cholilithiasis.pptx
- 1. CHOLELITHIASIS Ms. T. Hari priya Clinical instructor AACON
- 2. Cholelithiasis Definition: • Cholelithiasis is derived from the Greek word chol means "bile" + lith means "stone” . • Acute or chronic inflammation of the gallbladder associated with choleliathesis. • Presence of stones in the gallbladder is referred to as cholelithiasis The stones may be lodged in the neck of the gall bladder or in the cystic duct.
- 3. Types • Cholesterol stones • Pigment stones • Mixed gallstones
- 4. Types • Cholesterol stones: It vary in color from light-yellow to dark-green or brown and are oval 2 to 3 cm in length, often having a tiny dark central spot. • Pigment stones: The small, dark stones made of bilirubin, calcium salts and 20% cholesterol that are found in bile.
- 5. Types • Mixed gallstones: It typically contain 20–80% cholesterol. Common constituents are Calcium carbonate, phosphate, Bilirubin, and other bile pigments.
- 6. Risk Factors • Family history • Most commonly in woman • Age 40yrs above • Obese • A diet high in fat and cholesterol but low in fiber • Don’t get much exercise
- 8. Etiology • Pregnancy :failure to empty bile appropriately by the gallbladder • Biliary tract infections • Drugs • Heredity
- 9. Etiology • Too much cholesterol in bile. Body needs bile for digestion. It usually dissolves cholesterol. But it can’t do that, the extra cholesterol might form stones. • Too much bilirubin in bile. Conditions like cirrhosis, infections, and blood disorders can cause liver to make too much bilirubin. • Gallbladder doesn’t empty all the way. This can make bile very concentrated.
- 11. Signs & symptoms • Gallstones may be asymptomatic, even for years, are called "silent stones" and do not require treatment. • It begin to appear once the stones reach a certain size (>8 mm). • A characteristic symptom of gallstones is a "gallstone attack", intense pain in the upper-right side of the abdomen. Often, attacks occur after a particularly fatty meal.
- 12. Signs & symptoms • Abdominal bloating • Intolerance of fatty foods • Gas • Indigestion.
- 13. Complications • Cholecystitis • Perforated Gallbladder • Gallbladder Cancer • Pancreatitis • Gangrene or Abscesses.
- 14. Diagnostic evaluation • Abdominal Ultrasound • History and Physical Exam • Abdominal CT Scan • Plain X-ray
- 15. • Blood tests. These check for signs of infection or blockage, and rule out other conditions. • Ultrasound. • CT scan. Specialized X-rays to see inside the gallbladder. • Magnetic resonance cholangiopancreatography(MRCP). This test uses a magnetic field and pulses of radio wave energy to make pictures of the inside of liver and gallbladder.
- 16. • (HIDA scan). This test can check gallbladder squeezes correctly. injects a harmless radioactive material and a technician can then watch its movement. • Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones.
- 17. Endoscopic retrograde cholangiopancreatography (ERCP). • A tube called an endoscope through mouth down to small intestine. They inject a dye so they can see bile ducts on a camera in the endoscope. • They can often take out any gallstones that have moved into the ducts
- 18. Medical Management • Narcotics to relieve pain (Morphine) • Antispasmodics and anticholinergics to relax smooth muscles and decrease ductal tone and spasm. • Nastro gastric tube also inserted and connected to intermittent, low- pressure suction to relieve vomiting. • Iv fluids
- 19. Medical Management • Chenodeoxycholic acid are the drugs used to dissolve the gallstones with a dose of 8-10 mg/kg/PO.
- 20. Non- Surgical Management Dissolution therapy: Tube or catheter is inserted into the gallbladder to dissolve stones. Extracorporeal shock wave lithotripsy: It is a technique that uses electric shock waves to dissolve gallstones.
- 21. ESWL
- 22. Surgical Management • Cholecystectomy Surgical removal of the gall bladder. • Cholecystostomy Is a procedure a stoma is created in the gallbladder, can facilitate placement of a tube for drainage.
- 23. COMPLICATIONS • Gallbladder inflammation (acute cholecystitis). • Blocked bile ducts cause fever, chills, and yellowing of skin and eyes (jaundice). • If a stone blocks the duct to pancreas, that organ may become inflamed (pancreatitis).
- 24. PREVENTION • Eat a healthy diet that's high in fiber and good fats, like fish oil and olive oil. Avoid refined carbs, sugar, and unhealthy fats. • Get regular exercise
- 25. Nursing Diagnosis • Acute pain related to gallbladder stones. • Ineffective breathing pattern related to pain secondary to disease. • The risk of dehydration related to vomiting • Imbalanced nutrition less than body requirements related to altered lipid metabolism and increased nutritional needs during healing • Risk for infection related to complications of disease.
- 26. Nursing Interventions • Monitor and record vital signs. • Administer medication as ordered. • Administer analgesic as ordered • Place the patient in low Fowler’s position to facilitates breathing. • Provide intravenous fluids and nasogastric suction. • Provide water and other fluids and soft diet. • Observe for indications of infection, leakage of bile, or obstruction of bile drainage