Nursing Care of the Patient with a Disorder of the Gallbladder

1. Nursing Care of the Patient with a Disorder of the Gallbladder

2. Cholecystitis and Cholelithiasis What is the difference in the two disorders?

3. Who is at Risk? • Higher in women: multiparous, over 40 • Sedentary lifestyle • Familial tendency • Obesity • Treatment with estrogen therapy

4. Pathophysiology of Acute Cholecystitis • Obstruction of cystic duct blocks flow of bile backs up in the GB leading to ischemia of GB mucosa or wall • Inflammation may follow GB becomes edematous during acute attack, distended with bile or pus gangrenous

5. Clinical Manifestations of Acute Cholecystitis Usually begins with a biliary colic attack • Epigastric pain that radiates to the right shoulder and scapula. • What precipitates a biliary colic attack? • What are additional signs and symptoms?

6. Pathophysiology of Cholelithiasis • Symptoms occur when one of the stones block the common bile duct. • Stones are made of: • Cholesterol • Pigments

7. Clinical Manifestations of Cholelithiasis • Sudden severe RUQ Pain biliary colic • Symptoms related to bile obstruction such as: • Jaundice • Dark orange and foamy urine • Steatorrhea and clay-colored stools • Pruritus

8. If the patient was displaying all the symptoms of cholelithiasis,which one is most important to intervene?

9. Complications • Gangrenous cholecystitis • Pancreatitis • Rupture of the gallbladder • Biliary Cirrhosis • Peritonitis

10. Diagnostic Studies • Ultrasound • Must be NPO • ERCP (Endoscopic Retrograde Cholangiopancreatography)

11. Additional Laboratory Tests • Laboratory tests * WBC count * Serum bilirubin

12. Treatment and Nursing Care

13. Treatment and Nursing Care • Control Pain • Analgesics - Morphine • Anticholinergic – Bentyl or Atropine • Maintain fluid and electrolyte balance • IV fluids • Prevent GB stimulation • NPO with NG suction • Control of Infection • Antibiotics

14. Treatment and Nursing Care • Relieve Pruritis • Bile acid Sequestrants • Cholestyramine (Questran) and hydroxyzine (Atarax)

15. Treatment and Nursing CareNutrition • Once the acute attack is over – patient is placed on low fat diet • Cooked fruits • Lean meats • Non-gas forming vegetables, mashed potatoes, rice • The patient should be taught to AVOID which foods?

16. Treatment and Nursing CareNonsurgical Approaches • Stone Removal Techniques: • ERCP with sphincterotomy • Mechanical extracorporeal shock-wave lithotripsy

17. Treatment and Nursing CareMedical Dissolution Therapy • Used for patients who are a poor risk for surgery and mildly symptomatic • May take 6 months to 2 years • Medications: • Chenodial • Ursodiol (Actigall) • Cholesterol solvents • Methyl tertiary terbutyl ether (MTBE)- infusion via tube directly into the gallbladder

18. Treatment and Nursing CareSurgery • Laparoscopic cholecystectomy * treatment of choice * gallbladder removed through four puncture holes

19. Treatment and Nursing CareSurgery • Incisional / Open cholecystectomy * Removal of GB through right subcostal incision * T tube inserted into CBD

20. Treatment and Nursing CarePost-op Care • Relieve post-op pain • Assess respiratory status • Wound care • Drains

21. Treatment and Nursing CarePost-op • Improve nutritional status – resume diet and fat back in diet in small increments. Medications: • Fat-soluble vitamins • Vitamins A,D,E,K • Bile salts

22. Post-op Teaching • When to call the doctor • Severe pain • Obstruction – stool and urine changes, jaundice, pruritis • Infection • Diet • Activity • Drains

23. How do you know they are getting better?

24. The End