Nursing seminar about gallbladder disease and gallstones

UOB/CON

1. gallbladder disorder Prepared by Master student : Haider Badr Hami : Supervised by Dr . Rajaa Ibrahim

2. outline Introduction Mechanism of gallbladder action Gallbladder disorders clinical manifestations Diagnostic finding Medical management Nursing diagnosis

3. The Gallbladder The gallbladder, a pear-shaped, hollow, saclike organ, 7.5 to 10 cm (3 to 4 in) long, lies in a shallow depression on the inferior surface of the liver, to which it is attached by loose connective tissue. The capacity of the gallbladder is 30 to 50 mL of bile. Its wall is composed largely of smooth muscle.

4. The Gallbladder The gallbladder is connected to the common bile duct by the cystic duct . The gallbladder functions as a storage depot for bile. Between meals

5. Mechanism of gallbladder action:

6. gallbladder disorder Several disorders affect the biliary system and interfere with normal drainage of bile into the duodenum. These disorders include : Inflammation of the biliary system Carcinoma that obstructs the biliary tree. Gallbladder disease with gallstones is the most common disorder of the biliary system. more than 90% of patients with acute cholecystitis have gallstones

7. Cholecystitis Cholecystitis , acute inflammation of the gallbladder. The causes : Pain, Tenderness, Rigidity of the upper right abdomen that may radiate to the mid sternal area or right shoulder Nausea and vomiting An empyema of the gallbladder develops if the gallbladder becomes filled with purulent fluid (pus).

8. Cholecystitis Etiology Calcolous cholecyctitis Bacrerial causes After major surgical procedures Severe trauma or burn . Torsion Cyctic duct obstruction . Multiple blood transfusions . Bile stasis (( lack of gallbladder contraction )) . Increased viscosity of the bile .

9. Cholelithiasis Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile  they vary greatly in size , shape, and composition. They are uncommon in children and young adults but become more prevalent with increasing age. affecting 30% to 40% of people by the age of 80 years.

10. Cholelithiasis Pathophysiology There are two major types of gallstones: These composed of pigment . These composed of cholesterol .

11. Cholelithiasis Pigment stone : Pigment stones probably form when unconjugated pigments in the bile precipitate to form stones. The risk of developing such stones is increased in patients with cirrhosis, hemolysis, and infections of the biliary tract. Pigment stones cannot be dissolved and must be removed surgically.

12. Cholelithiasis

13. Cholelithiasis Cholesterol stone : Cholesterol, a normal constituent of bile,  is insoluble in water . Its solubility depends on bile acids and lecithin (phospholipids ( in bile. In gallstone-prone patients, there is decrease bile acid synthesis and increased cholesterol synthesis in the liver, resulting in bile supersaturated with cholesterol, which precipitates out of the bile to for stones.

14. Cholelithiasis The cholesterol-saturated bile predisposes to the formation of gallstones and acts as an irritant that produces inflammatory changes in the gallbladder

15. Cholelithiasis

16. Cholelithiasis Risk Factors for Cholelithiasis Obesity Women, especially those who have had multiple pregnancies or who are of Native American or U.S. Southwestern Hispanic ethnicity. Older than 40 years of age Multiparous . 2-3 times more than men develop cholesterol stone and gallbladder disease

17. Cholelithiasis 3 . Frequent changes in weight 4 . Rapid weight loss (leads to rapid development of gallstones and high risk of symptomatic disease) 5 . Treatment with high-dose estrogen ( eg , in prostate cancer) 6. Low-dose estrogen therapy–a small increase in the risk of gallstones , oral contraceptive , or clofibrate ; these medications are known to increase biliary cholesterol saturation .

18. Cholelithiasis 7. Ileal resection or disease 8 . Cystic fibrosis 9 . Diabetes mellitus. 10 . age : as result of increased hepatic secretion of cholesterol and decreased bile acid synthesis.

19. Clinical manifestation : Gallstone may be silent The symptoms may be acute or chronic Pain and biliary colic Epigastric distress, such as fullness, abdominal distention, and vague pain in the right upper quadrant of the abdomen that radiates to the back or right shoulder. Biliary colic is usually associated with nausea and vomiting, and it is noticeable several hours after a heavy meal.

