GALLBLADDER

 The gallbladder is a small

pouch that sits just under
the liver. The gallbladder
stores bile produced by the
liver.
 After meals, the
gallbladder is empty and
flat, like a deflated balloon.
 Before a meal, the
gallbladder may be full of
bile and about the size of a
small pear.
 In response to signals, the
gallbladder squeezes stored
bile into the small intestine
through a series of tubes
called ducts. Bile helps digest
fats, but the gallbladder itself
is not essential.
 Removing the gallbladder in
an otherwise healthy individual
typically causes no observable
problems with health or
digestion yet there may be a
small risk of diarrhea and fat
malabsorption.
Gallbladder Conditions
Gallstones (cholelithiasis): For unclear
reasons, substances in bile can
crystallize in the gallbladder, forming
gallstones. Common and usually
harmless, gallstones can sometimes
cause pain, nausea, or inflammation.
Cholecystitis: Infection of the
gallbladder, often due to a gallstone in
the gallbladder. Cholecystitis causes
severe pain and fever, and can require
surgery when infection continues or
recurs.
Types:

1. ACALCULOUS: inspissation of bile

2. CALCULOUS: obstruction of the duct
(cholesterol pigment) (STONE)
PATHOPHYSIOLOGY

PREDISPOSING FACTORS: PRECIPITATING FACTORS:

6F
DIET: Increased cholesterol
Intake

Female,
Fat, Forty, Abnormal Metabolism of Cholesterol and Bile Salts
Fair
Complexio
Impaired Gallbladder Motility
n, Fertile,
Frequent
Weight Biliary Stasis
Changes
Gallstone Formation/Cholelithiasis

Obstruction of cystic duct, then Common bile duct/Choledocholithiasis

Inflammation of the gallbladder

Trapped bile irritates the Gallbladder wall

 Infection of the Gallbladder

Episodes of cystic duct obstruction Acute Cholecystitis

Gallbladder becomes fibrotic

Decreased motility and deficient absorption

Chronic Cholecystitis
  Pain. It usually occurs in the mid to 
upper-right section of your abdomen.
(BOA’S SIGN,MURPHY’S SIGN)
 Nausea or vomiting. Chronic gallbladder
disease may cause digestive problems, such as 
acid reflux and gas.
 Fever or chills. This may be a sign of infection
SIGNS AND and should be treated immediately.
SYMPTOMS  Chronic diarrhea. Defined as 
more than four bowel movements per day for at
least 3 months.
 Jaundice. Marked by yellow-tinted skin, it may
be a sign of a block or stone in the 
common bile duct.
 Stool abnormality. Lighter-colored stools is a
possible sign of a common bile duct block.
 Discolored urine. Dark urine is a potential sign
of a common bile duct block.
Gallbladder Tests

