Ø Gallbladder
- A sac like organ approximately 7-10 cm long
- The left and right hepatic ducts transport bile to the gallbladder
- Acts as a reservoir of bile max of 40-70ml
- Concentrates bile by absorbing salts and water
- Responds to ingestion of fats by releasing bile to duodenum through sphincter of Oddi
- If surgically removed, biliary ducts enlarged and takes over its function but cannot consistently respond to ingestion of fatty foods
- Cholecystitis
- Inflammation of the gallbladder
- Can be acute or chronic
- Affects more in women than in men 3:1 ratio
- Risk factors:
- Gallstones
- Surgery
- Trauma
- Obesity
- Long term dietary fasting
- Infection
- Clinical Manifestation
- Acute:
- Abdominal pain
- Nausea and vomiting
- High fever
- Positive Murphy’s sign
- Flatulence and belching
- Vague non specific abdominal pain
- Chronic:
- Low grade fever
- Jaundice
- Steatorrhea
- Diagnostics
- Ultrasound
- Imaging – CT scan
- Blood studies – elevated AST, WBC, serum bilirubin, alkaline phosphatase, lactete dehydrogenase
- Management
- Anti cholinergic (prophantheline bromide) to relax smooth muscles and prevent biliary contraction
- Narcotics (meperidine) releive pain and decrease spasm
- Antiemetics
- Oral gallstone dissolving drugs ( chenodeoxycholic acid) if cause is gallstone
- Surgery
- Cholecystectomy
- T- tube insertion
- Nursing Management
- Low fat diet- broil or grill food instead of frying
- Weight reduction
- Monitor serum levels and signs of peritonitis
- Monitor I/O, electrolytes, V/S
- Wound care after surgery: instruct client to report sings of inflammation, avoidance of heavy lifting, avoid driving for at least 6 weeks to prevent strain on wound
- Care of T –tube:
- Keep tube below site of wound
- Change dressing at least daily
- Empty T-tube drainage bag at same time of the day
- Attach T-tube on clothing or abdomen to prevent pulling
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