CHOLECYSTECTOM

YPRESENTED BY:

PILORIN, PINGEN, PINTO, PIRA,

PRADES
Introduction
Part 01
History
Cholecystitis is an inflammation of the
gallbladder, a pear-shaped organ, which holds
digestive fluid that is released into the small
intestine. This condition occurs when there is a
buildup of bile causing an inflamed gall
bladder.
Etiology/Causes
• Gallstones. Hard particles that develop in the
gallbladder (gallstones). Gallstones can block the tube
(cystic duct) through which bile flows when it leaves
the gallbladder. Bile builds up, causing inflammation.
• Tumor. A tumor may prevent bile from draining out of
your gallbladder properly, causing bile buildup that can
lead to cholecystitis.
Etiology/Causes
• Bile duct blockage. Kinking or scarring of the bile
ducts can cause blockages that lead to cholecystitis.
• Infection. AIDS and certain viral infections can trigger
gallbladder inflammation.
• Blood vessel problems. A very severe illness can damage
blood vessels and decrease blood flow to the gallbladder,
leading to cholecystitis.
Anatomy & Physiology
Gallbladder.
The gallbladder is a pear-shaped, hollow structure located under the liver
and on the right side of the abdomen. Its primary function is to store and
concentrate bile, a yellow-brown digestive enzyme produced by the liver.

Cystic Duct.
The cystic duct connects the top of the gallbladder’s neck to the common
hepatic duct. It then joins the common bile duct, which meets pancreatic
duct before it empties into the duodenum.
Anatomy & Physiology
Right Hepatic Duct.
The right hepatic duct drains bile from the right half of the liver.

Left Hepatic Duct.

The left hepatic duct drains bile from the left half of the liver.

Common Hepatic Duct.

The common hepatic duct is formed by the junction of the right and left
hepatic ducts.
Anatomy & Physiology
Common Bile Duct.
The common bile duct is a small, tube-like structure
formed where the common hepatic duct and the cystic
duct join. Its physiological role is to carry bile from
the gallbladder and empty it into the upper part of the
small intestine (the duodenum).
Procedure
CHOLECYSTECTOMY
This is a surgical intervention for
cholecystitis. This procedure is done by
removing the inflamed or obstructed gall
bladder.
Procedure
CHOLECYSTECTOMY
• Open (traditional) method. In this method,
1 cut (incision) about 4 to 6 inches long is
made in the upper right-hand side of your
belly.
• Laparoscopic method. This method uses 3
to 4 very small incisions.
Type of Anesthesia
GENERAL ANESTHESIA
Cholecystectomy is conventionally done
under general anaesthesia (GA) and may be
associated with postoperative pain and
nausea and vomiting (PONV).
Type of Anesthesia
SPINAL ANESTHESIA
Spinal anesthesia (SA) is a commonly used
anaesthetic technique that has a very good
safety profile. SA has several advantages
over GA.
Positioning
SUPINE POSITION
The patient should be in the supine
position. The patient’s arms are abducted
or tucked comfortably at the sides.
 Clinical
Manifestation
Part 02
Acute cholecystitis comes on suddenly
and causes severe, ongoing pain. More
than 95% of people with acute
cholecystitis have gallstones. Pain begins
in your mid to upper right abdomen and
may spread to your right shoulder blade
or back. Pain is strongest 15 to 20 minutes
after eating and it continues. Pain that
remains severe is considered a medical
emergency.
Most Common Presenting Symptom:
UPPER ABDOMINAL PAIN
The following characteristics may be reported:
• Signs of peritoneal irritation may be present,
and the pain may radiate to the right shoulder
or scapula
• Pain frequently begins in the epigastric region
and then localizes to the right upper quadrant
(RUQ)
• Pain may initially be colicky but almost always
becomes constant
• Nausea and vomiting are generally present,
and fever may be noted

Chronic cholecystitis means
you’ve had repeated attacks of
inflammation and pain. Pain tends
to be less severe and doesn’t last
as long as acute cholecystitis. The
repeated attacks are usually caused
by gallstones blocking the cystic
duct intermittently.
Other signs and symptoms:
• Tenderness in your abdomen when it's touched.
• Nausea and bloating.
• Vomiting.
• Fever above 100.4 F (38 C). Fever may not be
present in older adults and usually doesn’t occur in
people with chronic cholecystitis.
• Chills.
• Abdominal pain that gets worse when taking a deep
breath.
• Abdominal pain and cramping after eating –
especially fatty foods.
• Jaundice (a yellowing of skin and eyes).
 Nursing
Management
and
Responsibility
Part 03
INTRAOPERATIVE

