CASE STUDY

“CHOLELITHIASIS”

PREPARED BY:
DE LA ROSA, KAREN N.
BSN III-C / SACLI

SUBMITTED TO:
MR. DELA CRUZ
I. OBJECTIVES

A. GENERAL

To be able to understand the disease process and to be

knowledgeable enough with regards the information to be
imparted to patients concerned.

B. SPECIFIC

a. To be able to know the condition of the patients having

cholelithiasis.
b. To be able to explain to the patient the nature of the
disease.
c. To be able to formulate ideal and appropriate
interventions for the client.
d. For the patient to be able to know their responsibilities
in the occurrence of the disease.
II. INTRODUCTION

a. BACKGROUND OF THE STUDY

Cholelithiasis is a common digestive disorder worldwide thus needed

prompt attention to be discussed. Over all 5 billion dollars were spent
annually in the United States due to the occurrence of this disorder.

b. DEFINITION OF THE CASE

Colelithiasis is the presence of stones in the gallbladder or bile ducts;

“chole” means bile, “Lithia” means stone, “-sis” means process.

c. GENERAL SIGNS AND SYMPTOMS

Gallstones may cause no signs or symptoms. If a gallstone lodges in a

duct and causes a blockage, signs and symptoms may result, such as:
 Sudden and rapidly intensifying pain in the upper right portion of
your abdomen
 Sudden and rapidly intensifying pain in the center of your abdomen,
just below your breastbone
 Back pain between your shoulder blades
 Pain in your right shoulder
Gallstone pain may last several minutes to a few hours.

d. ETIOLOGY

 Your bile contains too much cholesterol. Normally, your bile

contains enough chemicals to dissolve the cholesterol excreted
by your liver. But if your bile contains more cholesterol than can
be dissolved, the cholesterol may form into crystals and
eventually into stones. Cholesterol in your bile has no relation to
the levels of cholesterol in your blood.
 Your bile contains too much bilirubin. Bilirubin is a chemical
that's produced when your body breaks down red blood cells.
Certain conditions cause your liver to make too much bilirubin,
including liver cirrhosis, biliary tract infections and certain blood
disorders.
 Your gallbladder doesn't empty correctly. If your
gallbladder doesn't empty completely or often enough, bile may
become very concentrated and this contributes to the formation
of gallstones.
III. PATIENTS PROFILE

BIOGRAPHIC DATA

Name: Adan Herminio

Age: 58 y/o

Gender: Male

Nationality: Filipino

Marital status: Married

Religion: Roman Catholic

Date of admission:

Date of discharge: July, 7, 2009

Attending physician: Dr. Pineda and Dr. Yap

Diagnosis: Cholelithiasis r/o choledocholithiasis

Chief complaint: for cholecystectomy.

IV. ANATOMY AND PHYSIOLOGY

The gallbladder is a small non-vital organ which aids in the digestive

process and concentrates bile produced in the liver.

The gallbladder is a hollow organ that sits in a concavity of the liver known
as the gallbladder fossa. In adults, the gallbladder measures
approximately 10 cm in length and 4 cm in diameter when fully distended.
It is divided into three sections: fundus, body, and neck. The neck tapers
and connects to the biliary tree via the cystic duct, which then joints the
common hepatic duct to become the common bile duct.

The different layers of the gallbladder are as follows:

• The gallbladder has a simple columnar epithelial lining
characterized by recesses called Aschoff’s recesses, which are
pouches inside the lining.
• Under the epithelium there is a layer of connective tissue (lamina
propria)
• Beneath the connective tissue is a wall of smooth muscle
(muscularis externa)that contracts in response to cholecystokinin, a
peptide hormone secreted by the duodenum.
• There is essentially no submucosa separating the connective tissue
from serosa and adventitia, but there is a thin lining of muscular
tissue to prevent infection.
• There are mucous glands in the neck of the gallbladder.

The gallbladder stores about 50 mL of bile, which is released when

food containing fat enters the digestive tract, stimulating the secretion
of cholecystokinin (CCK). The bile, produced in the liver, emulsifies fats
in partly digested food.

After being stored in the gallbladder, the bile becomes more

concentrated than when it left the liver, increasing its potency and
intensifying its effect on fats. Most digestion occurs in the heat.

Most vertebrates have gallbladders, while invertebrates do not.

The human gallbladder is shaped like a pear, although the organ’s

shape and function vary considerably among other mammalian
species; in fact, in some species, such as the lamoids, the gallbladder
is absent.
V. PATHOPHYSIOLOGY
VI. LABORATORY AND DIAGNOSTIC TEST

HEMATOLOGY

interpretati
Result Normal
on
WBC count 10.9 5-10×10 9/L

Segmenters 0.75 0.55-0.65

Lymphocyte
0.25 0.25-0.35
s
Monocytes 0 0.01-0.06
Blood Indices
MCV 95.5 80.96 fl
RDW 17.8 11.5-14.5%
VII. DISCHARGE PLANNING METHOD

INDEPENDENT NURSING CARE

• Health teaching about the foods to be avoided

such as highly cholesterol food.
• Health teaching about the symptoms to be
reported including dark urine and signs of
inflammation and infection such as fever and pain.
• Instruct the patient for the adherence to treatment
regimen.
• Instruct the patient to avoid extra-exertion of force
to avoid exertion of force to the incision area.
• Instruct the patient to return to after 7 days prior
to discharge for check up.
 PRIMARY APPLIED
THEORY
REASON INTERVENTION
• Maintained
safe
environment
• Maintained
well ventilated
ENVIRONMENTAL External conditions
environment
THEORY affect life and the
• Maintained
(Florence individual’s
Nightingale) development. cleanliness
and noise free
environment.
• Providing diet
appropriate for
the condition.
•
INTERPERSONAL To develop an
P
RELATIONS IN interpersonal
rovide rapport
NURSING interaction between
With the client.
(Hildegard E. Peplau) client and nurse.
• Establish NPI.
• Encouraged to
increase fluid
intake.
14 basic needs is
• Encouraged
provided assist the
mobilization to
client sick or well
facilitate bowel
14 BASIC NEEDS that the client would
movement.
(Virginia Henderson) perform unaided if
• Suggested rest
they have necessary
and sleep for
strength, will or
faster recovery.
knowledge.
• Encouraged
verbalization of
feelings.
FOUR To use conservation • Encouraged to
CONSERVATION activities aimed at eat highly
PRINCIPLES optimal use of nutritious foods
(Myra Levine) client’s resources to enhance
 individual
energy.
VIII. RECOMMENDATION