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Nursing Care of the Patient with a Disorder of the Gallbladder. Cholecystitis and Cholelithiasis. What is the difference in the two disorders?. Who is at Risk? . Higher in women: multiparous, over 40 Sedentary lifestyle Familial tendency Obesity Treatment with estrogen therapy.
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Nursing Care of the Patient with a Disorder of the Gallbladder
Cholecystitis and Cholelithiasis What is the difference in the two disorders?
Who is at Risk? • Higher in women: multiparous, over 40 • Sedentary lifestyle • Familial tendency • Obesity • Treatment with estrogen therapy
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
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?
Pathophysiology of Cholelithiasis • Symptoms occur when one of the stones block the common bile duct. • Stones are made of: • Cholesterol • Pigments
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
If the patient was displaying all the symptoms of cholelithiasis,which one is most important to intervene?
Complications • Gangrenous cholecystitis • Pancreatitis • Rupture of the gallbladder • Biliary Cirrhosis • Peritonitis
Diagnostic Studies • Ultrasound • Must be NPO • ERCP (Endoscopic Retrograde Cholangiopancreatography)
Additional Laboratory Tests • Laboratory tests * WBC count * Serum bilirubin
Treatment and Nursing Care
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
Treatment and Nursing Care • Relieve Pruritis • Bile acid Sequestrants • Cholestyramine (Questran) and hydroxyzine (Atarax)
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?
Treatment and Nursing CareNonsurgical Approaches • Stone Removal Techniques: • ERCP with sphincterotomy • Mechanical extracorporeal shock-wave lithotripsy
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
Treatment and Nursing CareSurgery • Laparoscopic cholecystectomy * treatment of choice * gallbladder removed through four puncture holes
Treatment and Nursing CareSurgery • Incisional / Open cholecystectomy * Removal of GB through right subcostal incision * T tube inserted into CBD
Treatment and Nursing CarePost-op Care • Relieve post-op pain • Assess respiratory status • Wound care • Drains
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
Post-op Teaching • When to call the doctor • Severe pain • Obstruction – stool and urine changes, jaundice, pruritis • Infection • Diet • Activity • Drains