Cholecystolithiasis or Cholelithiasis (Gallstones) Are crystalline structures formed by concentration (hardening) or accretion (adherence of particles, accumulation) of normal or abnormal

bile constituents Common disorder that refers to biliary tract stones, most of which in the gallbladder itself

Four Possible explanations for stone formation:

1. Change in bile composition 2. Gallbladder stasis may lead to bile stasis 3. Infection 4. Genetics and Demography

Gallstone formation involves three factors:

I. Bile must become supersaturated with cholesterol or calcium II. The solute must precipitate from solution as solid crystals III. Crystals must come together and fuse to form stones

Three Groups of Gallstone

a. Cholesterol Stone- stones are whitish yellow to tan in color b. Pigment Stone- contains an excess of unconjugated bilirubin Subdivided into: - black(associated with hemolysis and cirrhosis) - Earthy Calcium Bilirubinate Stones (associated with the infection of in the biliary system c. Mixed Stones- may be a combination of cholesterol and pigment stones or either of these stones with some other substance.

Clinical Manifestations:
Nausea and Vomiting Restless Flatulence Bloating Dyspepsia Belching Intolerance to fatty foods Vague upper abdominal sensations Right upper quadrant pain/ Epigastric area Biliary Colic

Risk Factors:
Fatty Foods Forty years old and above Female (Estrogen) Fair Skin(Whites, Native Americans) Fertile (Multiple Pregnancy) Family History

Complications
Bacterial Cholangitis Cholecystitis Gallbladder Cancer Choledocholithiasis

Cholecystitis (Inflammation of Gallbladder)

 2nd most frequent cause of abdominal pain that requires abdominal surgery

Types: a. Acute Cholecystitis - Arises from obstruction of cystic duct by gallstones and may cause complications with abscesses or perforation of the gallbladder

b. Chronic Cholecystitis - Arises from repeated attacks of acute Cholecystitis c. Acalculous Cholecystitis (-) gallstones; person has no previous symptoms or other evidence of gallbladder disease and experiences sudden excruciating pain in the upper abdomen.

Diagnostic Examinations:
1. Ultrasonography
 non-invasive technique in which high- frequency sound waves are passed into internal body structures and the ultrasonic echoes are recorded on an oscilloscope as they strike tissues of different densities.  It is useful in detecting enlarged gallbladder or pancreas, the presence of gallstones or appendicitis.

 Advantages: (-) ionizing radiation No suitable side effects Relatively low cost Immediate results Disadvantages: Cannot be used to examine structures that lie behind bony tissue because bone prevents transmission of ultrasound

Nursing Responsibilities:
Secure Consent Instruct patient to fast for 8-12 hours before the test to decrease the amount of gas in the bowel Instruct the patient to eat a fat free meal the evening before the test. Describe the test, including who will perform it, where it will take place, and how long it will last Provide for client privacy.

Position the patient

Result
- Mild Hepatomegaly with fatty infiltration and simple hepatic cyst - Multiple gallbladder stones with top normal size wall thickness - Normal Hepato- biliary tree and pancreatic head

Blood Chemistry
is defined simply as identifying the numerous chemical substances found in the blood. Nursing Responsibilities: - Define and explain the test - State the specific purpose of the test - Explain the procedure - Discuss test preparation, procedure, and posttest care Result: Glucose fasting: 5.56 mmol/L BUN: 6.5 mmol/L Creatinine: 73 micromolecule/L

Differential Count
 this test measures the percentage of each type of white blood cell (WBC) that you have in your blood. It also reveals if there are any abnormal or immature cells.  Nursing Responsibilities: - Define and explain the test - State the specific purpose of the test - Explain the procedure - Discuss test preparation, procedure, and posttest care Result: Lymphocytes: 39.4 Monocytes: 6.2 Granulocytes: 54.4

Hepatobiliary Iminoacedetic Acid Scan (HIDA)

 is an imaging procedure that helps track the production and flow of bile from your liver to your small intestine  Cholescintigraphy, hepatobiliary scintigraphy and hepatobiliary scan are alternative names for HIDA scan.  A HIDA scan is a type of imaging study called a nuclear medicine scan. This means the HIDA scan uses a radioactive chemical, or tracer, that helps highlight certain organs on the scan. Contraindications: - Pregnant and Lactating mother

Nursing Responsibilities
Secure consent Fast for a few hours. Delay taking some medications. Take medications that enhance the scan. Explain the procedure to the patient. Provide for privacy

Ask the client to change into a hospital gown before your HIDA scan begins.

