Cholelithiasis

Presence of gallstones which are concretions that form

in the biliary tract, usually in Gallbladder.
A. Introduction
 Cholelithiasis is another name for
gallstones. Gallstones are hard, solid
lumps that form from the bile in the
gallbladder. Bile is a special liquid
chemical made by the the liver that helps
the body break down and digest fats. The
gallbladder is a storage sack for bile. One
may have just one or many gallstones that
can be as small as a piece of sand or as
large as golf balls.
 Gallstones in the gallbladder or in
the bile ducts can cause problems. Stones
can block bile ducts (flexible tubes). Bile
ducts go from the liver to the gallbladder
or from the gallbladder to the small
intestine. Gallstones are more common in
woman than in men between 20 and 50
years of age. But, as one gets older,
anyone can get gallstones.
THERE ARE THREE MAIN TYPES OF GALLSTONES:
1. Mixed stones – the most common type. They are
comprised of cholesterol and salts. Mixed stones
tend to develop in batches.
2. Cholesterol stones – comprised mainly of
cholesterol, a fat-like substance that is crucial to
many metabolic processes. Cholesterol stones can
grow to significant sizes, large enough to block bile
ducts.
3. Pigment stones – bile is greenish-brown in colour,
due to particular pigments. Gallstones made from
bile pigment are typically small but numerous.
B. Anatomy and
Physiology
 Gallbladder, muscular organ that
serves as a reservoir for bile, present in
most vertebrates. In humans, it is a pear-
shaped membranous sac on the
undersurface of the right lobe of the liver
just below the lower ribs. It is generally
about 7.5 cm (about 3 inches) long and 2.5
cm (1 inch) in diameter at its thickest part;
it has a capacity varying from 1 to 1.5 fluid
ounces.
 The function of the gallbladder is to
store bile, secreted by the liver and
transmitted from that organ via the cystic
and hepatic ducts, until it is needed in the
digestive process. The gallbladder, when
functioning normally, empties through
the biliary ducts into the duodenum to aid
digestion by promoting peristalsis and
absorption, preventing putrefaction, and
emulsifying fat.
Digestion of fat occurs mainly in the small
intestine, by pancreatic enzymes called
lipases. The purpose of bile is to help the
Lipases to Work, by emulsifying fat into
smaller droplets to increase access for the
enzymes, Enable intake of fat, including
fat-soluble vitamins: Vitamin A, D, E, and
K, rid the body of surpluses and metabolic
wastes Cholesterol and Bilirubin.
Removal of the Gallbladder?
In some cases, the gallbladder must be
removed. The surgery to remove the gallbladder
is called a cholecystectomy (pronounced co-lee-
sist-eck-toe-mee). In a cholecystectomy, the
gallbladder is removed through a 5- to 8-inch
long cut in your abdomen.
Once the gallbladder is removed, bile is
delivered directly from the liver ducts to the
part of the intestine.
B. Pathophysiology of
Cholelithiasis
 RISK FACTORS OF CHOLELITHIASIS

PREDISPOSING FACTORS: PRECIPITATING FACTORS:

Family History Diet
Female Obesity
Middle age Rapid weight loss
Use of oral contraceptives
Gallbladder, pancreatic or ileal disease
Low HDL cholesterol level
Hypertriglyceridemia
 Middle age (female > male before age 50), obesity,
infection, pregnancy, hormonal contraceptive, celiac
disease. Cirrhosis, pancreatitis, diabetes mellitus

CHOLELITHIASIS
Refers to the formation of calculi

Major constituent are cholesterol and

pigment

Cholecystectomy Gallstones in Pain Fever Nausea and Jaundice

bile duct Vomiting

Removal of the There is

gallbladder after inflammation
Bile stasis Gastric Increase
ligation of the cystic due to
irritation bilirubin
duct infection

Bile accumulates Bacterial Abnormal fat

Body will return to in the liver proliferation digestion There is restlessness
normal function and increase in RR, T,
PR and WBC values

Gallbladder Diarrhea
RECOVERY and duct
infection

Cholestatic
IF NOT TREATED
Rupture of GB Cholecystitis
Biliary
cirrhosis

Peritonitis DEATH
 C. Laboratory &
Diagnostic Examinations
Diagnostic and Laboratory procedures:

