Gallbladder Disease Overview

Gallbladder Disease Overview

• Gallbladder disease encompasses conditions related to the gallbladder, including gallstones (cholelithiasis) and inflammation (cholecystitis).
• Gallstones are a common issue, with approximately 10-15% of adults in North America and Europe affected.
• The prevalence of gallstones is lower in Africa and Asia, reasons are not elaborated in the presented information.

Gallbladder Function

• The gallbladder concentrates and stores bile secreted by the liver.
• Bile is a yellow-green fluid responsible for fat digestion and absorption.

Disorders of the Biliary Tract

• Cholelithiasis: Presence of gallstones in the gallbladder.
• Cholecystitis: Inflammation of the gallbladder often related to gallstones.
• Gallbladder cancer is a rare condition.

Cholecystitis Etiology and Pathophysiology

• Obstruction, usually from gallstones or biliary sludge.
• Infections, such as Escherichia coli.
• Trauma, extensive burns, or recent surgeries.
• Other factors including adhesions, neoplasms, or anesthesia.
• Major pathophysiological condition that may be confined to the mucous lining or entire wall, gallbladder is edematous and hyperemic.
• Bile or pus may be present in a distended gallbladder.
• Cystic duct may become occluded.

Cholecystitis Signs and Symptoms

• Common symptoms include upper abdominal pain (often severe, intermittent, or persistent), Right Upper Quadrant (RUQ) tenderness that may radiate to the right shoulder or epigastric area.
• Nausea and vomiting.
• Potential history of intolerance to fatty foods, dyspepsia, or heartburn, flatulence.
• If obstruction is present, jaundice, clay-colored stool, steatorrhea (fatty stools), dark urine, and tendency to bleeding may also be seen.

Cholelithiasis Etiology and Pathophysiology

• Cause of gallstones is unknown.
• Balance between cholesterol, bile salts, and calcium in solution can be altered, leading to infection or metabolic disturbances in cholesterol.
• Bile supersaturated with cholesterol results in precipitation.
• Other components such as bile salts, bilirubin, calcium, or protein may contribute to stone formation.
• Primarily cholesterol stones are most common (90%).
• Immobility, pregnancy, and inflammatory or obstructive lesions of the biliary system can decrease bile flow.

Cholelithiasis Signs and Symptoms

• Pain severity can vary from mild to severe based on whether stones move or are lodged,
• Biliary colic: Intermittent severe pain in the upper right abdomen. Possible symptoms may also include: -Tachycardia -Diaphoresis (sweating) -Prostration (collapse)
• Pain lasting for an hour or more.
• Tenderness in the right upper quadrant after attack subsides.
• Pain attacks often after a heavy meal or lying down.

Complications of Gallbladder Disease

• Cholangitis
• Choledocholithiasis
• Gangrenous cholecystitis
• Pancreatitis
• Gallbladder rupture
• Peritonitis
• Biliary cirrhosis
• Carcinoma

Diagnostic Tests

• Ultrasound for visualizing the gallbladder and assessing gallstones.
• Laboratory tests including liver function studies, WBC count, serum bilirubin, and serum amylase.
• ERCP (Endoscopic Retrograde Cholangiopancreatography), and Percutaneous transhepatic cholangiography—invasive procedures.

Collaborative Care: Conservative Treatment of Cholelithiasis

• Oral medications to dissolve gallstones.
• Replacement of fat-soluble vitamins.
• Lithotripsy.
• ERCP to treat complications like obstruction or remove stones.

Collaborative Care: Surgical Treatment of Cholecystitis

• ERCP
• Laparoscopic cholecystectomy (minimally invasive): Removal of gallbladder.
• Open cholecystectomy (large incision): Removal of gallbladder.
• Transhepatic biliary catheter—to treat complications like obstruction.

Post-Op Nursing Care

• Routine monitoring and pain management.
• Management of nausea and vomiting.
• Monitoring for complications such as obstruction.
• Keeping incisions dry and teaching about signs of infection
• Gradual resumption of usual activities.
• Low-fat diet.
• No heavy lifting for 4-6 weeks (following open cholecystectomy).
• Postoperative pain relief and support strategies are important.

Gallbladder Cancer

• Primary cancer in the gallbladder is uncommon, often detected in advanced stages.
• Early detection and surgery may be curative but prognosis is considered poor.

Case Study (Example)

• 35-year-old woman with severe abdominal pain in the right upper quadrant.
• Elevated WBCs and bilirubin.
• Ultrasound confirms the presence of gallstones.

Discussion Questions

• What are the immediate and long term priorities of care?
• What are the available treatment options?
• What considerations should be made for prevention or recurrence?

Term Paper Format

• APA format, professional presentation (in a folder), title page and header, pagination, and in-text citations, and references page (3+ references).
• Spelling, punctuation, and grammar are necessary

Introduction (8 points)

• Formal academic paper format.
• Purpose statement of paper.
• Patient profile, medical diagnosis, history of present illness.
• Relevant medical history.
• Psychosocial (emotional) aspects and family involvement.

Assessment & Planning (30 points)

• Actual or potential concerns; using JAC framework.
• Significant data.
• SMART outcomes/objectives.
• Proposed nursing interventions with rationales.

Implementation (5 points)

• Detailed account of actions taken.
• Justification for choices made.
• Any deviation from the plan and rationale.

Evaluation (5 points)

• Whether identified outcomes were achieved, modifications made to the plan, and rationale for each strategy.

Collaborative Care Plan (9 points)

• Involvement of other health professionals.
• Specific interventions and rationale.
• Medical and/or surgical treatment plan.

Discharge Planning (15 points)

• Examining the patient's strengths and resources (using the 5 basic resources method).
• Information and support for significant others.

Conclusion (3 points)

• Summary of paper's learnings.

This quiz covers the basics of gallbladder diseases, including gallstones and cholecystitis. It explores the function of the gallbladder, common disorders like cholelithiasis, and the underlying etiology and pathophysiology of cholecystitis. Test your knowledge on this essential aspect of digestive health.