• assessment of the patient’s physiologic and psychologic

status
• promoting safety and privacy,
• preventing wound infection, and
• promoting healing
INTRAOPERATIVE
Role of the Circulating Nurse:
• Coordinating patient care before, during, and after the surgical procedure
• Providing emotional support to the patient and assisting the anesthesiologist
during the initiation of anesthesia
• Ensuring patient safety, positioning and monitoring the patient, and enforcing
policies and procedures throughout the surgery – including a “time out”
INTRAOPERATIVE
Role of the Circulating Nurse:
• Maintaining sterile technique while providing supplies and equipment for the sterile team
• Documenting all nursing care during the intraoperative period and making sure that surgical
specimens are labeled correctly and placed in the appropriate media
• Recognizing and resolving environmental hazards that involve the patient or surgical team, including
protecting the patient from electrical hazards
• Ensuring with the scrub tech that all sponge, instrument, and sharps counts are completed and
documented
• And communicating relevant information to family members and other healthcare workers outside the
OR
INTRAOPERATIVE
Role of the Scrub Nurse:
• Scrubbing for surgery.
• Setting up sterile tables.
• Preparing sutures and special equipments.
• Assists the surgeon and assistant during the surgical procedure by anticipating the
required instruments, sponges, drains and other equipment.
• Keeps track of the time the patient is under anesthesia and the time the wound is open.
• Checks equipments and materials such as needles, sponges and instruments as the
surgical
INTRAOPERATIVE
Patient Skin Preparation
• The intraoperative circulating nurse will be involved in hair
removal from the surgical site (when necessary) and cleaning
the incision site with skin antiseptic, using the manufacturer’s
recommendation for contact and drying time.
INTRAOPERATIVE
“Time-Out”
• Once the patient is prepped and draped in the OR, the
circulating nurse usually initiates the “time-out” that takes
place between the entire surgical team. The time-out is a verbal
agreement that includes, at a minimum, the following: correct
patient identity, correct site, and correct procedure to be
performed.
INTRAOPERATIVE
Anesthesia
• The circulating RN plays a role in assisting the anesthesiologist
with anesthesia. The OR nurse needs to know the various types
of anesthetics used in surgery, methods of administration, and
the potential side effects and complications, in order to assist
the anesthesia team.
INTRAOPERATIVE
Thermoregulatory Response
• The intraoperative nurse also needs to be aware of the
thermoregulatory response of the patient during surgery. The
intraoperative nurse needs to take measures to keep the patient
warm—covering exposed areas as much as possible with warmed
blankets and using warmed IV solutions will help prevent
hypothermia.
INTRAOPERATIVE
Patient’s Psychosocial Needs
• Surgery is a stressful experience for anyone, and
providing explanations of procedures and events helps
promote a sense of security and effective coping for the
patient.
POSTOPERATIVE
• Provide routine postoperative recovery care.
• Monitoring: Healthcare providers may check for pulses on patient’s arms or
wrists. This helps healthcare providers learn if patient have problems with
blood flow after surgery.
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed
on your skin record your heart's electrical activity.
• Intake and output may be measured. Healthcare providers will keep track
of the amount of liquid that the patient is getting. They also may need to
know how much the patient is urinating.
• A pulse oximeter is a device that measures the amount of oxygen in
patient’s blood
POSTOPERATIVE
3. Tubes and drains:
a. Nasogastric (NG) tube: Food and medicine may be given through an NG
tube if the patient cannot take anything by mouth. The tube may instead be attached
to suction if healthcare providers need to keep stomach empty.
b. Drains: The drains are taken out when the incision stops draining.
c. T-tube: This tube drains bile onto a bandage or into a small bag. The T-tube is
removed when the amount of bile draining decreases. Expect 300 to 500 ml of thick,
blood-tinged, bright yellow to dark green bile drainage the first 24 hours after
surgery. Report drainage greater than 500 ml/day. After about 4 days, the amount will
be less than 200 ml/day.
POSTOPERATIVE
4. Assist to chair at bedside as allowed. Early mobilization promotes
lung ventilation and circulation, reducing the potential for
postoperative complications. Take deep breaths and cough 10 times
each hour. This will decrease your risk for a lung infection.

5. Advance oral intake from ice chips to regular diet as tolerated. Oral
intake can be rapidly resumed due to minimal disruption of the
gastrointestinal tract during surgery.
POSTOPERATIVE
6. Provide and reinforce teaching: pain management, incision care, activity
level, postoperative follow-up appointments. With early discharge, the
client and family assume responsibility for the majority of postoperative
care. A clear understanding of this care and expected needs reduces anxiety
and the risk of postoperative complications.

7. Initiate follow-up contract 24 to 48 hours after discharge to evaluate adequacy

of pain control, incision management, and discharge understanding. Contact
following discharge provides an opportunity to evaluate care and reinforce
teaching.
Instruments
Part 04
TOWELCLIPS
SPONGE HOLDING FORCEPS
KNIFE HANDLE
STRAIGHT MAYO SCISSOR
CURVED MAYO SCISSOR
ARTERY FORCEPS
CAUTERY LEAD
ALLIS TISSUE FORCEPS
NEEDLE HOLDER
DISSECTING FORCEP PLAIN
DISSECTING FORCEP TOOTHED
BLAKE GALL STONE FORCEP
RECTANGLE CHOLE FORCEP
SUCTION TUBE WITH NOZLE
CZERNY RETRACTOR
DEAVER RETRACTOR
KIDNEY TRAY