CHOLELITHIASIS

DEFINITION OF TERMS; STATISTICAL DATA

comes from the greek word
chol- (bile) lith + (stone) + iasis (process)

defined as the presence of stones in the gallbladder

In Asian countries, the prevalence rate of

cholelithiasis ranges from 3% to 10%
 TYPES OF STONES
CHOLESTEROL STONES
precipitated cholesterol (supersaturation, gallbladder
stasis)
most common type (75-90%)
PIGMENTED STONES
BILIRUBIN STONES
black pigment stones that are made of pure calcium
bilirubinate
BROWN STONES
associated with a bacterial infection or parasitic
infestation of the biliary system (e.coli, roundworm)
5 F'S OF CHOLELITHIASIS
FEMALE
FORTY
FERTILE
FAT
FAIR
 WHY FEMALE?
Women are twice as likely as men are to have gallstones. That’s because
the female hormone estrogen causes more cholesterol to be excreted in
bile. Pregnancy, which causes estrogen levels to rise, also increases the
risk. In addition, birth control pills and hormone replacement therapy
increase bile cholesterol levels and reduce gallbladder emptying.
ETIOLOGY
 PATHOPHYSIOLOGY
Gallstones are hard, pebble-like structures that obstruct the cystic duct.
The formation of gallstones is often preceded by the presence of biliary
sludge, a viscous mixture of glycoproteins, calcium deposits, and
cholesterol crystals in the gallbladder or biliary ducts.
CLINICAL MANIFESTATIONS
Sudden and moderate to intense pain
in your upper abdomen, possibly
spreading to your back or right
shoulder blade and lasting from 15
minutes to several hours
Nausea and vomiting
Fever and chills
Jaundice (yellowing of your skin and
whites of your eyes)
Dark-colored urine
Pale-colored stools
NURSING ASSESSMENT
 DIAGNOSTIC FINDINGS
Abdominal ultrasound- most commonly used to look for signs of gallstones. Abdominal ultrasound
involves moving a device (transducer) back and forth across your stomach area. The transducer
sends signals to a computer, which creates images that show the structures in your abdomen.

Endoscopic ultrasound (EUS). This procedure can help identify smaller stones that may be missed on
an abdominal ultrasound. During EUS your doctor passes a thin, flexible tube (endoscope) through
your mouth and through your digestive tract. A small ultrasound device (transducer) in the tube
produces sound waves that create a precise image of surrounding tissue.

Other imaging tests. Additional tests may include oral cholecystography, a hepatobiliary
iminodiacetic acid (HIDA) scan, computerized tomography (CT), magnetic resonance
cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP).
Gallstones discovered using ERCP can be removed during the procedure.

Blood tests. Blood tests may reveal infection, jaundice, pancreatitis or other complications caused
by gallstones.
NURSING DIAGNOSIS
 PLANNING
Goals include relief of pain, adequate
ventilation, intact skin and improved
biliary drainage, optimal nutritional
intake, absence of complications, and
understanding of self-care routines
NURSING MANAGEMENT; NURSING INTERVENTION
Nursing care planning and management for patients
with cholelithiasis include relieving pain and
promoting rest, maintaining fluid and electrolyte
balance, preventing complications, and provision of
information about the disease process, prognosis,
and treatment.

MEDICAL MANAGEMENT
The usual treatment for gallstones is surgery to
remove the gallbladder. Doctors sometimes can use
nonsurgical treatments to treat cholesterol stones,
but pigment stones usually require surgery.
NUTRITIONAL AND SUPPORTIVE THERAPY
•Diet immediately after an episode is usually low-fat
liquids with high protein and carbohydrates followed
by solid soft foods as tolerated, avoiding eggs,
cream, pork, fried foods, cheese, rich dressings, gas-
forming vegetables, and alcohol.

PHARMACOLOGIC THERAPY
•oxycholic acid (UDCA [Urso, Actigall]) and
chenodeoxycholic acid (chenodiol or CDCA [Chenix])
are effective in dissolving primarily cholesterol
stones.
•Patients with significant, frequent symptoms; cystic
duct occlusion; or pigment stones are not candidates
for therapy with UDCA.
EVALUATION
 CAN WE LIVE WITHOUT A GALLBLADDER?
After your gallbladder is removed, your liver will continue to produce
enough bile to digest a normal diet. But instead of being stored in your
gallbladder, the bile will empty directly into the small intestine. You may
notice that you will have more bowel movements than you used to, and
that your stools are softer. These changes are often temporary as your
body’s digestive system readjusts to the absence of a gallbladder.
Thanks for listening, and remember

DON'T LET THE GALL OF

GALLSTONES FAZE YOU!