Gallbladder Disease 51J Fall 2024 Notes PDF

GALLBLADDER DISEASE D e v e lop e d b y T.S t runa F2 0 1 6 ; Re v ise d b y C. D a v id son F2 0 1 9 P re se nt e d b y B O a b e l 2 0 2 0 Re v ise d a nd p r e se nt e d By M. Cy r Fa ll 2 0 2 4 Readings & References ◦ Lewis, S., Heitkemper, M., Dirksen, S...

GALLBLADDER DISEASE D e v e lop e d b y T.S t runa F2 0 1 6 ; Re v ise d b y C. D a v id son F2 0 1 9 P re se nt e d b y B O a b e l 2 0 2 0 Re v ise d a nd p r e se nt e d By M. Cy r Fa ll 2 0 2 4 Readings & References ◦ Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher, L. (2023). Medical- Surgical nursing in Canada: Assessment & management of clinical problems. (5th Canadian Ed.). Toronto, ON: Elsevier Canada. pp 1111-1116 Objectives ◦Explain the pathophysiology, clinical manifestations, complications, and collaborative care, including surgical therapy, of patients with gallbladder disorders. ◦Describe the nursing management of patients undergoing conservative or surgical treatment of cholecystitis and cholelithiasis. Where is our gallbladder?  The biliary tract consists of the gallbladder and the duct system. The gallbladder is a pear- Function of shaped sac located below the liver. the The function of the gallbladder is to gallbladder concentrate and store bile. What is bile? A. Bile is a bitter, alkaline, brownish- yellow or greenish- yellow fluid that is secreted by the liver, stored in the gallbladder, and discharged into the du odenum and aids in the emulsification, digestio n, and absorption of fats B. Bile is a bitter, alkaline, browning-yellow or greenish-yellow fluid that is secreted by the pancreas and stored in the gallbladder, and aids in the emulsification and digestion of fats. What is bile? C. Bile is a yellowish fluid that is secreted by the stomach and aids in the absorption of fats. D. Bile is a blackish fluid that is secreted by the liver, and stored in the gallbladder and discharged into the duodenum and aids in the emulsification, digestion, and absorption of fat s  Cholelithiasis (stones in the Disorders gallbladder) of the Cholecystitis (inflammation of the biliary gallbladder) tract Gallbladder cancer (rare)  Interesting facts! Cholecystectomy Cholelithiasis The prevalence is (removal of the occurs in 10 to lower in Africa and gallbladder) ranks 15% of adults in Asia- Why do you among the most North America and think? common surgical in Europe. procedures.  The incidence of cholelithiasis is higher in women, particularly multiparous women, and in people older than 40 years. Postmenopausal women receiving estrogen therapy Risk factors Women receiving oral contraceptives Other risk factors: sedentary lifestyle, a familial tendency, and obesity. ◦ Cholecystitis ◦ Most commonly associated with obstruction ◦ Gallstones or biliary sludge ◦ In absence of obstruction ◦ Occurs in older adults and those who have Etiology and trauma, extensive burns, or recent surgery ◦ Bacteria Pathophysiolo ◦ Escherichia coli—most common gy- ◦ Other factors include ◦ Adhesions Cholecystitis ◦ Neoplasms ◦ Anaesthesia ◦ Opioids  Etiology and Pathophysiology ◦ Cholecystitis causes (Cont.) ◦ Inflammation ◦ Major pathophysiological condition ◦ Confined to mucous lining or entire wall ◦ Gallbladder is edematous and hyperemic ◦ May be distended with bile or pus ◦ Cystic duct may become occluded Signs & Symptoms of Cholecystitis ◦Upper abdominal pain which may be severe (Pain may be intermittent or persistent) ◦RUQ tenderness, may be referred to right shoulder or to the epigastric area ◦Nausea and vomiting ◦May have history of fat intolerance, dyspepsia, heartburn or flatulence  Signs & Symptoms of Cholecystitis If cholecystitis is accompanied by obstruction, may also have: ◦Jaundice ◦Clay colored stool ◦Steatorrhea ◦Tendency to bleeding ◦Dark colored urine ◦Intolerance to fatty foods  Etiology and Pathophysiology Cholelithiasis ◦Cholelithiasis ◦-Cause of gallstones unknown ◦Develops when balance that keeps cholesterol, bile salts, and calcium in solution is altered ◦Causes include infection and disturbances in metabolism of cholesterol. ◦Bile in gallbladder is supersaturated with cholesterol. ◦Precipitation of cholesterol results. ◦ Cholelithiasis (Cont.) ◦ Other components of bile that precipitate into stones include ◦ Bile salts ◦ Bilirubin ◦ Calcium ◦ Protein  Etiology and Pathophysiology ◦Cholelithiasis (cont.) ◦Stones that are primarily cholesterol are the most common. (90%) ◦Immobility, pregnancy, and inflammatory or obstructive lesions of biliary system ↓ bile flow. Cholelithiasis  May be severe or silent Signs & Symptoms Severity depends on stationary or mobile stones of Cholelithia Obstruction sis biliary colic  Pain severity depends on Presence of obstruction Whether or not stones move Signs & Stones lodged in ducts or moving Symptoms may cause spasm. Can produce severe pain Termed biliary colic, although more steady of than colicky Pain could be accompanied by tachycardia, Cholelithia diaphoresis, and prostration Pain may last an hour. sis When it subsides, tenderness in right upper quadrant develops. Attacks of pain occur 3 to 6 hours after a heavy meal or after lying down. ◦ Cholangitis ◦ Choledocholithiasis ◦ Gangrenous cholecystitis Complicatio ◦ Pancreatitis ns of ◦ Gallbladder rupture gallbladder ◦ Peritonitis ◦ Biliary cirrhosis disease ◦ Carcinoma  Common diagnostic tests ◦Ultrasound ◦Laboratory tests ◦Liver function studies ◦WBC count ◦Serum bilirubin ◦Serum amylase ◦ERCP ◦Percutaneous transhepatic cholangiography Collaborat ive Care Conservati ◦ Oral medications which dissolve stones ve ◦ Replacement of fat soluble vitamins Treatment ◦ Lithotripsy ◦ ERCP of Cholelithia sis ERCP ◦In-patient or day surgery ◦NPO before and until gag returns ◦Local anaesthetic to throat to decrease gag reflex ◦Sedation (sleepiness) or sometimes general anaesthetic ◦Subjective data  Collaborative Care Conservative Treatment of Cholecystitis ◦Low fat or NO fat diet ◦Pain control+++++ ◦Control of fever ◦Antibiotic treatment ◦Maintain fluid & electrolyte balance ◦Gastric decompression ◦Anticholinergic medications  Collaborative Care Surgical or ◦ ERCP procedure Invasive ◦ Laparoscopic cholecystectomy Treatment of ◦ Open cholecystectomy Cholecystitis/Chol ◦ Transhepatic Biliary catheter elithiasis  Post-op Nursing Care ◦Routine post-op monitoring & care (see Lewis: Table 22- 3) ◦Pain management ◦Manage nausea & vomiting ◦Monitor for signs of obstruction/acute complications ◦Keep incisions dry for 3 days ◦Teaching signs & symptoms of infection ◦Resume usual activities as tolerated/gradually ◦Low fat diet (72h-1w) –> DAT as tolerated (need adjustment) ◦No heavy lifting x 4-6 weeks (open cholecystectomy)  Postoperatively, a patient with an 1. Assess lung sounds every 2 to 4 hours incisional cholecystectomy has a 2. Provide analgesics to relieve incisional pain nursing diagnosis of ineffective breathing 3. Assist the patient to cough and deep pattern related to breathe every hour splinted respirations secondary to a high 4. Position the patient on the operative side to abdominal incision. The splint the incision nursing intervention that should be implemented first for this patient is to: Gallbladder Cancer ◦Primary cancer of the Gallbladder is very uncommon ◦Gallbladder cancer often is not detected until the advanced stage ◦If found early, surgery can be curative (rare) ◦Can lead to liver involvement, presence of venous or lymphatic invasion, and lymph node metastasis ◦Poor prognosis  ◦ a. Recommendation of a diet low in The nursing saturated fat management of a client with ◦ b. Information that gallstones once removed cholecystitis in tend not to recur association with ◦ c. Avoidance of morphine in the cholelithiasis management of pain should include which of the ◦ d. Treatment with oral bile salts that following? dissolve gallstones  What information ◦ a. Keeping the bandages on the puncture sites should be for 48 hours included in teaching about ◦ b. Reporting any bile-coloured drainage or pus home from any incision management after a ◦ c. Using over-the-counter antiemetics if nausea and vomiting occur laparoscopic cholecystectom ◦ d. Emptying and measuring the contents of the y? bile bag from the T-tube every day  ◦ 35-year-old woman presents to emergency department complaining of acute abdominal pain. ◦ She points to pain in the right upper quadrant. Case study ◦ She describes the pain as 7 out of 10. ◦ Lab values show elevated WBCs and bilirubin. ◦ Ultrasound confirms gallstones.  1. What is her priority of care? Discussion 2. What are her treatment options? questions 3. What can you teach her about avoiding complications or recurrences?  51J Nursing Term Paper ◦APA format (10) ◦Professional presentation in a folder ◦Title page and Header ◦Pagination in right upper corner starting on Title page ◦In-text citations ◦Reference page (3 + references) ◦Spelling, punctuation & grammar (10)  Introduction to paper Formal academic paper – introduce purpose of the paper Introduction of patient Introductio Patient profile: n (8) medical diagnosis history of present illness pathology of current illness pertinent past medical history Psychosocial & family  (30) Assessment & Planning: Two priority concerns ◦Can be actual or potential concerns ◦Include the following for each concern ◦Use JAC framework ◦Link significant data ◦State Outcomes/ objectives (SMART) ◦Proposed nursing interventions with rationales Implementati What did you actually do? on: Was the entire plan Nursing carried out … or not? Why, interventions why not? Justify selection of (5) interventions that were or were not implemented  Evaluation of Modificati whether on of identified Nursing outcomes were Care Plan (5) achieved (5) Reassessment & Evaluation: modification of original plan (2 strategies) Provide rationale for each strategy  Medical and/or surgical treatment plan Collaborati Involvement and planning of other professional ve Care members of the health care team (identify at least Plan (9) two) Identify specific interventions carried out by them and include rationales for each  Examine all strengths & resources using the 5 Basic Resources Patient Significant others Information Discharge planning (15) Professional Environment Discuss each resource even if absent or no issues and provide explanation Explain for each how the client’s strengths & resources facilitate or interfere with discharge planning Conclusion (3) ◦ State what you learned from writing this paper ◦ Remember!!! ◦ An electronic copy of your paper must be sent to your first rotation clinical teacher by 23:59 on October 21st , 2024. ◦ In addition, a hard copy of your paper may be required by your first rotation clinical teacher (additional instruction to follow).