Transcript Care of the Client with Disorders of the Gallbladder

Nursing Care of the Patient
with a
Disorder of the Gallbladder
What is the difference in the two disorders?
Who is at Risk?
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Higher in women: multiparous, over 40
Sedentary lifestyle
Familial tendency
Obesity
Treatment with estrogen therapy
Pathophysiology of
Acute Cholecystitis
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Obstruction of cystic duct blocks flow of
bile backs up in the GB leading to ischemia
of GB mucosa or wall
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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.
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What precipitates a biliary colic attack?
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What are additional signs and symptoms?
Pathophysiology
of Cholelithiasis
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Symptoms occur when one
of the stones block the
common bile duct.
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Stones are made of:
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Cholesterol
Pigments
Clinical Manifestations of Cholelithiasis
Sudden severe RUQ Pain
biliary colic
 Symptoms related to bile obstruction
such as:
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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
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Gangrenous cholecystitis
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Pancreatitis
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Rupture of the gallbladder
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Biliary Cirrhosis
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Peritonitis
Diagnostic Studies
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Ultrasound
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Must be NPO
 ERCP (Endoscopic Retrograde
Cholangiopancreatography)
Additional Laboratory Tests
 Laboratory
tests
* WBC count
* Serum bilirubin
Treatment and Nursing Care
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Control Pain
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Maintain fluid and electrolyte balance
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IV fluids
Prevent GB stimulation
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Analgesics - Morphine
Anticholinergic – Bentyl or Atropine
NPO with NG suction
Control of Infection
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Antibiotics
Treatment and Nursing Care
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Relieve Pruritis
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Bile acid Sequestrants
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Cholestyramine (Questran) and hydroxyzine
(Atarax)
Treatment and Nursing Care
Nutrition
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Once the acute attack is over – patient is
placed on low fat diet
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Cooked fruits
Lean meats
Non-gas forming vegetables, mashed potatoes, rice
The patient should be taught to AVOID which
foods?
Treatment and Nursing Care
Nonsurgical Approaches
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Stone Removal Techniques:
 ERCP with sphincterotomy
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Mechanical extracorporeal
shock-wave lithotripsy
Treatment and Nursing Care
Medical Dissolution Therapy
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Used for patients who are a poor risk for surgery
and mildly symptomatic
May take 6 months to 2 years
Medications:
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Chenodial
Ursodiol (Actigall)
Cholesterol solvents
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Methyl tertiary terbutyl ether (MTBE)- infusion via tube
directly into the gallbladder
Treatment and Nursing Care
Surgery
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Laparoscopic cholecystectomy
* treatment of choice
* gallbladder removed through four
puncture holes
Treatment and Nursing Care
Surgery
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Incisional / Open cholecystectomy
* Removal of GB through right subcostal
incision
* T tube inserted into CBD
Treatment and Nursing Care
Post-op Care
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Relieve post-op pain
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Assess respiratory status
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Wound care
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Drains
Treatment and Nursing Care
Post-op
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Improve nutritional status – resume diet and
fat back in diet in small increments.
Medications:
 Fat-soluble vitamins
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Vitamins A,D,E,K
Bile salts
Post-op Teaching
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When to call the doctor
Severe pain
 Obstruction – stool and urine changes,
jaundice, pruritis
 Infection
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Diet
 Activity
 Drains
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How do you know they
are getting better?
The End