cholilithiasis, cholecystitis,gall bladdder .pdf

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1. Thar Institute of nursing and allied health science umerkot
Subject; adult health nursing ;1
Unit; 1
gastrointestinal disorder
Alteration in hepatobiliary system
Date; 17-11-2021
Lecture; 28
Topic; cholecystitis& cholelithiasis,
Faculty; madam Sapna Kumari

2. objective
By theend of ofthesessionlearn will beableto;
Explain gallbladder & their function
Explain difference b/w cholelithiasis & cholecystitis
•Explain types of cholelithiasis
•Explain risk factors of gall stone
•Explain clinical manifestation of cholelithiasis

3. Cont..
•Explain clinical manifestation of cholelithiasis
•Discuss causes of cholelithiasis
•Explain pathophysiology of cholelithiasis
•Describe Diagnosis evaluation of cholelithiasis
•Discuss complication of cholelithiasis
•Describe medical ,surgical management of cholecystitis, cholelithiasis
•Explain nursing management of cholelithiasis

5. Gallbladder
•The gallbladder apear shaped, organ that is ( 3 to 4 inch ) long, located
directly below the liver.
•OR GB is pouch that store bile that is green yellow liquid the help digestion
•Function of gallbladder
•The gallbladder's primary function is to store bile,
•bileis a fluid that is made and released by the liver and store in the
gallbladder. Through bile duct
•Bile help with digestion. It breaks down fats..

6. •Gallstones (cholelithiasis). Common and usually harmless, gallstones can
sometimes cause pain, nausea, or inflammation.
•Cholecystitis:Inflammation 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
•Choledocholithiasis mean stone in common bile duct
•. Cholecystitis causes severe pain and fever, and can require surgery when
infection continues or recurs.
•Gallbladder cancer: Although rare, cancer can affect the gallbladder. It is
difficult to diagnose and usually found at late stages when symptoms appear.
Gallbladder condition

7. Gallbladder

8. What is difference between cholecystitis and
cholelithiasis?
•Cholelithiasis and cholecystitis both affect your gallbladder.
•Cholelithiasis occurs when gallstones develop.
•If these gallstones block the common bile ductfrom the gallbladder cause
inflammation.
•This inflammation is called cholecystitis

9. types
•Calcules;( stone or obstruction)
•a calculus; (due to inflammation)

10. Types of cholelithiasis/ gallstone
•Cholesterol gallstone
•Pigment gall stone
•Mix gall stone

12. Causes
causes still unknown
To much cholesterolin bile( yellow cholesterol stone)
To much bilirubin in bile (dark brown or black pigment stone

13. pathophysiology
•A) cholesterol supersaturation( excessive cholesterol in bile )
•B) hypomotility of gallbladder (bile is present in gallbladder )
•C) Cholesterol nucleation( liquid convert in to the crystal form )
•D) Accretion hypersecretion ( hypersecretion of mucus in gallbladder it
traps the Chrystal )
Gallstone

14. Risk factor of gall stone
•Cholesterol gall stone
•Obesity
•Use of oral contraceptive
•Rapid weight loss
•Cholesterol lowering drugs.
•Pigment gall stone ( can not be dissolved and must b removed surgically )
•Chronic( hemolytic anemia )
•Chronic liver disease
•Biliary infection
•Obstruction of gall bladder or bile ducts.

15. s/s
80% people have silent gall stone
•Fever
•Pain ( in right upper quadrant region) specially when eating fried foods
•Nausea, vomiting
•indigestion
•Heart burn
•Feeling of pressure in right upper abdomen)
•Jaundice ( if obstruction)

16. Cont..
•dark urine color
•Cloddy color stool
•Burping
•Murphy's sign-patient is unable to take deep inspiration when
hepatic region press by fingers

18. Complication
•Jaundiceincrease bilirubin level in blood cause jaundice
•Cholecystitis
•Infection
•Cholangitis( bile duct infection)
•Gall bladder cancer//carcinoma

20. Diagnostic finding
•History collection
•Physical examination
•USG
•CT scan
•Blood test ( increase bilirubin )

21. Medical management
•Ursodeoxycholic acid (UDCA)
•chenodeoxycholic acid (CDCA)
•are effective in dissolving primary cholesterol gall stone & also reducing size
of stone
•Other symptomatic drug should be given as like;
•Analgesics ( for reducing pain)
•Antacids
•Antiemetic
•Rest
•Iv fluid

22. Surgical management
•Cholecystectomy( the gall bladder is removed through an abdomen
incision )
•Choledocholithotomy
•a surgical procedure it involved making an incision in the common duct

24. Nursing management
•Provide complete bed rest.
•Administer prescribed analgesics to patient
•Provide comfortable position to patient
•Administer I.vfluid as prescribed,
•I/O charting maintain ( intake/ output)
•Administer antiemetic as prescribed ( if patient have nausea, vomiting )
•Change the position 0f patient regularly
•Observe changes in patient skin color
•Provide psychological support to the patient.

