GALL BLADDER DISORDER
PRESENTED BY
MR RESKOLA RANI
1st year MSC NURSING
INTRODUCTION
Gallbladder disorders occur when this organ
becomes inflamed, infected, or obstructed, leading to
various symptoms like pain nausea and vomiting
abdominal tenderness and complications.
CHOLELITHIASIS
DEFINITION
A Greek chol-(bile)+ lith-
(stone)+-iasis (process)
Cholelithiasis refers to the
formation of gallstones
(solid deposits of cholesterol,
bile pigments, and calcium
salts) within the gallbladder.
INCIDENCE
• It is approximately 10–20% of the population.
• Women are more likely than men to develop gallstones, with a
2:1 female-to-male ratio, especially during their reproductive
years, likely due to hormonal factors such as estrogen.
• Increases significantly after age 40, peaking in the 60–70 age
group.
Types of stone
Cholesterol Pigment
stone:- containing stone:- made of
crystalline bilirubin
cholesterol calcium salts
Most common
monohydrate
stone PIGMENT
STONE
Brown stone: - Black stone:-
Calcium Calcium
bilirubinate+ bilirubinate +
calcium soap of fatty calcium
BLAC
acids + cholesterol carbonate+20% K
BROWN
STONE
cholesterol STON
E
ANATOMY AND PHYSIOLOGY
CAUSES
Eating a very low calorie diet,
Excess Bilirubin in Bile
Leading to rapid weight loss
Poor Gallbladder Emptying
inflammatory bowel diseases
Biliary tract infections
Medications (cholesterol-
Excess Cholesterol in Bile lowering drugs Increase
liver cirrhosis (scarring and
cholesterol in the bile)
poor functioning of the
liver) Gallstones
Diabetes Tumour
Bone marrow transplant Infections
RISK FACTORS
5 F’s of Cholelithiasis
• Female
• Fat
• Forty
• Fertile
• Fair
PATHOPHYSIOLOGY OF CHOLELITHIASIS
Cholesterol, bile salts and phospholipids + etiological factors
When excessive cholesterol is secreted into bile, it exceeds the
solubilizing capacity of bile salts and phospholipids, leading to
cholesterol crystal precipitation.
Decreased bile salt concentration & increased bilirubin (due to
liver dysfunction, ileal disease, or bile stasis) increases the risk of
stone formation
The presence of pro-nucleating factors (such as mucus and
proteins) accelerates gallstone formation
Gallstone formed
CHOLECYSTITIS
DEFINATION
Cholecystitis refers to inflammation of the
gallbladder, often due to an obstruction of the
cystic duct, typically caused by gallstones.
TYPES OF CHOLECYSTITIS
Acute cholecystitis: Cholecystitis presents with sudden and
severe pain, usually in the upper right abdomen, often triggered by
fatty meals
Chronic cholecystitis: results from repeated inflammation and
can lead to scarring and dysfunction of the gallbladder.
CONT
• Calculus Cholecystitis:
A gall stone obstruct the bile out flow. Bile remain in the gall bladder
initiates a chemical reaction; autolysis and edema occurs and the blood vessels
in the gall bladder are compressed, compromising its vascular supply.
• Acalculus Cholecystitis:
A calculus cholecystitis describes acute gall bladder inflammation in the
absence of obstruction by gall stones. A calculus cholecystitis may occur with
or without localized or generalized tissue ischemia and obstruction, Acalculus
cholecystitis occurs after major surgical procedures, severe trauma or burns.
PATHOPHYSIOLOGY OF CHOLECYSTITIS
Due to etiological factors
Gall stone obstruct bile flow
Impacted gallstone causes bile to become trapped in
the gallbladder
Buildup of bile causes irritation and pressure in the
gallbladder
Gall bladder becomes inflamed and distended
CONT
Edema of gall bladder obstruct bile flow
Cell in the gall bladder wall may become oxygen
staved and die as the distended organ
Presses on vessels and impair blood flow
Dead cells slough off and exudate covers ulcerated
area
Gangrene
CLINICAL MANIFESTATIONS
• Pain (Biliary colic)
• Murphy sign: Pain on deep inspiration
MURPH
while palpating the right upper quadrant
Y SIGN
• Abdominal tenderness
• Distended Gall bladder
• Low grade fever
• jaundice
• Loss of appetite
CLINICAL MANIFESTATIONS CONT
• Nausea & vomiting
• Sweating
• Clay colored stools
• Presence of fat in the
stool (steatocrhaea)
• Recurring fat intolerance
DIAGNOSTIC EVALUATION
1. History collection and Physical Assessment
2.Liver Function Tests
Test Normal Findings
Value
Alanine 7-56 U/L ↑ Elevated in bile duct obstruction
Aminotransferase (ALT)
Aspartate 10-40 U/L ↑ Mildly elevated in bile stasis
Aminotransferase (AST)
Alkaline Phosphatase 44-147 ↑ High in bile duct obstruction or
(ALP) U/L choledocholithiasis
Gamma-Glutamyl 9-48 U/L ↑ Increased in biliary obstruction
Transferase (GGT)
Total & Direct Bilirubin 0.1-1.2 ↑ High in bile duct obstruction or
mg/dL cholangitis
3. Complete Blood Count (CBC) – Detects
Infection & Inflammation
Findings
Test Normal Value
White Blood Cell 4,000-11,000 /µL ↑ Elevated in acute
Count (WBC) cholecystitis or
cholangitis
Neutrophil Count 40-70% ↑ High in bacterial
infections
Prothrombin levels 11-13.5 seconds Reduced when
obstruction to the flow
of bile into the intestine
decreases absorption of
vitamin K
4. Pancreatic Enzymes – Check for
Gallstone Pancreatitis
Test Normal Findings
Value
Amyla 30-110 ↑ High in
se U/L pancreatitis due to
bile duct blockage
Lipase 0-160 ↑ More specific for
U/L pancreatitis
Ultrasonography:
Ultrasound is considered the gold
standard for detecting gallstones
shows Stones that move with position
changes distended gallbladder
Abdominal computed tomography (CT) scan:
Abdominal CT scan may detect stones in the gallbladder. Gallbladder wall
thickening (>3 mm) in cholecystitis
Percutaneous trans hepatic
cholangiography: done under fluoroscopic control,
distinguishes between gallbladder and bile duct disease
and cancer of the pancreatic head in patients with jaundice.
