwards by a form of movement called mass movement. In is divided into the cecum. the Internal and external Anal sphincters. which usually operate in a symbiotic mode. In the colon electrolytes and water are removed. . The microscopic appearance is similar to that of the small intestine. transverse. descending and sigmoid colon.The large intestine extends from the ileo-caecal junction to the rectum and anus. Any food that has not been processed may be digested by these bacteria. The colon is populated with bacteria. The process of elimination is controlled by two sphincters. and the products will then be absorbed by the Large Intestine. The former is under involuntary control. the latter under voluntary control. The feces are now passed to the rectum where they await elimination.

. ‡ Sphincter ² allows food to enter the stomach and squeezes shut to keep food or fluid from flowing back into the esophagus.PHYSIOLOGY ‡ Mouth.7 cm) long. ‡ Pharynx ² a passageway of food and air. ‡ Epiglottis ² reflexively closes over the windpipe when swallowing to prevent choking. about 5 inches (12. ‡ Salivary glands ² secretes saliva which moistens and lubricates the food particles for easy swallowing.where digestion begins by chewing and breaks up large pieces of food into smaller particles that can be swallowed. ‡ Esophagus ² do not contribute to digestion but provides the pathway which ingested materials reach the stomach.

which helps the body absorb fat. It is also where mixing and propulsion of contents occur. dissolve and partially digest the macromolecules in food. ‡ Gallbladder ² it store and concentrate bile between meals. It is also where salt and water are absorbed. It secretes HCl and Pepsin. . ‡ Pancreas ² it secretes enzymes and bicarbonate. ‡ Large intestine ² it is a storage and has concentration of undigested matter.‡ Stomach ² saclike organ which store. ‡ Small intestine ² where digestion and absorption of most substances occurs. It has also a nondigestive endocrine function. ‡ Liver ² it secretes bile. it is a final outlet of undigested food particle through defecation. ‡ Anus ² Exit from the rectum.

PATHOPHYSIOLOGY .

elderly may affect her gastrointestinal system due to age PRECIPITATING FACTORS ‡Sedentary Lifestyle ‡Diet( Cholesterol) ‡Environmental ( smoke. pollutants) ‡Rapid weight loss Bile is supersaturated with cholesterol and calcium The solute precipitate from solution as solid crystals Crystals come together and fuse to form stones Gallstones Obstruction of the cystic duct and common bile duct Sharp pain in the right lower part of the abdomen Distention of the gall bladder Jaundice Venous and lymphatic drainage is impaired Proliferation of Bacteria Localized cellular Irritation The gall bladder gets inflammed .PREDISPOSING FACTORS SEX: Female AGE: 59 y.o.

N. Winnie Salcedo. Baltazar BSN 4-G Presented To: Ms.Prepared By: Jamaica C. USA-CI . R.

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