Position the client, usually on his/her back. Advice the client to drink water throughout the day to help flush the radioactive tracer from the body.

Results
Normal: A normal result means that the radioactive tracer moved freely along with the bile from your liver to your small intestine. No problems were detected. Slow movement of radioactive tracer. If the radioactive tracer moves through your bile ducts very slowly, this may indicate a blockage or obstruction. Or it may indicate a problem in your liver.

 No radioactive tracer seen in the gallbladder: If the radioactive tracer isn't seen in your gallbladder, this may indicate inflammation (cholecystitis). Radioactive tracer detected in other areas: If the radioactive tracer is found outside of your biliary system, this may indicate a leak.

Cardio-Pulmonary Evaluation
1. Chest X-Ray- is a procedure used to evaluate organs and structures within the chest for symptoms of disease. Nursing Responsibilities: Ask if the patient is pregnant Secure Consent Explain to the patient that chest radiography assess chest anatomy. And tell to the patient that he needs to restrict food and fluids.

 Describe the test; including who will perform it and when will it take place. Provide for client privacy. Instruct client to remain motionless as much as possible while the procedure is going on. Provide gown without snaps, and instruct the patient to remove the jewelry and other metallic objects that may be in x-ray field. Explain to the patient that hell be asked to take deep breath and to hold it momentarily while the film is being taken to provide a clearer view of pulmonary structure.

Electrocardiography
is the graphical representation of the electrical activity of the heart. Nursing responsibilities: Secure Consent Explain to the patient an ECG evaluates the hearts electrical activity Tell the patient that he need not restrict food and fluids Describe the test, including who will perform it, where it will take place, and how long it will last

 Tell the patient that electrodes will be attached to his arms, legs, and chest and that the procedure is painless. Explain that during the test, hell be asked to relax, lie still, and breathe normally. Advise the patient not to talk during the test because the sound of his voice may distort the ECG tracing. Check the patients medication history for use of cardiac drugs and note the use of such drugs on the test request form.

Blood Typing
is a method to tell what specific type of blood you have. What type you have depends on whether or not there are certain proteins, called antigens, on your red blood cells. Nursing Responsibilities: - Define and explain the test - State the specific purpose of the test - Explain the procedure - Discuss test preparation, procedure, and posttest care

Subjective and Objective assessment

Monitor V/S Monitor the client for manifestations of obstructions from the gallstones Administer pain medications as ordered and document clients response to medications Encourage client to verbalize the effectiveness of the medication by describing whether the pain is absent or decreased Providing a quite environment and using relaxation techniques, such as back rub, or comfortable positioning may promote rest and enhance the effects of analgesics

Medical Management
Analgesics- PRN for pain Antacids- given to neutralize gastric acid hyperacidity and to reduce associated pain Antibiotics- to reduce the likelihood of infection Fluid and electrolyte balance- to maintain hydration

Surgical Management
Cholecystectomy (removal of the Gallbladder)
 Consist of excising the gallbladder from the posterior liver wall and ligating the cystic duct, vein and artery.

Nursing Interventions:
Secure Consent Explain the procedure and instruct the patient for NPO after midnight Give verbal instructions and demonstrations to ensure that the client can perform postoperative exercises Provide for clients privacy Position the patient Skin preparation

Contraindications: clients physical condition may not be able to withstand the stress of surgery, including loss of fluid, electrolyte and anesthesia

Complications: Hemorrhage Pneumonia Thrombophlebitis Urinary retention Ileus

STATISTICS
Number of Patients who suffered from Cholecystolithiasis in North America as of 2010
20,000,000 18,000,000

16,000,000

14,000,000

12,000,000

10,000,000

Number of Patients who suffered from Cholecystolithiasis in North America as of 2010

8,000,000

6,000,000

4,000,000

2,000,000

0 USA Canada

Number of Patients who suffered from Cholecystolithiasis in Asia as of 2010

90,000,000

80,000,000

70,000,000

60,000,000

50,000,000

40,000,000 Number of Patients who suffered from Cholecystolithiasis in Asia as of 2010 30,000,000

20,000,000

10,000,000

Analysis:
The data presented above clearly shows that the incidence of Cholecystolithiasis is common among Americans due to their diet and age because almost all American adults are obese.