Hepatobiliary Iminodiacetic Acid (HIDA)/ Para-IodoPhenyl
Iminodiacetic Acid (PIPIDA) scan: May be done to confirm
diagnosis of cholecystitis, especially when barium studies are
contraindicated. Scan may be combined
with cholecystokinin injection to demonstrate abnormal
gallbladder ejection.
COMPLICATIONS
Acute cholecystitis
Mucocele of gall bladder
Empyema of the gall bladder
Choledocholithiasis
Biliary obstruction obstructive jaundice MUCOCELE OF GALL
BLADDER
Acute cholangitis
Perforation/Gallbladder Rupture EMPYEMA OF GALLBLADDER
Peritonitis
Pancreatitis
Gangrene
Carcinoma of the gall bladder
STONE IN CBD
GENERAL MANAGEMENT
1. Low-fat diet
2. Vitamin K administration
3. NGT insertion
4. IV therapy
5. Gallbladder stimulation
MEDICAL MANAGEMENT
• Gallstone Dissolution: to
dissolve the stone
• Antispasmodics:
• Ursodeoxycholic Acid (UDCA)
Reduce gallbladder
• Chenodeoxycholic Acid (CDCA)
spasm
• Analgesic: to reduce pain E.g. Hyoscine,
E.g. Diclofenac, Ibuprofen dicyclomine
• Antiemetic: to prevent nausea • Antibiotic: To prevent
and vomiting complication
E.g. Metoclopramide, E.g. Ceftriaxone +
Ondansetron Metronidazole
NON-SURGICAL REMOVAL OF GALL STONE
Extracorporeal Shock Wave lithotripsy
NON-SURGICAL REMOVAL OF GALL STONE
Endoscopic retrograde
cholangiopancreatography
(ERCP):ERCP visualizes the biliary tree
after insertion of the endoscope, down
the oesophagus to the duodenum, cannulation of
the common bile duct and the pancreatic ducts, if
stone is detected removal is done through suction
SURGICAL MANAGEMENT
Open cholecystectomy Open
cholecystectomy
Laparoscopic cholecystectomy
Advantages over Open Surgery
• Minimally invasive (small incisions, less pain)
• Faster recovery (1-2 weeks vs. 4-6 weeks for open
surgery)
• Less blood loss & fewer complications
• Lower risk of infections & scarring
• Lower Hospital Stay & Costs
• Less Postoperative Pain
DIET MANAGEMENT
Low-Fat Foods
Plenty of Fluids
High-Fiber Foods
Smaller, Frequent Meals
NURSING MANAGEMENT
The nursing management follows the standard
framework of
1.Assessment
2. Diagnosis
3.Planning
4. Implementation
5. Evaluation (ADPIE) to ensure comprehensive
patient care
NURSING DIAGNOSES
• Acute pain related to inflammation and obstruction of bile flow due to
gallstones evidenced by severe right upper quadrant (RUQ) or epigastric
pain
• Imbalanced nutrition less than body requirements related to nausea,
vomiting, and fat intolerance Evidenced by loss of appetite &weight loss
• Fluid volume deficit related to nausea, vomiting, and reduced oral intake
evidenced by dry mucous membranes
• Risk for infection related to inflammation of the gallbladder due to
gallstone obstruction evidenced by fever elevated white blood cell (WBC)
count
• Risk for Ineffective Coping Related to Chronic Pain & Lifestyle Changes
• Deficient knowledge related to lack of information about dietary
modifications, treatment options, and disease process Evidenced by Patient
expressing concerns or asking questions about cholelithiasis
NURSING INTERVENTIONS
1. Pain Management
2. Dietary Modifications
3. Fluid maintenance
4. Infection Prevention and Monitoring
5. Coping strategy
6. Deficit knowledge
PATIENT EDUCATION
1. Lifestyle Changes
2. Dietary Guidelines
3. Medication Adherence
4. Postoperative Care
1. Which of the following is the most common type of
gallstone?
A) Cholesterol stones
B) Pigment stones
C) Mixed stones
D) Calcium stones
Answer: A) Cholesterol stones
2. The most common cause of acute cholecystitis is:
A) Bacterial infection
B) Gallstone obstruction of the cystic duct
C) Trauma
D) Pancreatitis
Answer: B) Gallstone obstruction of the cystic duct
3. Murphy’s sign is
A) Pain referred to the left shoulder
B) Pain on deep inspiration while palpating the right upper quadrant
C) Pain relieved by eating
D) Pain radiating to the back
Answer: B) Pain on deep inspiration while palpating the right upper
quadrant
4. The definitive treatment for symptomatic
cholelithiasis is
A) Ursodeoxycholic acid
B) Low-fat diet
C) Extracorporeal shock wave lithotripsy (ESWL)
D) Laparoscopic cholecystectomy
Answer: D) Laparoscopic cholecystectomy
CONCLUSION
Gallbladder disorders, including gallstones & cholecystitis
requiring timely diagnosis and management. Treatment options
vary depending on the severity of the disorder and may include
lifestyle modifications, medications, or surgical intervention. Early
detection and appropriate treatment are crucial in preventing
severe complications and improving patient outcomes