 Abdominal ultrasound: a noninvasive test in which a probe on the skin bounces high-frequency
sound waves off structures in the belly. Ultrasound is an excellent test for gallstones and to check
the gallbladder wall.
 HIDA scan (cholescintigraphy): In this nuclear medicine test, radioactive dye is injected
intravenously and is secreted into the bile. Cholecystitis is likely if the scan shows bile doesn’t
make it from the liver into the gallbladder.
 Endoscopic retrograde cholangiopancreatography (ERCP): Using a flexible tube inserted through
the mouth, through the stomach, and into the small intestine, a doctor can see through the tube
and inject dye into the bile system ducts. Tiny surgical tools can be used to treat some gallstone
conditions during ERCP.
 Magnetic resonance cholangiopancreatography (MRCP): An MRI scanner provides high-resolution
images of the bile ducts, pancreas, and gallbladder. MRCP images help guide further tests and
treatments.
 Endoscopic ultrasound: A tiny ultrasound probe on the end of a flexible tube is inserted through the
mouth to the intestines. Endoscopic ultrasound can help detect choledocholithiasis and gallstone
pancreatitis.
 Abdominal X-ray: Although they may be used to look for other problems in the abdomen, X-rays
generally cannot diagnose gallbladder disease. However, X-rays may be able to detect gallstones.
Gallbladder Treatments
 Gallbladder surgery (cholecystectomy): A surgeon removes the
gallbladder, using either laparoscopy (several small cuts) or
laparotomy (traditional “open” surgery with a larger incision).
 Antibiotics: Infection may be present during cholecystitis. Though
antibiotics don’t typically cure cholecystitis, they can prevent an
infection from spreading.
 Ursodeoxycholic acid: In people with problems from gallstones who
are not good candidates for surgery, this oral medicine is an option.
Ursodeoxycholic acid may help dissolve small cholesterol
gallstones and reduce symptoms. Another oral solution is called
chenodiol.
 Extracorporeal shock-wave lithotripsy: High-energy shockwaves
are projected from a machine through the abdominal wall, breaking
up gallstones. Lithotripsy works best if only a few small gallstones
are present.
 Contact solvent dissolution: A needle is inserted through the skin
into the gallbladder, and chemicals are injected that dissolve
gallstones. This technique is rarely used.
Nursing Diagnosis
 Pain, acute
May be related to
 Biological injuring agents: obstruction/ductal spasm, inflammatory process, tissue ischemia/necrosis
Possibly evidenced by
 Reports of pain, biliary colic (waves of pain)
 Facial mask of pain; guarding behavior
 Autonomic responses (changes in BP, pulse)
 Self-focusing; narrowed focus

Nursing Interventions
 Observe and document location, severity (0–10 scale), and character of pain (steady, intermittent,
colicky).
 Rationale: Assists in differentiating cause of pain, and provides information about disease
progression and resolution, development of complications, and effectiveness of interventions.
 Note response to medication, and report to physician if pain is not being relieved.
 Rationale: Severe pain not relieved by routine measures may indicate developing complications or
need for further intervention.
 Promote bedrest, allowing patient to assume position of comfort.
 Rationale: Bedrest in low-Fowler’s position reduces intra-abdominal pressure; however, patient will
naturally assume least painful position.
 Encourage use of relaxation techniques. Provide
diversional activities.
 Rationale: Promotes rest, redirects attention, may
enhance coping.
 Make time to listen to and maintain frequent contact with
patient.
 Rationale: Helpful in alleviating anxiety and refocusing
attention, which can relieve pain.
 Maintain NPO status, insert and/or maintain NG suction as
indicated.
 Rationale: Removes gastric secretions that stimulate
release of cholecystokinin and gallbladder
contractions.
Nursing Diagnosis
Nutrition: Less Than Body Requirements, Risk for Imbalanced
Risk factors may include
 Self-imposed or prescribed dietary restrictions, nausea/vomiting,
dyspepsia, pain
 Loss of nutrients; impaired fat digestion due to obstruction of bile
flow
Nursing Interventions
 Calculate caloric intake. Keep comments about appetite to a
minimum.
 Rationale: Identifies nutritional deficiencies and/or needs.
Focusing on problem creates a negative atmosphere and
may interfere with intake.
 Weigh as indicated.
 Rationale: Monitors effectiveness of dietary plan.
 Consult with patient about likes and dislikes, foods that cause
distress, and preferred meal schedule.
 Rationale: Involving patient in planning enables patient to
have a sense of control and encourages eating.
 Provide a pleasant atmosphere at mealtime; remove noxious
stimuli.
 Rationale: Useful in promoting appetite/reducing nausea.
 Assess for abdominal distension, frequent belching, guarding,
reluctance to move.
 Rationale: Nonverbal signs of discomfort associated with
impaired digestion, gas pain.
 Ambulate and increase activity as tolerated.
 Rationale: Helpful in expulsion of flatus, reduction of
abdominal distension. Contributes to overall recovery and
sense of well-being and decreases possibility of
secondary problems related to immobility (pneumonia,
thrombophlebitis).
 Consult with dietitian or nutritional support team as indicated.
 Rationale: Useful in establishing individual nutritional
needs and most appropriate route.
 Begin low-fat liquid diet after NG tube is removed.
 Rationale: Limiting fat content reduces stimulation of
gallbladder and pain associated with incomplete fat
digestion and is helpful in preventing recurrence.
Nursing Diagnosis
 Deficient Knowledge
 May be related to
 Lack of knowledge/recall
 Information misinterpretation
 Unfamiliarity with information resources
Desired Outcomes
 Verbalize understanding of disease process, prognosis,
potential complications.
 Verbalize understanding of therapeutic needs.
 Initiate necessary lifestyle changes and participate in
treatment regimen.
Nursing Interventions
 Explain reasons for test procedures and preparations as
needed.
 Rationale: Information can decrease anxiety, thereby
reducing sympathetic stimulation.
 Review disease process and prognosis. Discuss
hospitalization and prospective treatment as indicated.
Encourage questions, expression of concern.
  Rationale: Provides knowledge base from which patient can make informed
choices. Effective communication and support at this time can diminish anxiety
and promote healing.
 Review drug regimen, possible side effects.
 Rationale: Gallstones often recur, necessitating long-term therapy.
Development of diarrhea or cramps during chenodiol therapy may be dose-
related or correctable. 
 Discuss weight reduction programs if indicated
 Rationale: Obesity is a risk factor associated with cholecystitis, and weight loss
is beneficial in medical management of chronic condition.
 Instruct patient to avoid food/fluids high in fats (pork, gravies, nuts, fried foods,
butter, whole milk, ice cream), gas producers (cabbage, beans, onions, carbonated
beverages), or gastric irritants ( spicy foods, caffeine, citrus).
 Rationale: Limits or prevents recurrence of gallbladder attacks.
 Review signs and symptoms requiring medical intervention: recurrent fever;
persistent nausea and vomiting, or pain; jaundice of skin or eyes, itching; dark urine;
clay-colored stools; blood in urine, stools, vomitus; or bleeding from mucous
membranes.
 Rationale: Indicative of progression of disease process and development of
complications requiring further intervention.
Nurse Nysell’s
1.Which best describes the role of the gallbladder? 

