Gallbladder Educational Materials

a cholecystectomy Handtony of Sai bladder *Present on inferior surfase of liver - is a Pear ShaPed, hollow, saclike organ - 7,5 to lo cm in long - is attached to liver with Connective tissue -CaPacitg 30: 50m bile * the function of the gait badder - Storage bite → stre bie untill needed far digestion after meal the gaubladder's wall Contract & SqueeZing bile red > hesi > is a thick, green to Yewswish brawn liquid made → liver Bile hePatic duct Connecting liver with gat bladder funcion help absorption of fat soluble substance aS › vitaminA, ED, excretion of bilirubin © bile Salts act as bactericides (destroy and kai bacteria) CANS 11, › water, Sodium, Potassium, Calcium, Chivide, biCarbonte and lecithin, fatty acid, Cholesterol, bili rubin, bile saits the absence of bile the fats became indigestable and exat excreted in fees steators the stool become white or gray and greasy instead of brown deficiency in fatty acids and fat Solude vitamins * the Cholesterol in bile accumiate Causing gunstones aT to 01e Disorders of gaubladder → Cholecystitis, Cholelithasis I Cholecystitis * is acure inflammation of gaubladder Causing Pain, tenderness, rigidity of upper right abdomen Vadiate, mid Stemal area or right shoulder with nausa, Vomiting & Signs of inflammation and Pus in gau bladder Types of Cholecystilis Calculus CholecyStitis Acalculus Cholecystins inflammation of gall bladderuith|Stone *is acute gaubiodder •* Stones → obstructs bile outFisw inflammation without * 907. of Cases of acute CholeCystitis gaul Stones *Bile veraining in Sull bladder Causes Causes → Surgicat Pratelues a Chemical reaction → autolysis →> edema severe trauma. Burns, Primary *Compression on biood vesser → decrease infeCtion, Blood Hans fission vascular supply → SarArene→ PefeForation, Bile Stasis, alter frid 2 *bacteria Play a tole in CholeCystitis anel electrolyte torsion 2 * organism - GIT: secondary infection increase viscosity of bile e 2 Stages of acute chole cystitis * Salbladder is swelling and edematous → obestraction of aystic duce → @ the lau bladder begins to be necrotic and get sPeckled → waul beinde ® Sau bradder become gangrenad WANI dark green or black → Perforate beone # cholelithiasis 3 x Calculi or Stones formed in gau bladder from the solid Constituents of bie Gastones is Callection of hard Solid materias that form in Scablate the size may be smai (seen by microscore) or large Risk factors of Choletithiasis *obesity * women had multiple Pregnancies *frequent Change in weight * Rapid weight lass & treatment with high dose estrosen * Cystic fibrosis *oliabetes mellieus = Patho Phystoogy two major tyPes of gau Stones 9 ment Stones Cholesterol stones *unconju gated Pigments (binkubin) * 75 7. of Cases of gaubladder in the bile help to form Stomps discuse * A bile acid & 1 cholesterol lead to the risk factors, increased Patient the form of Stones Fromcholester, C with cirrhosis, hemolysis, and * Sene act as irritant Cause infection of biliary tralt inflammation *Pigment stones Cann't be dissolves Characteristics → Should be remuved Surgicaly (female), more than 40 Years old (forry) , multiParous (ferfle), *Stoneformation more frequent and obese (fally) With People use oral ContacePtive Pilk * Femore 2:3 msrethan mate and estrogen →Tes cholesterol * Stone plage = , tcholsterse, Ubie Manifestation. *may be silent (no Symptoms) _yno Pain only, Mild GI TsymPtoms * Stones can be detected during surgery * two types of SymPtoms → D due disease of gambladder it self › D due obestraction of bill Passuge by D Pain → gau stone obstructs the Custic duct, gan bladder become Stone distended, Patient have fever and Palfable abdominal mass, have Pain in upper right abdominal cavity radiates to back and righr shoulder, nausea, Vomiting Jaundice oCcur with obestraction of Comman bile duct, bile Bib, skin, mucous membrane Causing itching and yensal color B changes in urine and Stal Colar bile T excreted, urine →dark urine + bile ] → Stool → grash. I vitamin Deleficienty clay colored obestruction of bile flow → L absofation of Vitamin D,E, A, K - Far Sumoe lead to deficiency of these vitumins aS > I, Vitamin lad, beeding Assessment and Diagnostic finding • *Abdominal X-ray *ulhasnography (bile iso isi do sidio prio) *Cholecystography → aup → stone dod one salate vill 2 *ERCP→/endasCoPic Retrograde cholangio Runcreato graphy) → direct visualization of Straqure, use endoscope isll → evaluate location of Staner" Nursing implecation for ERCP → Parent take nothing fer mouth, maderate sedation, nurse observe CiS and resPiratory dePression, monitar Iv fluid, administer mediCatien and Position After ERCP → monitor a Patient's condition. observe vital signs, monitar signs of infection * * Radinudide imaging or chaesintigraphy asino asto used when ultrasonography is not conclusive ding blockage f bileduG. disadvatage → more exfensive take lonfer, tea eXPose Patic to radiation @ *Percutaneous Trans hePatic cholangiegrapiinjection of dye directry into the binary tract is