Gallbladder Disease in Pediatrics and Pregnancy

Gallbladder Disease in Children and Adolescents

• Pediatric gallbladder disease was previously often linked to underlying conditions causing hemolysis and bilirubin release.
• This type of gallstone is still prevalent at a stable 15%.
• Cholesterol gallstones have become the dominant type due to rising pediatric obesity.
• Cholecystectomy for cholesterol gallstones has increased dramatically, over 200%.

Gallbladder Disease in Pregnant Women

• Pregnancy physiology increases the incidence of gallbladder disease.
• Symptoms during pregnancy include pain, nausea, vomiting, itching, jaundice, and dark urine.
• Gallbladder disease frequently requires surgery during pregnancy.
• Maternal-fetal outcomes are generally better with surgery during pregnancy than waiting until after childbirth.
• Gallbladder disease is common in the first year postpartum, and the incidence of biliary sludge and gallstones is linked to the number of pregnancies and age at pregnancy.

Gallbladder Disease in Older Adults

• Older adults may present with vague gallbladder disease symptoms, such as malaise or lack of appetite.
• Surgery poses higher risks for older adults, leading to increased ICU admissions and mortality.
• For those 70 years of age or older, ICU admissions were 14.1% vs. 4% in younger patients, and mortality was 6.5% vs. 0.6% in both elective and emergent cases.
• Exploration of non-surgical treatments for gallbladder stones in older adults is recommended.

Nursing Care of the Patient with Gallbladder Disease

• Nursing care focuses on patient teaching, pain management, and healthy nutrition guidance.

### Assessment

• The nurse observes and interviews the patient to assess current manifestations, including:

  • Right upper quadrant (RUQ) pain, its character (e.g., sharp, dull, cramping), relationship to meals, duration, and radiation
  • Nausea and vomiting
  • Other symptoms (e.g., fever, chills, jaundice)
  • Duration of symptoms
  • Risk factors or previous history of symptoms
  • Chronic diseases such as diabetes, cirrhosis, or inflammatory bowel disease (IBD)
  • Current diet
  • Use of oral contraceptives or possibility of pregnancy

• The nurse conducts a physical examination to assess:

  • Current weight
  • Color of skin and sclera
  • Abdominal tenderness
  • Color of urine and stool

Diagnosis

• Potential problems for patients with cholelithiasis or cholecystitis include:
  • Potential for infection
  • Acute pain
  • Need for education on a healthy diet

Planning

• Goals of nursing care, developed in collaboration with the patient, may include:
  • The patient will demonstrate no signs or symptoms of infection.
  • The patient will report adequate pain control.
  • The patient will verbalize understanding of a low-fat diet with adequate intake of fat-soluble vitamins.
  • The patient will verbalize awareness of symptoms that require immediate notification of the healthcare provider (HCP).

Explore the complexities of gallbladder disease in children, adolescents, and pregnant women. This quiz covers the increasing prevalence of cholesterol gallstones, the impact of obesity, and the significance of timely surgical interventions during and after pregnancy. Test your knowledge on symptoms, treatment, and maternal-fetal outcomes.