After 1 and a half hour of case presentation, the students should be able to:
1. Differentiate between acute and chronic cholecystitis. 2. Compare approaches to management of cholelithiasis. 3. Describe the indications for cholecystectomy.
4. Assess a patient scheduled for cholecystectomy for effective preoperative, intraoperative and postoperative needs. 5. Formulate nursing diagnoses related to cholecystectomy. 6. Establish outcomes that meet the needs of a pateint requiring a cholecystectomy. 7. Plan appropriate nursing care to ensure quality nursing care. 8. Implement common preoperative and postoperative care measures for cholecystectomy. 9. Evaluate outcome criteria for achievement and effectiveness of nursing care. 10. Identify National Health Goals related to cholecystitis that nurses can be instrumental in helping the nation to achieve. 11. Use critical thinking to analyze common complications of cholecystectomy to develop preventive strategies.
A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. These calculi are formed in the gallbladder but may distally pass into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater. Rarely, in cases of severe inflammation, gallstones may erode through the gallbladder into adherent bowel potentially causing an obstruction termed gallstone ileus.
Presence of gallstones in the gallbladder may lead to acute cholecystitis, an inflammatory condition characterized by retention of bile in the gallbladder and often secondary infection by intestinal microorganisms, predominantly Escherichia coli and Bacteroides species. Presence of gallstones in other parts of the biliary tract can cause obstruction of the bile ducts, which can lead to serious conditions such as ascending cholangitis or pancreatitis. Either of these two conditions can be life-threatening and are therefore considered to be medical emergencies.
Presence of stones in the gallbladder is referred to as cholelithiasis (from the Greek chol- (bile) + lith- (stone) + iasis- (process). If gallstones migrate into the ducts of the biliary tract, the condition is referred to as choledocholithiasis, from the Greek chol- (bile) + docho- (duct) + lith- (stone) + iasis- (process). Choledocholithiasis is frequently associated with obstruction of the biliary tree, which in turn can lead to acute ascending cholangitis, from the Greek: chol- (bile) + ang- (vessel) + itis- (inflammation), a serious infection of the bile ducts. Gallstones within the ampulla of Vater can obstruct the exocrine system of the pancreas, which in turn can result in pancreatitis.
Gallstones can vary in size and shape from as small as a grain of sand to as large as a golf ball. The gallbladder may contain a single large stone or many smaller ones. Pseudoliths, sometimes referred to as sludge, are thick secretions that may be present within the gallbladder, either alone or in conjunction with fully formed gallstones. The clinical presentation is similar to that of cholelithiasis. The composition of gallstones is affected by age, diet, and ethnicity. On the basis of their composition, gallstones can be divided into the following types:
Cholesterol stones vary from light yellow to dark green or brown and are oval, between 2 and 3 cm long, each often having a tiny, dark, central spot. To be classified as such, they must be at least 80% cholesterol by weight (or 70%, according to the Japanese- classification system).
Pigment stones are small and dark and comprise bilirubin and calcium salts that are found in bile. They contain...