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Approach to a Patient

with Gallbladder
Anatomy of Gallbladder
Anatomy of the
 Pear-shaped

hollow sac-like
 lies in a shallow

depression on the
inferior surface of
the liver
 Normal capacity is

Bile Flow
 In the fasting state, the Sphincter of
Oddi offers a high pressure zone:
- to prevent reflux of duodenal
contents into the bile ducts
- to promote bile filling of the
- is released in the duodenal
mucosa in response to the ingestion
of fats and amino acids.
 Contraction of gallbladder
 Decreased resistance of the Sphincter of
 Increased hepatic secretion of bile
 Enhanced flow of biliary contents into the
Enterohepatic Circulation
Diseases of the
Acute Cholecystitis
 Types: calculous (90%) stone
obstructs bile
acalculous absence of
obstruction by
Cholelithiasis (Gallstones)
 Formation of stones in the cystic duct
 Types of Stones:

- cholesterol
- pigment
- stones
Risk Factors:
 Obesity
 Women,especially those who had
multiple pregnancies
 Frequent changes in weight
 Rapid weight loss
 Treatment with high dose estrogen
 Ileal resection/ disease
 Diabetes Mellitus
Clinical Manifestations
 Pain and Biliary Colic
 Jaundice
 Changes in urine and stool color
 Vitamin Deficiency
Diagnostic Procedures
A. Plain Abdominal X-ray - to rule out
other possible diseases
B. US – detects gallstones with 95%
C. Cholescintigraphy – biliary tract is
scanned after
administration of a
radioactive agent
D. Cholecystography – to visualize
biliary tract; x-ray is
obtained after an oral
contrast is administered
Surgical Management
 Laparoscopic Cholecystectomy
 Open Cholecystectomy
Nutritional and Supportive
 80% of patients with acute
cholecystitis achieve remission with
rest, IV fluids, analgesia and
 Low-fat liquid diet; should avoid hihg
fat diet
Pharmacologic Management
 Dissolving agents
 Ursodeoxycholic acid
 Chenodeoxycholic acid

*** desaturates bile by inhibiting the

synthesis and secretion of cholesterol
*** taken for 6-12months
Nonsurgical Management
 Dissolving gallstones – infusion of a
solvent in the gallstone (MTBE)
 Stone removal by instrumentation
 Extracorporeal Shock-wave
 Intracorporeal Lithotripsy
Nursing Management
 Assessment
 History taking
 Preadmission testing
 Client teaching on procedures
 Patient’s capability to undergo
 Diagnosis
 Acute pain and discomfort
 Impaired gas exchange r/t high
abdominal surgical incision
 Impaired skin integrity r/t altered biliary
drainage (T-tube)
 Imbalance nutrition
 Deficient knowledge about self-care
activities r/t incision care, dietary
modifications, medications and follow-
 Planning and Goals
 Relief of pain
 Adequate ventilation
 Intact skin and improved biliary
 Optimal nutrition intake
 Absence of complications
 Understanding of self-care routines
 Nursing Interventions
 Monitoring and Managing Complications
 Bleeding, infection, leakage
 Improving Nutritional Status
 Low fat high carbohydrate and protein
 Promoting Skin Care and Biliary
 T-tube care
 Improving Respiratory Status
 Turning, early ambulation, deep breathing
 Relieving Pain
 Administer analgesics as ordered
 Pillow or binder on the side of incision site
 Evaluation
 Reports decrease in pain
 Demonstrates appropriate respiratory
 Exhibits normal skin integrity
 Obtains relief of dietary intolerance
 Absence of complications