A. Similar to the appendix, the gallbladder has little known physiologic function.
Because of this, it can be removed without any consequence to the patient. 

B. The gallbladder synthesizes bile. It also stores and secretes bile, a yellow-
green substance needed to digest lipids. 

C. The gallbladder makes cholecystokinin (CCK). CCK stimulates the Vagus

nerve and facilitates movement of bile through the intestines. 

D. The gallbladder stores, concentrates, and secretes bile. Its structure allows for
easy absorption of fluid and electrolytes, leaving behind highly concentrated bile
that is needed for fat digestion.
2. Which of the following is NOT considered a
differential diagnosis for acute cholecystitis?

A. Acute pancreatitis

B. Irritable bowel syndrome

C. Peptic ulcer disease

D. Appendicitis
3. Symptoms of gallbladder disease often resemble those of
other GI diseases. Which group of symptoms suggest
cholecystitis?
A. Pain in the right lower quadrant, leukocytosis, low-grade fever

B. Pain in the right upper quadrant, low-grade fever, bloody stools

C. Pain in the right upper quadrant that radiates to the right shoulder
or back, positive Murphy’s sign, bloody stools

D. Pain in the right upper quadrant that radiates to the right shoulder
or back, positive Murphy’s sign, low-grade fever
4. G.B. is concerned about the need for additional medical workup. She
asks, “Why do I need to have a CT scan. Is there not a simple blood test
that could confirm my diagnosis?” What is the most appropriate way to
respond to Mrs. G.B.’s question?
A. Blood tests are not appropriate in this situation given your symptoms.

B. Yes, that is a great suggestion. Thank you for being an advocate for yourself!

C. While some blood tests may be able to help with diagnosis, there is not a
definitive blood test for detecting cholecystitis. Imaging provided by a CT will
enable a more accurate diagnosis because the medical team can evaluate for the
presence of gallbladder inflammation and stones which can help differentiate
from other possible causes of your symptoms.

D. We must do a CT scan, HIDA scan, and blood work to confirm your diagnosis.
5. G.B.’s family history reflects a maternal history of
gallbladder disease. True or false: family history is the ONLY
risk factor for cholecystitis.
A. True
B. False