Gallbladder and

Bile Duct
Disorders
Biliary System
 Composed of:
Gallbladder
Bile ducts
Cystic duct
 Cystic duct: from gallbladder
joins with hepatic duct from
liver to form common bile duct
 Function of the biliary system:
to transport bile secreted by
liver from gallbladder where it
is stored into duodenum
Possible Disorders

 Gallstones
 Inflammatory conditions
 Infections
 Tumours
 Congenital malformations
Biliary Tract Terminology
 Chole-: pertaining to bile
 Cholangitis: inflammation of the bile
duct
 Cholecyst-: pertaining to the
gallbladder
 Cholecystectomy: removal of the
gallbladder
 Cholecystitis: inflammation of the
gallbladder
 Choledocholithiasis: Stones in common
bile duct
 Cholelithiasis: presence of gallstones
Cholelithiasis/Gallstones
 Gallstones occur anywhere in the
biliary tree but most frequently in
the gallbladder
 Gallstones are precipitates
components of bile
 Bile: cholesterol, bilirubin, bile
salts, calcium and protein
 80% of gallstones are composed of
cholesterol
Predisposing Conditions

1. Metabolic Disorders:
Excessive breakdown of RBC’s
produces pigment stones
Dietary -copious cholesterol intake
Excess sucrose intake has been found
to decrease bile salt formation
2. Pregnancy: blood cholesterol rises
during pregnancy
Multiple pregnancies cause the
problem
3. Infection: any organism can be
responsible but commonly salmonella
Inflammatory reaction may cause
physical disturbance in bile and
throw cholesterol, bile pigments
and calcium carbonate out of
solution. Crystals form multiple
stones.
Stasis tends to allow stones to
increase in size
Clinical Features

 Fewer than half the people

with gallstones report distress
 Pain (right upper quadrant pain
or biliary colic)
 Jaundice-if stone lodged in the
common bile duct.
 Ifthe stone blocks the cystic
duct the person may have signs
and symptoms of acute
cholecystitis
Biliary Colic
 Refers to pain associated when stone
blocks the flow of bile
 Starts in upper midline area, increases
in intensity over several hours, then
centers in right upper.
 Person restless and changes position
frequently in attempt to get rid of the
pain
 Pain may radiate to area below
right shoulder blade
 Pain frequently follows a fatty
meal-1/2 hour or the middle of
the night
 Accompanied by nausea and
vomiting
 Lasts minutes to hours
Acute Cholecystitis
 Complication of cholelithiasis
 Acute inflammation most
commonly follows stone in the
cystic duct
 Which in turn causes
gallbladder distension leading
to:
Decreased blood supply
Decreased lymph drainage
Proliferation of bacteria
Signs and Symptoms

 Fatty food intolerance

 Belching that leaves a sour taste
 Flatulence and bloating
 Dyspepsia: imperfect digestion, vague
abdominal discomfort, a sense of
fullness after eating, heart burn,
nausea, vomiting, loss of appetite
 Signs appear irregularly and in
different patterns, symptoms
increase with stress
 Tenderness and muscle
guarding on palpation in RUQ,
 Pyrexia mild 38-38.5 and mild
leukocytosis
Diagnostic Studies
 Ultrasound: detects gallstones
quickly and accurately
 Flat plate of the abdomen:
identifies calcifies but not
cholesterol stones
 Liver function tests and serum
amylase may be ordered to
evaluate the functional effects
of obstruction
 Endoscopic retrograde
cholangiopancreatography:
identify or treat stone
obstruction in the ducts
Treatment
 See current EDLIZ in surgical section
of treatment
 Surgery:
1. Cholecystectomy: removal of gall
bladder
2. Choecystectomy with choedochostomy:
exploration and drainage of common
bile duct
Conservative Management
 Analgesia for pain: pethidine
drug of choice. Morphine
contraindicated because it may
increase spasm of sphincter of
oddi
 Phenobarbital may be given for
sedation and to relax smooth
muscle
 Eliminate infection: usually
broad spectrum antibiotics.
Monitor temperature carefully
and report elevations
immediately
 Low fat diet
 Small frequent meals and
restrict alcohol
 Ifvomiting NG to suction to relieve
distention and vomiting
 Assess Intake and output
 Assess for dehydration
 Assess abdomen
 Give and monitor prescribed IV
solutions
 Check electrolytes as ordered and
report abnormal results
 Rest
Nursing Diagnoses

 Painrelated to spasms of the

gallbladder
 Riskfor fluid volume deficit
related to nausea and vomiting
 Riskfor infection related to
stasis of bile in the gallbladder
Preoperative preparation

 Investigations:FBC, Serum
bilirubin and prothrombin time if
jaundice present: vitamin K may
be given
 Diet:
reduced fat, increased
glucose fluids, protein intake
normal, Vitamin C to aid healing
 Ambulation encouraged
 Deep breathing and coughing taught
since pulmonary complications
common after surgery due to closeness
of liver to diaphragm and patient’s
desire to limit pain by shallow
breathing
 Observe skin, stools and urine for
colour
 Pruritis:calamine lotion,
antihistamine drugs if severe
 Nasogastric tube if vomiting
Post-operative Care

 Position:Elevate to semi-upright
to aid chest expansion and
relieve tension on suture line
 Fluids:
sips of water if tolerated
within a few hours. IV infusion
continues if vomiting continues
 Diet:as tolerated once bowel sounds
heard. Light diet graduating to normal
usually within a week. Patient may
prefer low fat initially
 Drugs:Pain meds. Antibiotics
especially in case of cholecystitis.
Vitamin K until the prothrombin time
normal
Dressings: Main wound left undisturbed
until sutures remove in 7-10 days, unless
evidence of infection or copious drainage
Deep breathing and coughing
immediately after surgery. Up first day
post op.
Drain tubes:
Drain in gallbladder bed: draining
sero-sanquinous drainage into
drainage bag. Change dressing
around the drain as needed.
Nursing Diagnoses
 Risk for fluid volume deficit related to
NPO status, nausea and vomiting,
haemorrhage
 Pain related to surgical procedure done
 Risk for infection related to surgical
incision and presence of tubes or
dislodgement of the t-tube
 Riskfor ineffective breathing
pattern related to painful
surgical incision, decreased
diaphragmatic movement or
anxiety
Assess for and Prevent
Complications
 Haemorrhage due to deficiency of
prothrombin
 Biliary obstruction due to accidental
damage, haematoma, abscess
 Liver failure
 Persistent biliary fistula when drain
tube removed due to obstruction in
common bile duct
 Peritonitisdue to leakage of
bile with possible abscess
 Pulmonary complications
 Gallstone ileus
Chronic Cholecystitis
 Gallbladder thickened and rigid
and functions poorly
 Results from frequent attacks
of cholecystitis, presence of
calculi or chronic irritation
 Treatment: as for acute
cholecystitis
Carcinoma of Biliary System

 Associated with acute infection

and gall stones, may spread
into liver and duodenum or
invades and obstructs common
bile duct
Rare, incidence is declining
due to prompt surgical
intervention for gallbladder
disease