Cholelithiasis

Definition:

Cholelethiasis is defined as stone in the Gall bladder, anywhere in the Billiary tree.

Gall bladder is the storage centre of the bile.

Etiology:

1. Bacteria (e-coli, Strepto-Cocci, Salmonella)
2. Neoplasm
3. Extensive fasting, Narcotics
4. Idiopathic actual cause
5. Risk factors as:
   1. Obesity
   2. Pregnancy
   3. Multiparity
   4. Hyper-cholestrolaemia

Clinical features:

1. Pain (Acute Cholelithiasis)
2. Fever
3. Jaundice
4. Tenderness RUQ
5. Anorexia
6. Nausea
7. Vomiting
8. Diaphoresis
9. Leukocytosis
10. Dyspepsia
11. Heart burn
12. Dark urine
13. Clay colored stool

Investigations:

1. Ultrasound
2. Cholecystogram
3. Liver function test
4. Leucocytes count
5. Serum bilirubin

Complications:

1. Subpheric abscess
2. Pancreatitis
3. Cholangitis
4. Billiary Cirrhosis
5. Peritonitis

Medical Management:

1. Analgesic
2. Antibiotics
3. IV fluids
4. Anti-cholergic drug (to decrease secretion to prevent Billiary contraction)

Surgical Management:

Cholecystectomy (Removal of Gall bladder)

Cholecytostomy (Incision of Gall bladder for removal of stones)

Choledocholithotomy (Incision of bile duct for removal of the stones)

Cholicystogastractomy (Anatomosis between stomach & Gall bladder)

Choledecysoduodenostomy (Anatomosis between Gall bladder & duodenum)

1. Laparoscopic Cholecystectomy (Removal of Gall bladder via Laparoscopy using a laser)

Nursing Management:

1. NPO
2. Administration of fat soluble vitamin (A, B, E & K)
3. Pre & post operative care
4. Check TPR & BP every 40 minutes.