25. Reference
•Brunner & suddarth’s text book of Medical surgical nursing vol-2 13
th
edition; page no 1391
•Medical surgical nursing first edition

26. Objective
•Explain gallbladder & their function
•Define GB cancer
•Explain stage of gallbladder cancer
•Explain risk factors of gallbladder cancer
•Explain clinical manifestation of gallbladder cancer
•describe Diagnosis evaluation of gallbladder cancer
•List complication of gallbladder cancer
•Describe medical ,surgical management of gallbladder cancer
•Explain nursing management gallbladder cancer

27. Gallbladder cancer

28. Gall bladder cancer
•Gallbladder cancer is a disease in which malignant (cancer) cells form in the
tissues of the gallbladder.
•OR
•Gallbladder cancer is rare disease in which malignant (cancer) cells are
found in the tissues of the gallbladder.
•Gallbladder cancer is uncommon. When gallbladder cancer is discovered at
its earliest stages, the chance for a cure is very good. But most gallbladder
cancers are discovered at a late stage, when the prognosis is often very
poor.

29. Stages of gallbladder cancer
•The scale used for grading gallbladder cancer is from 1 to 3.
•Grade 1 (G1)
•means the cancer cells look a lot like normal gallbladder cells.
•Grade 3 (G3) means the cancer cells looks very abnormal.
•Grade 2 (G2) falls somewhere in between.
•Low-grade cancers (G1) tend to grow and spread more slowly than high-
grade (G3) cancers.

32. S/S
•these and other signs and symptoms following:
•Jaundice (yellowing of the skin and whites of the eyes).
•Pain above the stomach.
•Fever.
•Nausea and vomiting.
•Bloating.
•Lumps In the abdomen.

34. Causes
•the causes of gallbladder is not clear or unknown
•Researchers have found some risk factors that make a person more likely
to develop gallbladder cancer.
•Chronic gallbladder inflammation is a common link among many of the
risk factors for gallbladder cancer.
•when someone has gallstones, the gallbladder may release bile more
slowly.
•This means that cells in the gallbladder are exposed to the chemicals in
bile for longer than usual. This could lead to irritation and inflammation.

35. Cont.…
•the causes of gallbladder is not clear or unknown
•Researchers have found some risk factors that make a person more likely
to develop gallbladder cancer.
•Chronic gallbladder inflammation

36. Risk factors
•Factors that can increase the risk of gallbladder cancer include:
sex.
•age
•Gallstones
gallstones
•polyps
•chronic inflammation
infection.

37. Risk factors
•Factors that can increase the risk of gallbladder cancer include:
sex.
Gallbladder cancer is more common in women.
•age
•risk of gallbladder cancer increases with age.
•Gallstones
•chronic inflammation
infection.

39. Diagnostic finding
•Physical exam and health history:
•Liver function tests:
•Ultrasound
•Three types of standard treatment are used:
•Surgery
•Radiation therapy
•Chemotherapy

42. Prevention
•There's no known way to prevent most gallbladder cancers. Many of the
known risk factors for gallbladder cancer, such as age, gender, and bile duct
defects
•. But there are things you can do that might help lower your risk.
•Taking these steps helps maintain good health and may reduce a person's
risk of gallbladder cancer, as well as many other types of cancer:

43. Cont..
•Get to and stay at a healthy weight
•Keep physically active and limit the time you spend sitting or lying
down
•Follow a healthy eating pattern that includes plenty of fruits,
vegetables, and whole grains,
•and limits or avoids red and processed meats,
•It's best not to drink alcohol.

45. Surgical management
•Laparoscopy
•Cholecystectomy

46. Nursing diagnosis
•Acute pain and discomfort able related to surgical incision.
•Impaired gas exchange related to high abdominal surgical incision
•Impaired skin integrity related to altered biliary drainage after surgical
incision
•Imbalanced nutrition, less than body requirement related to
inadequate bile secretion.
•Deficient knowledge about self care activities related to incisional
care, disease condition

47. Reference
•Medical surgical nursing vol-2 13thedetion
•https://www.cancer.org/cancer/gallbladder-cancer/detection-
diagnosis-staging.html
•https://www.drnikhilagrawal.com/gallbladder-cancer-infographic

48. Reference
•Medical surgical nursing 1stedetion
•Medical surgical nursing vol-2 13
th
edition page no;1391
•https://www.cancer.org/cancer/gallbladder-cancer/detection-
diagnosis-staging.html
•https://www.drnikhilagrawal.com/gallbladder-cancer-infographic