CHOLELITHIASIS (gall bladder stone).pptx

Cholelithiasis is the stones in the gallbladder.
incidence : The gallbladder disease is a common health problem in India, particularly North India
The prevalence of gall stones in India ranges from 2% in South India up to 7%in North India
riskfactor
Age
Gender
Malabsorption of bile salts with GI disease
Bile fistula
Carcinoma of the gallbladder.
Obesity
Multiple pregnancies
Diabetes mellitus
Rapid weight loss (leads to rapid development of gallstones and high risk of symptomatic disease)
Treatment with high-dose estrogen (ie, in prostate cancer).
Cystic fibrosis
types
Cholesterol stones : radiating crystal like appearance
Mixed stone : most common type of stone, contains cholestrol, calcium salts of phosphates and carbonates, protein
Pigment stone : small, black or greenish black, multiple and often sludge like
Gallstones that remain in the gallbladder are usually asymptomatic.
Biliary colic can be caused by gallstones.(Steady, severe, aching pain to right hypocondrium & epigastserium, radiating to chest, back & shoulder.)
Sensation of pressure in the— Epigastrium or Right upper quadrant, begins suddenly and persists for 1 to 3 hours until the stone falls back into the gallbladder.
Vomiting
Fever
Increased WBCs
Murphy’s sign

1. CHOLELITHIASIS DEPARTMENT OF MEDICAL SURGICAL NURSING

2. At the end of the class students will be able to:--- Define cholelithiasis Enlist the etiology and risk factors of cholelithiasis Discuss the clinical manifestations and diagnostic evaluation of cholelithiasis Learning objectives

3. 4.Explain the management of cholelithiasis. 5.Discuss the complications & health education of cholelithiasis. Ct- Learning objectives

4. Cholelithiasis is the stones in the gallbladder. Definition

5. Incidence The gallbladder disease is a common health problem in India, particularly North India The prevalence of gall stones in India ranges from 2% in South India up to 7%in North India

6. Age Gender Malabsorption of bile salts with GI disease Bile fistula Carcinoma of the gallbladder. Obesity Multiple pregnancies Diabetes mellitus Risk Factors

7. Rapid weight loss (leads to rapid development of gallstones and high risk of symptomatic disease) Treatment with high-dose estrogen ( ie , in prostate cancer). Cystic fibrosis Risk Factors

8. Types

9. Type of gall stones Cholesterol stones : radiating crystal like appearance Mixed stone : most common type of stone, contains cholestrol , calcium salts of phosphates and carbonates, protein Pigment stone : small, black or greenish black, multiple and often sludge like

10. Pigmented stones Black pigment stones Brown pigment stones Most common Rarely form in gall bladder Formed in gall bladder Formed in bile duct Made of calcium, bilirubinate , phosphate, bicarbonate Related to bile stasis & infected bile Common in hemolytic disorder, cirrhosis e. coli, bacteroides Multiple, small & hard in consistency

11. Pathophysiology Decrease bile acid synthesis Increased cholesterol synthesis in the liver Super saturation of bile with cholesterol Formation of precipitates

12. Gall stones Inflammatory changes ( cholecystitis )

13. Gallstones that remain in the gallbladder are usually asymptomatic . Biliary colic can be caused by gallstones.(Steady, severe, aching pain to right hypocondrium & epigastserium , radiating to chest, back & shoulder.) Clinical Manifestations

14. Sensation of pressure in the— Epigastrium or Right upper quadrant , b egins suddenly and persists for 1 to 3 hours until the stone falls back into the gallbladder. Vomiting Fever Increased WBCs Murphy’s sign

15. Cholecystography Ultrasonography Radionuclide imaging or cholescintigraphy ERCP or PTC to visualize location of stones & extension of obstruction). Diagnostic Evaluation

16. Nutrition & Supportive management Adequate bed rest Low fat and liquid diet Give - Cooked vegitable /fruits, rice, lean meat, bread etc. avoid- fried food, pork, cream, cheese, other fats and alcohol Management

17. Pharmacological therapy Ursodeoxycholic acid Chenodeoxycholic acid To decrease the size of existing gall stone and stop formation of new stone 6-12 month therapy are required

18. Non surgical removal of stone Dissolving gallstone Stone removed by instrumentation (ERCP) Extracorporeal shock wave lithotripsy Intracorporeal lithotripsy

19. Cholecystectomy . Choledochostomy Surgical management

20. Cholangitis. Necrosis, empyema, or perforation of the gallbladder. Biliary fistula through the duodenum . Adenocarcinoma of the gallbladder. Complications

21. Obtain history and demographic data that may indicate risk factors for biliary disease. Assess patient's pain for location, description, intensity, relieving and exacerbating factors. Nursing Assessment

22. 3. Assess for signs of dehydration: dry mucous membranes, poor skin turgor , low urine output with elevated specific gravity. 4. Assess sclera and skin for jaundice. 5. Monitor temperature and white blood count for indications of infection. Nursing Assessment

23. 1.Acute Pain related to biliary colic or stone obstruction. Assess pain location, severity, and characteristics. Administer medications or monitor patient-controlled analgesia to control pain. Assist in attaining position of comfort. Ct--Nursing Assessment

24. 2.Deficient Fluid Volume related to nausea and vomiting and decreased intake . Administer I.V. fluids and electrolytes as prescribed. Administer antiemetic as prescribed to decrease nausea and vomiting. Maintain NG decompression, if needed. Ct--Nursing Assessment

25. Begin food and fluids as tolerated, after acute symptoms subside or postoperatively. Observe and record amount of biliary tube drainage, if applicable. Ct--Nursing Assessment

26. Impaired gas exchange related to the high abdominal surgical incision Impaired digestion related to altered biliary drainage Impaired nutrition less than body requirement related to altered bile secretion

27. Instruct patient in care of tubes or catheters that may be in place at discharge. Review discharge instructions for activity, diet, medications, and postoperative follow-up. Encourage follow-up as indicated. Health Education

28. Definition of cholelithiasis Etiology and risk factors of cholelithiasis Clinical manifestations and diagnostic evaluation of cholelithiasis . M anagement of cholelithiasis . C omplications & H ealth education of cholelithiasis . SUMMARY

29. BIBLIOGRAPHY Black, J.M. & Hawks, J.H. (2009). Medical-Surgical Nursing: Clinical Management for Positive Outcomes (8th ed.). Philadelphia: Elsevier/Saunders. Porth , C.M. (2009). Pathophysiology : Concepts of Altered Health States (8th ed.). Philadelphia: Lippincott Williams & Wilkins. Smeltzer , S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.

30. THANK YOU !