• Urinalysis

• Bilirubin test

• Hematologic test

• Radiology exam

• Hepatobiliary Ultrasound

• Ultrasound
Other tests that may help in the diagnosis of gallstones
include the following:

• Computed Tomography (CAT scan)

• Endoscopic Retrograde Cholangiopancreactography

(ERCP)

• Magentic Resonance Imaging (MRI)

• Endoscopic Ultrasound (EUS)

D. Medical Management
 Medical management may include oral bile acid
therapy. Antibiotics may be given to manage infection
along with bowel rest, intravenous hydration,
correction of electrolyte imbalances, and pain
management with follow-up care. Criteria for
outpatient treatment include that the patient is
febrile, with no evidence of obstruction on laboratory
assessment and sonogram, no underlying medical
problems, adequate pain control, and proximity to an
acute care facility if needed from home. However,
given the effectiveness of laparoscopic
cholecysterectomy, the only patients who will receive
medical dissolution are generally those who are non-
obese patients with very small cholesterol gallstones
and a functioning gallbladder.
 E. Nursing
Management
Provide nursing interventions during an acute gallbladder
attack.
• Intervene to relive pain; give prescribed analgesics
• Promote adequate rest
• Administer IV fluids, monitor intake and output
• Monitor nasogastric tube and suctioning
• Administer antibiotics if prescribed
Provide adequate nutrition
• Assess nutritional status. Encourage a high-protein, high-
carbohydrate, low-fat diet.
F. Sample Meal Plan
DATA BASE
Patient’s Name: JD
Gender: Female
Age: 32 years old
Occupation: Office Personnel
Height: 5’6
Weight: 140lbs
BMI: 23
Interpretation: Overweight
 Diet RX: 1850 kcal
CHO 300, CHON 70, FATS 40
SAMPLE MEAL PLAN POST-OPERATIVE

BREAKFAST CHO CHON FATS

1cup of oatmeal 58g 12g 7g

2tbsp condensed 21g 3g 3g

milk
1 medium size 27g 1g 0g
banana
6 fluid oz orange 19g 1g 0g
juice (no added
sugar)
 LUNCH CHO CHON FATS
1cup steamed 45g 0g 0g
rice
1cup tofu stir fry 11g 12g 9.5g
1cup watermelon 10.5 0g 0g
SNACK CHO CHON FATS
1cup macaroni 15g 10g 3.5g
soup (sopas)
1 sliced bread 11.6g 3g 0.9g
1tbsp fat-free 1.4g 2g 0.2g
cream cheese
 DINNER CHO CHON FATS
1cup steamed 45g 0g 0g
rice
1cup chicken 10g 16g 7.8g
chopsuey
1cup vegetable 11g 4g 7g
salad
1glass skim milk 12g 8g 0g
(non-fat)
TOTAL 297.5g or 71g or 38.9g or
300g 70g 40g
NOTE: Drink plenty of water & select 100% fruit juices with no sugar added.

Reference:
www.nutritionist.com
G. Nutritional Toxicity
and Deficiencies
 NUTRIENT S/S OF DEFICIENCY S/S OF TOXICITY
VITAMIN A (RETINOL) Night blindness, xerosis, Anorexia, headache,
Bitot’s spot, blurred vision, dry skin,
keratomalacia, pruritus, painful
perifollicular extremities,
hyperkeratosis, hepatomegaly,
anorexia, bone changes splenomegaly
VITAMIN D* Rickets/Osteomalacia, Hypercalcemia &
bone pain, muscle tetany, anorexia,
weakness, fatigue, nausea, vomiting,
frequent infections, constipation, polydipsia,
geriatric cognitive polyuria, renal stones,
defects, pediatric hypertension
asthma
 NUTRIENT S/S OF DEFICIENCY S/S OF TOXICITY
VITAMIN E* Loss of reflexes, gait Fatigue, headache,
disturbances (posterior delayed wound healing,
tract-spinocerebellar increased bleeding,
sx), paresis of gaze, muscle weakness
eczema, psoriasis, poor
wound healing, broken
capillaries
VITAMIN K Bruising, bleeding Arrhythmias,
gums, poor wound anaphylactic shock with
clotting large intravenous doses
IRON Fatigue, anemia, Acute: vomiting,
glossitis cyanosis, diarrhea,
shock
Chronic: hepatomegaly,
slategray skin,
cardiomyopathy,
arthropathy