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.