cholelithiasis-151102200045-lva1-app6891.pptx

cholithiasis

1. BEDSIDE CLINIC CHOLICYSTECTOMY JINSI .P.G 2 ND YEAR MSC NURSING

2. BEDSIDE CLINIC A bedside clinic is a teaching-learning method commonly used in medical, nursing, and allied health education. It involves direct interaction between educators (such as instructors, clinical tutors, or senior clinicians) and students, with the patient physically present during the teaching session .

3. CHOLELITHIASIS Cholelithiasis refers to the formation of gallstones in the gallbladder, which are solid particles that develop from bile components. The gallbladder is a small organ beneath the liver that stores bile, a digestive fluid. Gallstones can vary in size and may cause symptoms depending on their size, number, and location .

4. ETIOLOGICAL FACTORS Excess cholesterol : When bile contains too much cholesterol, it may crystallize and form stones . Excess bilirubin : Conditions like liver disease or certain infections can cause higher levels of bilirubin , leading to gallstone formation . Poor gallbladder emptying : If the gallbladder doesn't empty completely or often enough, bile may concentrate, encouraging stone formation.

5. Types of Gall stones Cholesterol stones – Radiating crystal like appearance Mixed stones - Most common type of stones ; contains cholesterol, calcium salts of phosphates and carbonates, palmitate ,proteins and are multiple faceted. Pigment stones - small, black or greenish black, multiple and often sludge like stones

6. Clinical features Gallstones may not always cause symptoms. When they do, it's referred to as symptomatic cholelithiasis or biliary colic, common symptoms include Sudden , intense pain in the upper right abdomen or center of the abdomen.Pain that may radiate to the right shoulder or back . Nausea or vomiting . Indigestion or bloating . Jaundice (if a stone blocks the bile duct Murphy sign

7. MURPHY’s SIGN Patient experience pain with catch of breath when inflamed gall bladder strikes palpating fingers on inspiration

8. Complications of Gall stones In Gall Bladder- Acute cholecystitis Chronic cholecystitis Empyema of gall bladder Perforation – leading to biliary peritonitis Gangrene of gall bladder C arcinoma In Bile duct- Obstructive jaundice Cholangitis A cute pancreatiti s In Intestine- Acute intestinal obstruction

9. DIAGNOSIS Ultrasound: Most common imaging test . CT scan or MRI : To identify stones and complications . ERCP (Endoscopic Retrograde Cholangiopancreatography ): Combines imaging and treatment.

10. MANGEMENT

11. Surgical therapy Laparoscopic cholecystectomy is ideal. Open cholecystectomy is done if patient unfit for laparoscopy through Right Sub-costal(KOCHERS’s) incision.

12. Nursing management NURSING ASSESSMENT • Assess the general condition of patient. • Monitor vital signs. • Monitor the degree of pain level. • Maintain the laboratory finding of patient • Monitor skin turgidity and hydration level. • Check the nutrition status of patient

13. Nursing management NURSING DIAGNOSIS Acute Pain related to inflammatory process as evidenced by patient’s facial expression Deficient Fluid Volume related to vomiting as evidenced by decreased skin turgor Risk of infection related to altered body mechanism as evidenced by increased body temperature Imbalanced nutritional status less then body requirement related to poor dietary pattern as evidenced by client verbalization Anxiety related to progress of disease condition as evidenced by patient’s verbalization Deficit knowledge related to treatment of disease condition as evidenced by asking questions about medical or surgical procedure of disease condition

14. Recent updates on cholecystectomy , particularly LAPAROSCOPIC AND ROBOTIC-ASSISTED techniques , highlight ongoing improvements in safety and recovery outcomes . Laparoscopic Cholecystectomy (LC) remains the gold standard for gallbladder removal. However, new strategies are being explored to optimize post-operative recovery, such as using lower-pressure pneumoperitoneum during surgery and employing various regional anesthesia techniques (e.g., port-site infiltration, intraperitoneal local anesthetic instillation). These interventions aim to reduce post-operative pain and the need for opioid use ​ Robotic-Assisted Cholecystectomy has seen increased adoption due to its potential to reduce complications. Studies suggest that robotic surgery leads to fewer severe complications ( Clavien-Dindo grade 3 or 4), fewer conversions to open surgery, and shorter hospital stays. Despite these benefits, the use of robotic assistance still requires higher surgical expertise and is generally more costly​PHYSICIAN'S WEEKLY . Outcomes for Elderly Patients : Some research suggests that while laparoscopic cholecystectomy remains safe for older adults, the risk of complications might increase with age. In these cases, a more conservative approach, possibly delaying surgery until complications arise, might be considered​ESRA.

15. CONCLUSION In conclusion, Mr. N.K. Chacko underwent a successful cholecystectomy for the management of cholelithiasis and associated complications. This surgical intervention effectively addressed his symptoms and improved his quality of life . Patient education regarding lifestyle adjustments, especially adhering to a low-fat diet and recognizing early signs of complications, is crucial in preventing recurrence or related issues. Regular follow-ups are essential to monitor his progress and address any long-term concerns . Through this bedside clinic I have highlighted the importance of a multidisciplinary approach in providing optimal care and achieving the best outcomes for patients like Mr. Chacko .