Arvin Kiel B.

Quejada BSN 4-2, WUP SN 11

Cholecystectomy
Definition: Cholecystectomy is the surgical removal of the gallbladder. It is the most common method for treating symptomatic gallstones. The two basic types of this procedure are open cholecystectomy and the laparoscopic approach. It is estimated that the laparoscopic procedure is currently used for approximately 80% of cases. Other name: Laparoscopic Retrograde Cholecystectomy Indication: A cholecystectomy is performed to treat cholelithiasis and cholecystitis. In cholelithiasis, gallstones of varying shapes and sizes form from the solid components of bile. The presence of these stones, often referred to as gallbladder disease, may produce symptoms of excruciating right upper abdominal pain radiating to the right shoulder. The gallbladder may become the site of acute infection and inflammation, resulting in symptoms of upper right abdominal pain, nausea, and vomiting. This condition is referred to as cholecystitis. The surgical removal of the gallbladder can provide relief of these symptoms. Cholecystectomy is used to treat both acute and chronic cholecystitis when there are significant pain symptoms. The typical composition of gallstones is predominately cholesterol, or a compound called calcium bilirubinate. Procedural Risks and Complications: Laparoscopic cholecystectomy does not require the abdominal muscles to be cut, resulting in less pain, quicker healing, improved cosmetic results, and fewer complications such as infection and adhesions. Most patients can be discharged on the same or following day as the surgery, and most patients can return to any type of occupation in about a week. An uncommon but potentially serious complication is injury to the common bile duct, which connects the gallbladder and liver. An injured bile duct can leak bile and cause a painful and potentially dangerous infection. Many cases of minor injury to the common bile duct can be managed non-surgically. Major injury to the bile duct, however, is a very serious problem and may require corrective surgery. This surgery should be performed by an experienced biliary surgeon. Abdominal peritoneal adhesions, gangrenous gallbladders, and other problems that obscure vision are discovered during about 5% of laparoscopic surgeries, forcing surgeons to switch to the standard cholecystectomy for safe removal of the gallbladder. Adhesions and gangrene, of course, can be quite serious, but converting to open surgery does not equate to a complication.

Arvin Kiel B. Quejada BSN 4-2, WUP SN 11 One common complication of cholecystectomy is inadvertent injury to an anomalous bile duct known as Ducts of Luschka, occurring in 33% of the population. It is non-problematic until the gall bladder is removed, and the tiny supravesicular ducts may be incompletely cauterized or remains unobserved, leading to biliary leak post operatively. The patient will develop biliary peritonitis within 5 to 7 days following surgery, and will require a temporary biliary stent. It is important that the clinician recognize the possibility of bile peritonitis early and confirm diagnosis via HIDA scan to lower morbidity rate. Aggressive pain management and antibiotic therapy should be initiated as soon as diagnosed. Perioperative Nursing Responsibilities: Pre-Op: Informed consent NPO post midnight Enemas to clean the bowel If has nausea and vomiting, suction tube to empty the stomach may be used For laparoscopic procedures, a urinary drainage catheter will also be used to decrease the risk of accidental puncture of the stomach or bladder with insertion of the trocar (a sharp, pointed instrument). IV pain medication and sedative General Anesthesia ET tube Orogastric tube Post-Op: For Open Cholecystectomy: Monitoring of vital signs o Breathing tends to be shallow because of the effect of anesthesia, and the patient's reluctance to breathe deeply due to the pain caused by the proximity of the incision to the muscles used for respiration. Deep breathing and coughing exercises Pain medication as necessary Fluid intake and output is measured Operative site is observed for color and amount of wound drainage Fluids are given intravenously for 2448 hours, until the patient's diet is gradually advanced as bowel activity resumes Patient is generally encouraged to walk eight hours after surgery Discharged from the hospital within three to five days, with return to work approximately four to six weeks after the procedure. For Laparoscopic Cholecystectomy: Similar interventions to that of any patient undergoing surgery with general anesthesia. A unique postoperative pain may be experienced in the right shoulder related to pressure from carbon dioxide used in the laparoscopic tubes.

Arvin Kiel B. Quejada BSN 4-2, WUP SN 11 o This pain may be relieved by lying down on the left side with right knee and thigh drawn up to the chest. o Walking will also help increase the body's re-absorption of the gas. patient is usually discharged the day after surgery and allowed to shower on the second postoperative day Gradually resume normal activities over a three-day period Avoiding heavy lifting for about 10 days.