Transcript Slide 1

 Location:
under the liver
 Description: a sac-like organ located on the
inferior surface of the liver
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Mucosa of the GB wall absorbs water and
electrolytes resulting in a high concentration of
bile salts, bile pigments and cholesterol.
Primary purpose of the GB is to store and
concentrate bile (90 mL)
 The
cystic duct connects the gallbladder to
the hepatic duct and they merge to form the
common bile duct.
 The sphincter of Oddi is at the distal end of
the common bile duct and controls the flow
of bile into the duodenum.
 The bile secretions that empty from the
common bile duct into the duodenum are
necessary for digestion.
 An
inflammation of the gallbladder.
 Remember
back to inflammation and what
happens within the body when that occurs.
“The body’s celllular response to injury,
infection or irritation. A protective
vascular reaction that delivers fluid,
blood products and nutrients to an area
of injury. The process neutralizes and
eliminates pathogens or dead (necrotic)
tissues and establishes a means of
repairing body cells and tissues.”
Perry and Potter, p. 646
 Severe
and steady pain in the upper right
part of your abdomen.
 Pain worsens when you inhale deeply.
(Murphy’s sign)
 Pain that radiates from your abdomen to
your right shoulder or back.
 Tenderness over your abdomen when touched
 Sweating
 N/V
 Anorexia
 Fever, chills, abdominal bloating
 Gallstones
 Injury
 Infection
 tumor
 Gallstones
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Cholesterol stones
Pigmented stones
 Long
labor
 Traumatic injury
 Diabetes
 Gallbladder
distention
 Infection
 Tissue
death
 perforation
 When
did you first begin experiencing
symptoms?
 Have you had bouts of pain similar to this
before?
 Do you have a fever?
 Have your symptoms been continuous or
occasional?
 What improves your symptoms?
 What makes them worse?
 Blood
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tests
CBC
Hyperbilirubinemia
Elevated Erythrocyte sedimentation rate (ESR)
E-lytes
Alkaline phosphatase
Liver Function Tests (LFTs)
 Imaging
tests
 Hepatobiliary iminodiacetic acid (HIDA) scan
(aka cholescintigraphy, hepatobiliary scan)
 Oral
dissolution therapy with ursodeoxycholic
acid
 Extracorporeal shock wave lithotripsy
 ERCP = Endoscopic retrograde
cholangiopancreatography
 Laparoscopic cholecystectomy
 Cholecystectomy
 Acute
pain
 Risk for impaired gas exchange related to
pain and ineffective inspiratory effort
 Imbalanced nutrition: less than body
requirements related to nausea, vomiting
and anorexia
 Anxiety related to lack of knowledge about
disease process and treatment measures
 Implement
comfort measures
 Provide education regarding diagnostic tests
and disease process
 Maintain NPO and Institute IV therapy as
ordered
 Nutrition counseling
 Weight loss (3 Fs)
 Monitor fluids and e-lytes
 Symptomatic
treatment of pain and nausea
with analgesics and antiemetics
 Meperidine (Demerol) is the preferred opioid
analgesic because Morphine can cause
spasms.
 Cholestyramine (Questran) is used for severe
cases of pruritus: Binds the bile salts to
hasten excretion through the feces.
 Chenodeoxycholic acid (CDCA) and
urodoxycholic acid (UDCA) are oral
dissolution medications
 Description:
an acute or chronic disorder,
most often caused by gallstones obstructing
the cystic duct resulting in distention and
inflammation of the gallbladder.
 Most
commonly caused by gallstones blocking
the cystic or common bile duct.
 A small percentage of clients develop
acalculous cholecystitis precipitated by
trauma, prolonged hyperalimentation,
fasting or surgery.
 Clinical
manifestations include all those
identified with cholelithiasis
 Fever leukocytosis, elevation of serum
bilirubin(possible jaundice), elevation of
alkaline phosphatase, and elevation of
amylase if pancreatic ducts are involved.
 Abdominal guarding, rigidity, and rebound
tenderness suggest peritoneal involvement.
 NPO
 IV
hydration
 Opioids for pain control
 IV antibiotics
 Surgical intervention is postponed until the
acute infectious process has subsided.
 Laproscopic
cholecystectomy
 Cholecystectomy
 Cholecystectomy with T-tube placement
 Prevent
infection
 Control pain
 Prevent pulmonary complications
 Maintain T-tube is needed
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Below the incision
Assess drainage and record amount
Assess skin at insertion site
Report bile drainage in excess of 500 mL after 3
days
T-tube is removed when drainage has subsided
and stools have returned to a normal color
 Maintain
NPO status as ordered
 Advance diet slowly; low fat diet
 Monitor bowel sounds
 Encourage ambulation to promote peristalsis
 Prevent DVTs
 Provide general postoperative instructions:
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Wound care
Analgesia
Diet
Signs of infection