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1. Topic: Cholelithiasis
Subject: AHN

2. Objectives
• At the end of this presentation the student will be
able to:
• Define Cholelithiasis.
• Identify types of gall stones.
• Describe Pathophysiology of Cholelithiasis.
• Enlist signs, symptoms and causes of Cholelithiasis.
• Discuss medical diagnosis and treatment
Cholelithiasis
• Make nursing diagnosis and nursing intervention for
Cholelithiasis.

3. Cholelithiasis
• Cholelithiasis is derived
from the Greek word
chol means "bile" + lith
means "stone”
• Presence of stones in the
gallbladder is referred to
as cholelithiasis

4. Types of gallstones
 There are three types which is given
below.
• Cholesterol stones (80% cholesterol by
weight) vary in color from light-yellow
to dark-green or brown and are oval 2
to 3 cm in length, often having a tiny
dark central spot.
• Pigment stones are small, dark stones
made of bilirubin, calcium salts and
20% cholesterol that are found in bile.

5. Conti…
• Mixed gallstones typically
contain 20–80% cholesterol.
Other common constituents
are calcium carbonate, palmitate
phosphate, bilirubin, and
other bile pigments. Because of
their calcium content, they are
often radiographically visible.

6. Pathophysiology
• Cholesterol gallstones develop when bile
contains too much cholesterol and not enough
bile salts
Two other factors are important in causing
gallstones are:
• Incomplete and infrequent emptying of the
gallbladder may cause the bile to become
overconcentrated and contribute to gallstone
formation.

7. Conti…
• The second factor is the presence of proteins
in the liver and bile that either promote or
inhibit cholesterol crystallization into
gallstones.

8. Etiology
Cholelithiasis is mainly caused by
• Obesity
• Pregnancy
• Gallbladder stasis
• Drugs
• Heredity

9. Signs and symptoms
• Gallstones may be asymptomatic, even for
years. These gallstones are called "silent
stones" and do not require treatment.
• Symptoms commonly begin to appear once
the stones reach a certain size (>8 mm).
• A characteristic symptom of gallstones is
a "gallstone attack", in which a person may
experience intense pain in the upper-right
side of the abdomen.

10. Conti….
• Often, attacks occur after a particularly fatty
meal and almost always happen at night.
Other symptoms include
• Abdominal bloating
• Intolerance of fatty foods
• Belching
• Gas
• Indigestion.

11. Medical Diagnosis
• Abdominal Ultrasound
• History and Physical Exam
• Abdominal CT Scan
• Plain X-ray

12. Treatments
• Surgical Removal of
Gallbladder
• Laparoscopic
Cholecystectomy

13. Complication
• Cholecystitis .
• Choledocholelithiasis.
• Perforated Gallbladder.
• Gallbladder Cancer.
• Cholangitis.
• Pancreatitis.
• Gangrene or Abscesses.

14. Nursing Diagnosis
• Acute pain related to gallbladder stones.
• Ineffective breathing pattern related to pain
secondary to disease.
• The risk of dehydration related to vomiting
• Imbalanced nutrition less than body requirements
related to altered lipid metabolism and increased
nutritional needs during healing.
• Risk for infection related to complications of disease.

15. Nursing Interventions
• Monitor and record vital signs.
• Administer medication as ordered.
• Administer analgesic agents as ordered
• Place the patient in low Fowler’s position to
facilitates breathing.
• Provide intravenous fluids and nasogastric suction.
• Provide water and other fluids and soft diet.
• Observe for indications of infection, leakage of bile,
or obstruction of bile drainage.

16. References
• Huffman JL, Schenker S. Acute acalculous cholecystitis - a review. Clin
Gastroenterol Hepatol. Sep 9 2009;[Medline].
• Donovan JM. Physical and metabolic factors in gallstone
pathogenesis. Gastroenterol Clin North Am. Mar 1999;28(1):75-
97. [Medline].
• Sitzmann JV, Pitt HA, Steinborn PA, et al. Cholecystokinin prevents
parenteral nutrition induced biliary sludge in humans. Surg Gynecol
Obstet. Jan 1990;170(1):25-31. [Medline].
• Cullen JJ, Maes EB, Aggrawal S, et al. Effect of endotoxin on opossum
gallbladder motility: a model of acalculous cholecystitis. Ann Surg. Aug
2000;232(2):202-7. [Medline].
• Forbes LE, Bajaj M, McGinn T, et al. Perihepatic abscess formation in
diabetes: a complication of silent gallstones. Am J Gastroenterol. Apr
1996;91(4):786-8. [Medline].