Cholelithiasis

Cholelithiasis

The presence of one or more calculi (gallstones) in the gallbladder is referred to as cholelithiasis. Gallstones affect 20% of persons over the age of 65 and roughly 10% of adults in wealthy nations. Gallstones often have no symptoms. Biliary colic is the most typical symptom; gallstones do not result in dyspepsia or a fatty food intolerance.

Gallstones, which are made of cholesterol, calcium salts, and bile pigments, form as a result of cholelithiasis. Gallstones that obstruct bile flow cause the gallbladder to swell, which increases the risk of discomfort, inflammation, or infection.

Causes

• There is too much cholesterol in bile. Normally, the molecules in your bile are sufficient to break down the cholesterol your liver excretes. However, if your liver excretes more cholesterol than your bile can break down, it may crystallize and eventually turn into stones.
• There is too much bilirubin in bile. The chemical bilirubin is created when your body destroys red blood cells. Your liver produces too much bilirubin under some circumstances, such as liver cirrhosis, biliary tract infections, and certain blood diseases. Gallstone development is influenced by the excess bilirubin.
• The gallbladder does not properly drain. Bile may become extremely concentrated if your gallbladder doesn't drain fully or frequently enough, which helps gallstones develop.

Symptoms

• Upper right abdominal region pain that develops suddenly and quickly,
• Immediately below your breastbone, in the middle of your abdomen, there is a sharp, rapidly escalating pain.
• Between your shoulder blades, back pain,
• Your right shoulder hurts.

Diagnosis

• Ultrasound. This quick procedure is done in your doctor’s office, and it makes images of the inside of your body.
• CT scan. Specialized X-rays allow your doctor to see inside your body, including your gallbladder.
• Magnetic resonance cholangiopancreatography (MRCP). This test uses a magnetic field and pulses of radio-wave energy to make pictures of the inside of your body, including the liver and the gallbladder.
• Cholescintigraphy (HIDA scan). This test can check on whether the gallbladder squeezes correctly. Doctors inject a harmless radioactive material, which makes its way to the organ. The technician can then watch its movement.
• Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones.
• Endoscopic retrograde cholangiopancreatography (ERCP). The doctor inserts an endoscope through your mouth down to the small intestine and injects a dye to allow the bile ducts to be seen. He can often then remove any gallstones that have moved into the ducts.

Treatment

• Laparoscopic cholecystectomy. This is the more common procedure. The surgeon passes instruments, a light, and a camera through several small cuts in the belly. He views the inside of the body on a video monitor. Afterward, you spend the night in the hospital.
• Open cholecystectomy. The surgeon makes bigger cuts in the belly to remove the gallbladder. You stay in the hospital for a few days after the operation.
• Medications to dissolve gallstones. Medications you take by mouth may help dissolve gallstones. But it may take months or years of treatment to dissolve your gallstones in this way. Sometimes medications don't work. Medications for gallstones aren't commonly used and are reserved for people who can't undergo surgery.

Nursing Management

• In the low Fowler's position, situate the patient.
• Nasogastric suction and intravenous fluids should be given.
• After bowel noises have returned, provide fluids like water and other soft foods.
• Tell the patient to splint the wound with a cushion.
• provide analgesics as directed.
• Remind the patient to fully expand their lungs to avoid atelectasis.
• Encourage early exercise.
• Watch out for respiratory issues especially attentively in elderly and obese people,
• When ambulating, put the drainage bag in the patient's pocket.
• Keep an eye out for any signs of infection, bile leakage, or bile drainage obstruction.
• Watch out for jaundice.
• Note and report any pain, nauseous, or vomiting in the right upper quadrant.
• Frequently changing the dressing and applying ointment to soothe irritated skin.

 References

• enlast.herbalyzer.com/ncp-for-cholelithiasis.html
• studylib.net/doc/7701198/diagnosis
• https://quizlet.com/69238216/pathology-week-4-flash-cards/
• https://quizlet.com/122696745/cholelithiasis-cholecystitis-flash-cards/

• Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013

• nursingcrib.com/nursing-care-plan/nursing-care-plan-cholelithiasis/
• www.mayoclinic.org/diseases-conditions/gallstones/basics/causes/con-2002046