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CHOLELITHIASISS
CHOLELITHIASISS
CHOLELITHIASIS
(calculi or gallstones) usually form in the
gallbladder from the solid constituents of
bile and vary greatly in size, shape and
composition.
Pigment stones
Black pigment stones
Most common
Formed in gall bladder
Made of Calcium
bilirubinate,phosphate,bic
arbonate
Common in hemolytic
disorders,cirrhosis
Multiple , small & hard in
consistency
Brown pigment
stones
Rarely form in gall
bladder
Formed in bile duct
Related to bile stasis
& infected bile
E.coli, Bacteroides
ETIOLOGY/CAUSES
It's not clear what causes gallstones to form.
Doctors think gallstones may result when:
Your bile contains too much
cholesterol. Normally, your bile contains enough
chemicals to dissolve the cholesterol excreted by your
liver. But if your liver excretes more cholesterol than
your bile can dissolve, the excess cholesterol may form
into crystals and eventually into stones.
RISK FACTORS
Liver Cirrhosis
Hemolysis
Infection in the Biliary System
Infection in the Biliary Tract
Geriatrics
GI Disease/ T-Tube Fistula
DM insulin increase the ablity to take up glucose
Cystic Fibrosis defective chloride channels which causes cells to
produce thick, viscous, mucous secretion Prevents pancreatic
enzymes in reaching the duodenum Results to slowed fat digestion
5 Fs Fair, Fat, Fertile, Female, Fourty
MULTIPARITY
Benign Cholestatic jaundice of Pregnancy, with
retention of conjugated bilirubin probably
secondary to unusual sensitivity to the hormones of
pregnancy
Repeated pregnancy causes increased gallstone
formation due to changes in gallbladder kinetics
leading to stasis and stone formation
ANATOMY OF GALL
BLADDER
The capacity of
the gallbladder is
30 to 50 ml of bile.
Its wall is
composed largely
of smooth muscle.
The gallbladder is
connected to the
common bile duct
by the cystic duct
PHYSIOLOGY OF
GALLBLADDER
It act as a storage depot for bile Between
meals, when the sphincter of Oddi is closed,
bile produced by the hepatocytes enters the
gallbladder
During storage, a large portion of the water in
bile is absorbed through the walls of the
gallbladder, so that gallbladder bile is 5-10
times more concentrated than that originally
secreted by the liver.
PATHOPHYSIOLOGY
Decreased bile acid synthesis
Increased cholesterol synthesis in the liver
Super saturation of bile with cholesterol
Formation of precipitates
Gall stones (Cholelithiasis)
Inflammatory changes (Cholecystitis)
CLINICAL MANIFESTATION
Epigastric distress
Feeling of Fullness
Abdominal distention
Vague pain in the right upper quadrant of the
abdomen
Distress may follow a meal high in fried or fatty
foods
Pain and biliary colic
Fever
In IntestineAcute intestinal
obstruction
Management
Investigations
USG abdomen posterior
acoustic shadowing
Plain X RAY abdomen
LFT- Increased
conjugated bilirubin
Increased Alkaline
Phosphate, GGT, 5Nucleotidase
Abdominal X-ray
USG
Radionuclide imaging or cholecintography
Cholecystography
Endoscopic retrograde
cholangiopancreatography (ERCP)
Percutaneous transhepatic
cholangiography (PTC)
Renal stone
Calcified 12th rib tip
Phlebolith
Faecolith
Calcified lymph node
Renal cell Ca calcification
Calcified Adrenal tumor
Treatment
Medical therapy GALL STONE DISSOLUTION
Ursodeoxycholic acid (UDCA) with a
functioning Gall bladder with stone less
than 10 mm
10-15 mg/kg/day
Pigment stones are non responsive to
medical therapy
NONSURGICAL REMOVAL
Dissolving gallstones MTBE Methyl
tertiary butyl ether
A catheter and instrument with basket
Extracorporeal shock-wave lithotripsy (ESWL)
Intracorporeal lithotripsy
SURGICAL MANAGEMENT
Laparoscopic
cholecystectomy is
ideal.
Open cholecystectomy
is done if patient unfit
for laparoscopy
through Right Subcostal(KOCHERSs)
incision.
Cholecystectomy
Minicholecystectomy
Laparoscopic cholecystectomy
Percutaneous cholecystostomy
SUPPORTIVE OR DIETARY
MANAGEMENT
Low fat liquids
Powdered supplements
high in protein and
carbohydrates
Cooked fruits
Rice or tapioca
Lean meats
Smashed potatoes
Non gas forming
vegetables
The following to be
avoided
Eggs
Cream
Pork
Fried foods, cheese and
rich dressings
Gas forming vegetables
Alcohol
NURSINGMANAGEMENT
Relieving pain
Improving respiratory status
Promoting skin care and biliary drainage
Improving nutritional status
Patient education and home care
considerations
Monitoring and managing potential
complications
THANK
YOU