used, distinguishing jaundice, Investigating GI symPtoms, locating Stones in the bire ducts and diagnosis Cancer MediCal Management. Nutritional and Supportive theraßy *80% of Patient -remission by rest, Iv fluids, nasogastric Suction, analgesia and antibiotic agents * diet → timited to low fat liquids -ol auton * avoid eggs, cream, Prok, Fried Foods , cheese, go forming vegetabies and alcohol * instruct Patient that fatty food induce an ePisode of Cholecyse l * don't increase amount of fruits, rice, tapioca, lean meats I Pharmaciogical therapy 1 → 6 to 12 manth * ursodeoxychoric acid → actigail, chenix → used to dissouve e Small, radiolucent Sal Stones Compased of Cholesterol * Treatment with UDCA → reduce size of Store and dissove Small vindication → Patient who refuse surgery or sungary is to isions → Contraindiafion→ Patient with cystic duct occlusion or Pigment & Non Surgical Removal of Saustone Stone → Dissolving gaul stones stel methy, tertiary butyl enr * by several methods infusion of (Solvent) into gau bladder → stone Venual by instrumentation → jost stone Malli! *A Catheter and instrument with a basket atached are threated thyough the T-tube tract or fistula formed at the time of T tube insertion * basket used to retrieve and removal of the stones lodged in the Common bile duct → Intracor Poreal * Stones in gail bladder may be fragmented by › laser Pulse technudy * A laser Purse is directed by under Fiuoroscopic quidence with the use of device that distinguish between stones and tissue * the laser Purise Procluce mechanical Shock wave on the Stone Surface → Exhacorporear shock wave tithotrißsy (Estil) * Non invasive Procedure, use repeated shock waves directed at the gall stone in gau bladder * *after Stone are broken up, the Stone fragments Can Pass from • gall biadder or Comman bie duct - Veruled by endoscopy or dissoives by sa veni Surgical Management goal → to refieve the symptoms, to remove Cause of biliary colic and to treat acute cholecyStitis 2 @ Preoperative measures 2 → Chest X-ray, electroCardio gram, liver function test, Kiray of gali biadde → → vitamin K administration If, low Prothrombin time 2→Nutritional reguirements aS SIV Sulose & Plotein -aid wound healing 2 and Pievent liver damage → tuming and deep breathing betire surgery 2 → inform Patient about drainage tubes and durgastric tube and suction Two methods use → laparoscopic cholecystectomy i surgical chorecystecromy *laparoscopic Cholecystectomy Xisused for symptomatic gau Stone *if bile duct is obestructed amn, E RCP with SPhin cteroforny to explore cluct Before aparoscopy * Inform Patient that open abdominal Procedure with general * is Performed through smau opening in abdominal wal anesthesic in afaroscopy → the Surgeon make four smau inscions in the abdomen, insert laParoscope with Camera throug inscion, the Camera Show Sau bladder and adjacent tissue which allow surgeon to visualize organ for remoual 3 Compilaion of laParo scope cholesteemy → bie duty * SurgiCal Chole Cystectomy *Performed for alute and chronic Cholecystits * the gaul bladder is remoued through an abdominal takin incision after the cystic duct and artery are ligated * if there is abile leat Place adrain close to gallbladder bed and brought out Through Puncture wound Nursing Process →Patient with surgery for gait bladder @ Assessment * nurse instruct Patient to avoid Smoking to Prevent Rumonary Comprican " use of AsPrinor other that alter * assess Respiratory Status history of smoking, urion stanlation (vote → After surgery → Hatient's Position IS lou) Fowler's Positin * Nursing Diagnosis and Interventions. (Acure Pain) → Altered in comfurt related to surgical incision *avoid turning & moving, encourage deep breath, administer analgesic * hep Patient to turn, Cough, breath, Put Pilbul on insicion Site • imPaired gas exchange related to abdominal surgical insician • * teach Patient to take deep breath and Cough, use in centive SPirometry, early ambutation to Prevent thrambaPhlebifis & Palmanany @Im Paired skin integriry felated to alter biliary drainage after › Surgical intervention #the nurse should fasten tube, dressing, gown • *obserue for indiCation of infection, leatage of bile vobserve yenow • discalation *obserue righr upper abdaminat Pain • *Change dressing to Aotect Skin uithin 7 to 14 day remove. dra nag • El Imbalanced vutrition, less than body requirements relared to inadequare bile secretion *fatient's diet → bowfat, high Carbohydrat deficient knowledge about Self Care acturies related to incision Care, , dietary modification, medication, signs & SymPlans(bleeding, vamiting) * Potential ComPiCations → Bleeding → gastrointestinal SymPtums → related to biliary leak * Monitor & managing Potential ComPlication→ Monitor Vital signs, assess for tenderness or rigidiry of abdomen, instruct to refort surgeon any abnormality in Stool, assess loss afRaitie, Pain * * Promating home & community Care 3 → Heuching Parient seif Care + Care of wound SENA - * Manage Pain * Resuming eating * monitor & follow up Care