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Cholelithiasis
Gallstones – 90% cholesterol gallstones
Cholecystitis
Inflammation of Gallbladder( usually caused by obstruction d/t gallstones)
4 F's Risk Factors For Gallbladder disordes
fat, female, fertile, forty, (flatulence, family hx)
Manifestations
-indigestion, mild to severe pain RUQ, R shoulder, scapula, fever, jaundice, N,V
-Cholelithiasis severity depends on the stone
-dark amber urine foamy, clay coloured stool, pruritus, bleeding tendencies, steatorrhea (fat in feces),
Complications
-Cholangitis (inflammation of bile duct)
- rupture of bladder
-fistula (abnorm. passaway)
-bile peritonitis
-biliary cirrhosis
Diagnostic Studies
Ultrasonography/ ERCP (bile sample), Lab : visualize and detect stones
Collaborative Care
Conservative therapyCholecystitis - pain mgt, abx, maintenance of fld & electrolyte balance, NG, anticholinergic – decrease secretion and counteract smooth muscle spasms
Cholelithiasis – Biles acids – to dissolve stones, ERCP clears stones from 90%, extracorporeal shock wave therapy
Surgical therapy - laparoscopic cholecystectomy
Drug therapy – analgesics, anticholinergics (antispasmodics & relax smooth muscles), fat-soluble vitamins (A,D,E,K), bile salts (facilitate digestion & vitamin absorption)
Nutritional therapy – smaller, more frequent meals, with some fat at each meal to promote gallbladder emptying, low in saturated fats (butter), high in fibre & Ca+
Patient Teaching
Cholecystectomy: remove bandage on puncture site after surgery, notify surgeon of redness or severe abdominal pain, resume normal activities gradually, return within 1 wk if no complications, normal/low-fiet diet
-fat soluble supplement, avoid heavy lifting
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