20577681 Cholecystitis With Cholecystolithiasis

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CHOLECYSTITIS withCHOLECYSTITIS with

CHOLECYSTOLITHIASISCHOLECYSTOLITHIASIS


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Overview

The normal anatomy and physiology of the GB

GALLBLADDER

The GB which is a small pear-shaped organ that stores and concentrates thebile. The gallbladder is connected to the liver by the hepatic duct. It isapproximately 3 to 4 inches (7.6 to 10.2 cm) long and about 1 inch (2.5 cm)wide.

What is its Function?

The function of the gallbladder is to store bile and concentrate. Bile is adigestive liquid continually secreted by the liver. The bile emulsifies fats andneutralizes acids in partly digested food. A muscular valve in the commonbile duct opens, and the bile flows from the gallbladder into the cystic duct,along the common bile duct, and into the duodenum (part of the smallintestine).

Cholecystitis

Cholecystitis is painful inflammation of the gallbladder, a small organ nearthe liver that plays a part in digesting food. Normally, fluid called bile passesout of the gallbladder on its way to the small intestine. If the flow of bile isblocked, it builds up inside the gallbladder, causing swelling, pain, andpossible infection.

Cholecystolithiasis
http://www.mamashealth.com/organs/liver.asphttp://www.mamashealth.com/organs/liver.asp


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Overview

What are the symptoms?

The most common symptom of cholecystitis is pain in your upper rightabdomen that can sometimes move around to your back or right shoulder

blade. Other symptoms include:

Nausea or vomiting.Tenderness in the right abdomen.Fever.Pain that gets worse during a deep breath.Pain for more than 6 hours, particularly after meals.

Constant pain in the right upper abdomen. It is usually made worse bymoving.

Jaundiced skin

Older people may not have fever or pain. Their only symptom may be atender area in the abdomen.

Eating fatty foods will often make the symptoms worse. When the bacterialinfection sets in, many patients experience a higher fever and shaking chills.


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OverviewWhat causes it?

A gallstone stuck in the cystic duct, a tube that carries bile from thegallbladder, is most often the cause of sudden (acute) cholecystitis. Thegallstone blocks fluid from passing out of the gallbladder. This results inan irritated and swollen gallbladder. Infection or trauma, such as aninjury from a car accident, can also cause cholecystitis.

Who gets it?

Cholecystitis strikes:

Twice as many women than men, particularly those between theages of twenty and sixty.

Pregnant women, or those on birth control pills or estrogen

replacement therapy have a greater risk of developing cholecystitis.

People who are overweight, or who lose a large amount of weightquickly are also at greater risk for developing the condition.


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PATIENTS PROFILEPATIENTS PROFILE

Name : Patient XBirth date : 11-14-35Nationality : FilipinoReligion : Roman CatholicOccupation : Palay Buying Station (Self-proprietor)Admission : 8-13-09

Admission time : 9:15 amPhysician : Dr. LagunillaChief Complaint : Right Lower Quadrant pain

History of Present illness

One year prior to admission the patient experiences Right LowerQuadrant pain but did not consult a doctor and chose to self medicate withpain relievers.

Few hours PTA as RLQ pain with vomiting, weakness.GeneticsHas family history of gallstones (-) Hypertension

First hospital confinement (-) diabetesNon-smoker


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CHOLECYSTITISCHOLECYSTITIS

Is inflammation of the gallbladder, usually resulting froma gallstone blocking the cystic duct.

Gallbladder inflammation usually results from a gallstoneblocking the flow of bile.

Typically, people have abdominal pain that lasts more than 6 hours,fever, and nausea.

Ultrasonography can usually detect signs of gallbladder inflammation.

The gallbladder is removed, often using a laparoscope.

Is the most common problem resulting from gallbladder stones. It

occurs when a stone blocks the cystic duct, which carries bile fromthe gallbladder.

Cholecystitis is classified as acute or chronic.


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Acute Cholecystitis:

Acute cholecystitis begins suddenly, resulting in severe,steady pain in the upper abdomen.

At least 95% of people with acute cholecystitis havegallstones.

The inflammation almost always begins without infection,although infection may follow later.

Inflammation may cause the gallbladder to fill with fluid and itswalls to thicken.

Rarely, a form of acute cholecystitis without gallstones(acalculous cholecystitis) occurs.


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Acalculous cholecystitis is more serious than other types ofcholecystitis. It tends to occur after the following:

Major surgery

Critical illnesses such as serious injuries, major burns, andbodywide infections (sepsis)

Intravenous feedings for a long time

Fasting for a prolonged time

A deficiency in the immune system

It can occur in young children, perhaps developing from a viral oranother infection.


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Chronic Cholecystitis:

Chronic cholecystitis is gallbladder inflammation that haslasted a long time. It almost always results from gallstones.

