Cholelithiasis (Gall stone)

A hardened deposit within the fluid in the gallbladder, a small organ under the liver.

1. Mr.Jagdish Sambad
M.Sc.N-MSN
Cholelithiasis

2. Introduction
Calculousdiseaseofthebiliarytractisthegeneral
term applied to diseases of
thegallbladderandbiliarytreethatareadirect
resultofgallstones.Gallstonediseaseisthemost
commondisorderaffectingthebiliarysystem.The
trueprevalencerateisdifficulttodetermine
because calculousdiseasemay often
beasymptomatic.

3. Definition
“Cholelithiasisisthepresenceofstonesinthe
gallbladder-chole-means"gallbladder",lithia
meaning"stone",and-sismeans"process".
Cholelithiasisistheformationofgallstones,which
arecomposedofcholesterol,calciumsalts,and
bilepigments.

9. Causes & Risk Factors
Fair, fat, female, fertile of course.
High fat diet
Obesity
Rapid weight loss
Increases with age
alcoholism.
Diabetics have more complications
Lack of Physical Activity
Family History of Gallstones

11. signs and symptoms
Therearethreestagesofgallstones:asymptomatic,
symptomatic,andwithcomplications.Sixtyto80%of
gallstonesareasymptomatic,meaningthattheycause
nosymptoms.
Ifgallstonesbecomesymptomatic,thepersonmay
havethefollowingsymptoms:
afeelingofabdominalbloatingandexcessivegas
nauseaandsometimesvomiting
painthatisusuallyintheupperrightormiddlepartof
theabdomen
radiationofthepainthroughtothebackorintothe
shoulder
worseningofthepainafteraheavyorfattymeal

12. signs and symptoms
Ifcomplicationsoccur,theindividualmay
developfurthersymptoms:
·abnormallylight-coloredstools
·blockageofthebowels
·dark-coloredurine
·fever
·itching
·jaundice,oryellowingoftheeyesandskin
·severe,constantabdominalpain

13. Diagnosis
HistoryTaking
AbdominalExamination
Ultrasound-Ultrasoundsareusedtoviewinternal
organsoftheabdomensuchastheliverspleen,and
kidneysandtoassessbloodflowthroughvarious
vessels.
cholangiography-x-rayexaminationofthebileducts
usinganintravenous(IV)dye(contrast).
percutaneoustranshepaticcholangiography(PTC)-
aneedleisintroducedthroughtheskinandintotheliver
wherethedye(contrast)isdepositedandthebileduct
structurescanbeviewedbyx-ray.

14. Diagnosis
Computedtomographyscan-ACTscanshows
detailedimagesofanypartofthebody,includingthe
bones,muscles,fat,andorgans.CTscansaremore
detailedthangeneralx-rays.
endoscopicretrogradecholangiopancreatography
(ERCP)-aprocedurethatallowsthephysicianto
diagnoseandtreatproblemsintheliver,gallbladder,bile
ducts,andpancreas.Theprocedurecombinesx-ray
andtheuseofanendoscope-along,flexible,lighted
tube.Thescopeisguidedthroughthepatient'smouth
andthroat,thenthroughtheesophagus,stomach,and
duodenum.

15. Treatment
Surgeryisthetreatmentofchoiceforgallbladder
andbiliarytractdiseasesandmayincludeopen
or laparoscopic cholecystectomy,
cholecystectomywithoperativecholangiography
and,possibly,explorationofthecommonbile
duct.
Stonedissolution:Forpatientswhodecline
surgeryorwhoareathighsurgicalrisk(eg,
becauseofconcomitantmedicaldisordersor
advancedage),gallbladderstonescan
sometimesbedissolvedbyingestingbileacids
orallyformanymonths.

16. Treatment
Othertreatmentssuchaslow-fatdiettopreventattacks
andvitaminKforitching,jaundice,andbleeding
tendendesduetovitaminKdeficiency.
Treatmentduringanacuteattacksuchasinsertionofa
nasogastrictubeandanI.V.lineand,possibly,antibiotic
andanalgesicadministration.
Anothertreatmentforthisdiseaseisnonsurgical,it
involvesplacementofacatheterthroughthe
percutaneoustranshepaticcholangiographicroute.
Guidedbyfluoroscopy,thecatheterisdirectedtowardthe
stone.Abasketisthreadedthroughthecatheter,opened,
twirledtoentrapthestone,closed,andwithdrawn.This
procedurecanbeperformedendoscopically.

17. Laparoscopic Cholecystectomy

18. Complications
Cholangitis, sepsis
Pancreatitis
Perforation (10%)
Hepatitis
Choledocholithiasis(Stone in Common Bile
Duct)

19. Nursing Management
Assessment
Subjective Data
Objective Data

20. Nursing Diagnosis
Preoperative
Knowledge deficit regarding cholecystectomy.
Anxiety related to surgery.

21. Nursing Diagnosis
Post-operative
Acutepainanddiscomfortrelatedtosurgical
incision.
Impairedskinintegrityrelatedtoalteredbiliary
drainageaftersurgicalintervention.
Imbalancenutrition,lessthanbodyrequirements
relatedtoinadequatebilesecretion.
Knowledgedeficitaboutself-careactivities
relatedtoincisioncareandfollowup.

22. Lifestyle and Gallstone Disease
Sandeep Sachdeva, Indian J Community Med. 2011 Oct-Dec; 36(4): 263–267.
Femaleshadahigherprevalenceofgallstonediseasethan
males(P<0.01).Amongmales,thegeriatricagegroup(<60
years)wasrelativelymoresusceptible(28%).Prepubertalage
groupwasleastafflicted(3.3%).Univariateanalysisrevealed
multiparity,highfat,refinedsugar,andlowfiberintakestobe
significantlyassociatedwithgallstones.Sedentaryhabits,
recentstress,andhypertensionwerealsoamongthe
significantlifestyle-relatedfactors.Highbodymassindexand
waisthipratios,againrepresentingunhealthylifestyles,were
thesignificantanthropometriccovariates.