20. Clinical manifestation : 2. Tenderness in the right upper quadrant on deep inspiration and prevents full inspiratory excursion. 3. Jaundice 4. Change in urine and stool color . 5. Vitamin deficiency Obstruction of bile flow interferes with absorption the fat-soluble vitamins A, D, E, and K. Patients may exhibit deficiencies of these vitamins if biliary obstruction has been prolonged

21. DIAGNOSTIC FINDING Abdominal x-ray Ultrasonography Radionuclide imaging or cholescintigraphy Cholecytography Endoscopicretrograde Cholangiopancreatography .(ERCP ) Blood test

22. Medical management Nutritional and Supportive Therapy Approximately 80% of the patients with acute gallbladder inflammation achieve remission with rest, IV fluids, nasogastric suction, analgesia, and antibiotic agents .

23. Medical management 2. Pharmacologic therapy : Ursodeoxycholic acid (UDCA [ URSO,Actigall ]) achenodeoxycholic acid ( chenodiol or CDCA [ Chenix ]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. It acts by inhibiting the synthesis and secretion of cholesterol thereby desaturating bile

24. Medical management 3. Nonsurgical Removal of Gallstone . Dissolving Gallstones Stone Removel by instrument Intracorporeal Lithotripsy 4. Surgical Management Laparoscopic cholecystectomy Cholecystectomy Choledochostomy

25. Nursing Diagnoses : 1. Acute pain and discomfort related to surgical incision Relieving Pain Ask the patient to take shallow breaths to prevent pain administers analgesic agents as prescribed. helping the patient turn, cough, breathe deeply, and ambulate as indicated. Use of a pillow or binder over the incision may reduce pain during these maneuvers .

26. Nursing Diagnoses : 2. Impaired gas exchange related to the high abdominal surgical incision Improving Respiratory Status the patient to take deep breaths and cough every hour to expand the lungs fully and prevent atelectasis Early ambulation prevents pulmonary complications as well as other complications, such as thrombophlebitis. Administer the oxygen as described .

27. Nursing Diagnoses : 3. Impaired skin integrity related to altered biliary drainage after surgical intervention Maintaining Skin Integrity and Promotion Biliary Drainage. Fasten the tubing to the dressings or to the patient’s gown, Observation for indications of infection, leakage of bile into the peritoneal cavity, and obstruction of bile drainage. assess the color of the sclerae . note and report right upper quadrant abdominal pain, nausea and vomiting, bile drainage around any drainage tube, clay-colored stools, and a change in vital signs .

28. Nursing Diagnoses : Improving Nutritional Status encourages the patient to eat a diet that is low in fats and high in carbohydrates and proteins immediately after surgery.

29. Nursing Diagnoses : Monitoring and Managing Potential Complications closely monitors vital signs and inspects the surgical incisions and any drains for bleeding. assesses the patient for increased tenderness and rigidity of the abdomen. Assesses the patient for anorexia, vomiting, pain, abdominal distension , and temperature elevation .

30. Promotion home care Instructs The patient about the medications that are prescribed (vitamins , anticholinergics , and antispasmodics) and their actions. Teach the patient and family about symptoms that should be reported to the physician, including jaundice, dark urine, pale-colored stools, pruritus, and signs of inflammation and infection, such as pain or fever. instructs them in proper care of the drainage tube and the importance of reporting promptly any changes in the amount or characteristics of drainage .

31. reference   BRUNNER & SUDDERHT . S : MEDICAL-SURGICAL NURSING . 12 ADITION , Lippincott Williams & Wilkins , phildelphia , newyork , USA , 2010 , PAGE ; 1171 – 1180.

32. رسمت ملامحي عند سريرها عله يراني فيخبرها بحالتي أخبرها بأني أبتسمت بجنبها من شدة آلآمي وحزني ولوعتي الله يعلم بإنني لا زلت صادقا متى تعودي ستعود بسمتي

33. I am gratefull & Thank you for listen