It is characterized by repeated attacks of pain (biliary colic). Inchronic cholecystitis, the gallbladder is damaged by repeated

attacks of acute inflammation, usually due to gallstones, and maybecome thick-walled, scarred, and small.

The gallbladder usually contains sludge (microscopic particles ofmaterials similar to those in gallstones), or gallstones that either block itsopening into the cystic duct or reside in the cystic duct itself.

Gallstones (choleliths) are crystalline bodies formed within the body byaccretion or concretion of normal or abnormal bile components.

CHOLECYSTOLITHIASIS
http://en.wikipedia.org/wiki/Crystallinehttp://en.wikipedia.org/wiki/Accretionhttp://en.wikipedia.org/wiki/Concretionhttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Concretionhttp://en.wikipedia.org/wiki/Accretionhttp://en.wikipedia.org/wiki/Crystalline


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CHOLECYSTOLITHIASCHOLECYSTOLITHIAS

CHOLECYSTOLITHIASIS

The presence of one or more gallstones in the gallbladder.
http://www.answers.com/topic/gallstonehttp://www.answers.com/topic/gallbladderhttp://www.answers.com/topic/gallbladderhttp://www.answers.com/topic/gallstone


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DIAGNOSTIC PROCEDDIAGNOSTIC PROCED

DIAGNOSTIC PROCEDURES

ASSESSMENT and DIAGNOSTIC METHODS

Abdominal radiograph ultrasonography orcholecytography radionuclide imaging orcholescintigraphy. (ERCP) Percutaneous transhepaticcholangiography (PTC)

ULTRA- SOUND RESULTS

The gallbladder is normal in size. The wall is thick,thickness measures 8mm. There is a large highly

echogenic density inside with acoustic shadow at theneck measures 24 mm


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CD and CND are normal in caliber. No billiaryobstruction.

The liver is not enlarged. The echo texture is

uniform. No focal lesion.

The pancreas, spleen and both kidneys areunremarkable.

The urinary bladder shows smooth wall no intraluminal

echo.

The uterus is atropic.


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BLOOD TESTBLOOD TEST


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IV FLUIDSIV FLUIDSTAKENTAKEN


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URINALYSURINALYSISIS


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PATHOPHYSIOLOGYPATHOPHYSIOLOGYRisk Factors

Heredity, age over40, gender,obesity

Bile issupersaturatedwith cholesterol

and calcium

The soluteprecipitate fromsolution as solid

crystals

Crystals cometogether andfuse to form

stones

Gallstones

Obstruction of the cystic duct andcommon bile duct

Sharp pain in

the right lowerpart of theabdomen

JaundiceDistention of thegall bladder

Venous and lymphaticdrainage is impaired

Proliferationof Bacteria

Localizedcellular

Irritation

The gall bladder getsinflammed


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PATHOPHYSIOLOGYPATHOPHYSIOLOGY

Cholelithiasis is the presence of stones in the gallbladder.

Cholecystitis is acute or chronic inflammation of thegallbladder.

Most gallstones result from supersaturation of cholesterol in thebile, which acts as an irritant, producing inflammation in thegallbladder, and which precipitates out of bile, causing stones.

Risk factors include :

gender (women four times as like to develop cholesterol stonesas men),

age (older than age 40),multiple parity, obesity,use of estrogen and cholesterol-lowering drugs,bile acid malabsorption with GI disease,genetic predisposition, rapid weight loss.

Pigment stones occur when free bilirubin combines with calcium.These stones occur primarily in patients with cirrhosis, hemolysis,


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MEDICAL MANAGEMEMEDICAL MANAGEME


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SURGICAL INTERVENTSURGICAL INTERVENTI

CHOLECYSTECTOMYCHOLECYSTECTOMY

is the surgical removal of the gallbladder. Theoperation is done to remove gallstones or to removean infected or inflamed gallbladder.BENEFITS and RISK

Gallbladder removal will relieve pain, treat infection, and in mostcases stop gallstones from coming back. The risks of not havingsurgery are the possibility of worsening symptoms, infection, orbursting of the gallbladder.

Possible complications include bleeding, bile duct injury, fever,liver injury, infection, numbness, raised scars, hernia at theincision, anesthesia complications, puncture of the intestine, anddeath.


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NURSING MANAGEMENURSING MANAGEME

Discharge planning:

Advise patient to continue medication as ordered by thephysician.

Instruct the patient to do exercise as tolerated such aswalking.

Encourage the patient to increase fluid intake

Encourage the patient to have enough and adequate restInstruct patient to attend follow up checkups to the

physician.

Advised patient to a diet as tolerated but preferably low saltand low fat diet.


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NURSING CARE PLANURSING CARE PLA


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20577681 Cholecystitis With Cholecystolithiasis

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