DEFINITION:- Gallstones are a  collection of one or more stones in the gallbladder, When the gallstones are in the gallbladder, the condition is called cholelithiasis; when they are in the bile ducts the condition is called choledocolithiasis. Affects both sexes  but twice as common in females. It is also more common in certain groups of people, such as Native

CAUSES • Alterations in bile composition.  • Failure of gallbladder to emptadequately  • Infection. . such as increased concentration of cholesterol or decrease in concentration of phopholipids or bile acids. Hemolytic disorders such as sickle cell anemia.

fat. female. NPO.Risk factors for gallstones • • • • • • • Fair. Increases with age. alcoholism. Diabetics Pregnancy . fertile (four Fs) High fat diet Obesity and family history Rapid weight loss.

Other illnesses that predispose to gallstone formation include the following: • Burns • Use of total parenteral nutrition • Paralysis( Impaired motility can predispose to stones.) • ICU care • Major trauma .

• Diseases that increase RBC destruction will cause these. • Formation of each types is caused by crystallization of bile. • Cholesterol stones most common. • Pigment stones (20%) are from calcium bilirubinate. phospholipids in a fine balance.PATHOPHYSIOLOGY • Bile consists of lethicin. cholesterol. • There are three types of stones. It may be a first step in stones. • Sludge is crystals without stones. Also in cirrhotic patients. . mixed. parasitic infections. bile acids. pigment. or be independent of it.

C LINICAL MANIFESTATIONS – Recurrent Abdominal pain in the right upper or middle upper abdomen: – May spread to the back or below the right shoulder blade – May be made worse by fatty or greasy foods – Occurs within minutes of a meal – Fever /chills occur in acute – Yellowing of skin and whites of the eyes (jaundice) .

– Colic and crampying pain ocures when stone lodges in the common bile duct. – Positive murph’s sign .

Ultrasound scanning is the best method for diagnosing gallstones in the gallbladder. . cholecystography.DIAGNOSTIC AND LABORATORY TESTS • Diagnostic tests may include laboratory studies such as • Blood count and blood chemistry • CT scan. ultrasound. and X-rays of the gallbladder.

• Antibiotics . • Strong antipains such as Demerol 2575mg IV/IM q3 • Antiemetics (phenergan. compazine). (20mg IM q46).MEDICATIONS • Anticholinergics such as Bentyl (dicyclomine hydrochloride) to decrease GB and biliary tree tone.

• Cholecystectomy can be performed after the first 24-48h or after the inflammation has subsided.• SURGERY can be done with an open or laparoscopic technique. • Oral dissolution therapy using ursodeoxycholic acid to dissolve cholesterol (8 to 10 mg/kg/day Po dissolves 80% of tiny stones ) • Lithotripsy( using shock wave to disintegrate the stones) • Endoscopic retrograde cholangiopancreatography .

diagnostic and therapuetic procedures and their expected out comes. . pain free • Encourage obese individual to lose weight. • Provide comfort measures. • Provide diet restriction (review of food high in fat) keep client NPO and IV fluid as ordered.NURSING MANAGEMENT • Give information about the disease process.

.PRE -OPERATIVE CARE • Maintaning hydration with appropriate fluid. • Prevent injury & give vitamin K may be given before surgery. • Prepare blood for transfusion.

. • Maintain pattent IV and Administration of IV antibiotic • Control pain (give analgesics prior to post operative exercise. • Keep wound incision clean and dry.POST OPERATIVE NURSING CARE • Monitor vital signs.

• Assess the skin for inflammation secondary to bile likage. coughing and turning position to prevent pulmonary infection. • Assess bile drainage and record the amount. .tube placement. • Place fowler’s position to clients with T.• Keep client comfortable to promote deep breathing.

sepsis Pancreatitis Perforation (10%) Hepatitis Choledocholithiasis .COMPLICATIONS • • • • • •   Cholangitis.

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