gall bladder nestled under the liver

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Gall bladder nestled under the liver. Gall Bladder. Location: under the liver Description: a sac-like organ located on the inferior surface of the liver Mucosa of the GB wall absorbs water and electrolytes resulting in a high concentration of bile salts, bile pigments and cholesterol. - PowerPoint PPT Presentation

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  • Location: under the liverDescription: a sac-like organ located on the inferior surface of the liverMucosa of the GB wall absorbs water and electrolytes resulting in a high concentration of bile salts, bile pigments and cholesterol.Primary purpose of the GB is to store and concentrate bile (90 mL)

  • The cystic duct connects the gallbladder to the hepatic duct and they merge to form the common bile duct. The sphincter of Oddi is at the distal end of the common bile duct and controls the flow of bile into the duodenum.The bile secretions that empty from the common bile duct into the duodenum are necessary for digestion.

  • An inflammation of the gallbladder.

    Remember back to inflammation and what happens within the body when that occurs.

  • The bodys celllular response to injury, infection or irritation. A protective vascular reaction that delivers fluid, blood products and nutrients to an area of injury. The process neutralizes and eliminates pathogens or dead (necrotic) tissues and establishes a means of repairing body cells and tissues.

    Perry and Potter, p. 646

  • Severe and steady pain in the upper right part of your abdomen.Pain worsens when you inhale deeply. (Murphys sign)Pain that radiates from your abdomen to your right shoulder or back.Tenderness over your abdomen when touchedSweatingN/VAnorexiaFever, chills, abdominal bloating

  • GallstonesInjuryInfectiontumor

  • GallstonesCholesterol stonesPigmented stonesLong laborTraumatic injuryDiabetes

  • Gallbladder distentionInfectionTissue deathperforation

  • When did you first begin experiencing symptoms?Have you had bouts of pain similar to this before?Do you have a fever?Have your symptoms been continuous or occasional?What improves your symptoms?What makes them worse?

  • Blood testsCBCHyperbilirubinemiaElevated Erythrocyte sedimentation rate (ESR)E-lytesAlkaline phosphataseLiver Function Tests (LFTs)Imaging testsHepatobiliary iminodiacetic acid (HIDA) scan (aka cholescintigraphy, hepatobiliary scan)

  • Oral dissolution therapy with ursodeoxycholic acidExtracorporeal shock wave lithotripsyERCP = Endoscopic retrograde cholangiopancreatographyLaparoscopic cholecystectomyCholecystectomy

  • Acute painRisk for impaired gas exchange related to pain and ineffective inspiratory effortImbalanced nutrition: less than body requirements related to nausea, vomiting and anorexiaAnxiety related to lack of knowledge about disease process and treatment measures

  • Implement comfort measuresProvide education regarding diagnostic tests and disease processMaintain NPO and Institute IV therapy as orderedNutrition counselingWeight loss (3 Fs)Monitor fluids and e-lytes

  • Symptomatic treatment of pain and nausea with analgesics and antiemeticsMeperidine (Demerol) is the preferred opioid analgesic because Morphine can cause spasms.Cholestyramine (Questran) is used for severe cases of pruritus: Binds the bile salts to hasten excretion through the feces.Chenodeoxycholic acid (CDCA) and urodoxycholic acid (UDCA) are oral dissolution medications

  • Description: an acute or chronic disorder, most often caused by gallstones obstructing the cystic duct resulting in distention and inflammation of the gallbladder.

  • Most commonly caused by gallstones blocking the cystic or common bile duct.A small percentage of clients develop acalculous cholecystitis precipitated by trauma, prolonged hyperalimentation, fasting or surgery.

  • Clinical manifestations include all those identified with cholelithiasisFever leukocytosis, elevation of serum bilirubin(possible jaundice), elevation of alkaline phosphatase, and elevation of amylase if pancreatic ducts are involved.Abdominal guarding, rigidity, and rebound tenderness suggest peritoneal involvement.

  • NPOIV hydrationOpioids for pain controlIV antibioticsSurgical intervention is postponed until the acute infectious process has subsided.

  • Laproscopic cholecystectomyCholecystectomyCholecystectomy with T-tube placement

  • Prevent infectionControl painPrevent pulmonary complicationsMaintain T-tube is neededBelow the incisionAssess drainage and record amountAssess skin at insertion siteReport bile drainage in excess of 500 mL after 3 daysT-tube is removed when drainage has subsided and stools have returned to a normal color

  • Maintain NPO status as orderedAdvance diet slowly; low fat dietMonitor bowel soundsEncourage ambulation to promote peristalsisPrevent DVTsProvide general postoperative instructions:Wound careAnalgesiaDietSigns of infection