Gallbladder Disease and Related Concepts

Gallbladder Disease

  • Choledocholithiasis: Remember "d duct," indicating stones in the bile duct.

Etiology and Risk Factors

  • Risk factors:
    • Increased age
    • Family history
    • Obesity: A major contributing factor

Gallbladder Function

  • The gallbladder processes bile, which is crucial for filtering fats.
  • Patients with gallbladder issues often cannot tolerate:
    • Fried foods
    • Oils
    • Gravies
    • High-fat foods
    • These foods cannot be processed effectively.

Gallbladder Attacks

  • Acute gallbladder attacks can mimic a heart attack.
    • Symptoms: Chest pain, heartburn, upper chest pain.
    • Patients may mistake it for a heart attack.
    • Often triggered by consuming fatty foods that the body cannot process.
  • Biostasis: Bile sitting in the gallbladder due to non-functioning, especially after eating fatty foods.

Liver and Gallbladder Interaction

  • Liver creates the bile.
  • Gallbladder concentrates the bile to break down fats.

Chronic Irritation and Scarring

  • Repeated acute cholecystitis (inflammation) attacks:
    • Cause chronic irritation from gallstones.
    • Lead to a fibrotic and thickened gallbladder.
  • Stones cause the gallbladder to become edematous and inflamed.
  • Rupture is a significant concern.

Additional Risk Factors

  • Secondary Lifestyle
  • Fasting: Can sometimes cause gallstones; more common in women.
  • High Cholesterol Intake and Sedentary Lifestyle: Significantly increase risk.
  • Diseases: Sickle cell disease, Crohn's bowel disorder.
  • Extreme Diet: Very low-calorie diets and gastric bypass can cause gallstones.
  • Anorexia: Patients with anorexia often develop gallstones due to extreme calorie deficit.

Symptoms

  • Asymptomatic Gallstones: Silent and may not require treatment.
  • Symptomatic Gallstones:
    • Elevated temperature, pulse, and respirations.
    • Vomiting.
    • Positive Murphy's Sign: Inability to take a deep breath when pressure is applied below the liver on the right side.
    • Steady, aching, severe pain in the right upper quadrant radiating to the right scapula or shoulder.
    • Pain starts suddenly after a fatty meal, peaking 1-6 hours after.
    • Worse with movement, such as breathing.
    • Heartburn, indigestion, and flatulence are common.

Complications

  • Perforation of the gallbladder.
  • Repeated injury and regeneration increase the risk of cancer in that organ.
  • Acute pancreatitis.

Diagnostics

  • Endoscopy, CAT scan (usually a CT scan is preferred).

Treatment

  • Pain medication.
  • Bile Acid Sequestrants: (Page 665)
  • Antiemetics.
  • NPO (nothing by mouth) and advance to a low-fat diet.
  • Low fat diet is essential for patients with gallbladder issues.

Bile Acid Sequestrants

  • Administer 4-6 hours before or 1 hour after other medications.
  • Examples: Cholestyramine – a common medication for lowering cholesterol.

Surgical Interventions

  • Laparoscopic Surgery
  • Traditional Surgery: Involves a bigger incision.
  • Gallbladder removal may be necessary due to repeated inflammation, which carries a high risk of perforation . Any perforation of abdominal cavity organs can lead to peritonitis.

Medications

  • Medications can be given to dissolve stones.

Nursing Diagnoses

  • Acute pain.
  • Deficient fluid volume.
  • Ineffective breathing patterns: Relate to Murphy's sign, where pain restricts breathing.

Review Questions

  • Best intervention during the icteric stage of hepatitis:

    • Icteric stage: Jaundice appears with continued prodromal symptoms.
    • Treatment goals: Identify cause, relieve symptoms, prevent cirrhosis.
    • Adequate fluid and nutrition, avoid extreme exertion, alcohol, and toxic medications.

  • Lactulose:

    • Understanding of education: "I can expect to have loose stools."
    • Lactulose removes ammonia through stools.

  • Data collection:

    • Distended abdomen, mild confusion, elevated ammonia level.
    • Give lactulose: To address the ammonia level.
    • Record daily weight: Due to the distended abdomen.
    • Monitor eyes and nose: For the same reason.
    • Reposition patient: Avoid supine position to ease breathing with an extended abdomen.
    • Fall precautions: Due to confusion.

  • Liver Disease Safety:

    • Avoid alcohol.
    • Avoid certain antibiotics (hepatotoxic ones) and check dosages.
    • Avoid narcotics and sedatives.
    • All these substances are metabolized by the liver.