BILIARY TRACT DISORDER
KGMU Institute of
Disorders of gallbladder and ducts are
Its more commonly affect people of
sedentary life style and obesity.
In the united states alone, it is estimated
that 20 million people have gall stones
with approximately 1 million new cases
developing each year.
The most common conditions are gall
stones and associated cholecystitis.
About 98% of clients who present with
symptomatic gall bladder disease have
Malignancies and congenital anomalies
are very rare.
ANATOMY OF GALL BLADDER
Pear shape sac
7-10 cm long
Average capacity 30-
When obstructed 300
PHYSIOLOGY OF GALL BLADDER
The smooth muscles in the gallbladder
wall contract, leading to the bile
being secreted into the duodenum to
rid the body of waste stored in the bile as
well as aid in the absorption of
dietary fat by solubilising them using bile
Bile consists of water, electrolytes, bile
acids, cholesterol, phospholipids and
Bile is secreted by the liver into small
ducts that join to form the common hepatic
duct and get stored in gall bladder.
Gallstones are collections of cholesterol,
bile pigment or a combination of the two,
which can form in the gallbladder or within
the bile ducts of the liver.
Gallstones . .
The presence of
gallstones in the
gallbladder is called
Common duct stones are found in about
10% tom15% of client with cholelithiasis.
The incidence increases with age, and the
frequency of gallstones it the common
duct in the older population may be as
high as 25%.
Change in bile composition-
supersaturation of bile with cholesterol
Infection and tissue injury
Those who are most at risk.
These are all adjectives to describe the person most at
risk of developing symptomatic gallstones.
FAIR FAT FORTY FEMALE
TYPES OF GALLSTONES
Most common type
Smooth & whitish
yellow to tan colour
May be black
with hemolysis and
cirrhosis) or earthy
pigment stones or
bile salts, and
SIGNS AND SYMPTOMS.
eating high fat foods.
Localized pain in the
rate – causing
patient to become
in turn makes them
think they are
having a heart
SIGNS AND SYMPTOMS.
Low grade fever.
Elevated leukocyte count.
Stools that contain fat – steatorrhea.
Clay colored stools caused by a lack of
bile in the intestinal tract.
Urine may be dark amber- to tea-colored.
History of patient
Laboratory test for-
Elevated conjugated bilirubin.
Elevated alkaline phosphate
Serum amylase and lipase
Elevated WBC count
Gall stone dissolution
Oral administration of agents-
chenodeoxycholic acid (CDCA) or
ursodeoxycholic acid (UDCA) or ursodiol
Action- reduces the amount of cholesterol
Lithotripsy Extracorporeal shock
1500 shock waves
directed at stones
Used for fewer than 4
stones, each smaller
If stones are present in the
common bile duct, an
must be performed to remove
them BEFORE a
cholecystectomy is done.
A number of various
instruments are inserted
through the endoscope in
order to "cut" or stretch the
Once this is done, additional
instruments are passed that
enable the removal of stones
and the stretching of
narrowed regions of the
Drains (stents) can also be
used to prevent a narrowed
area from rapidly returning to
its previously narrowed state.
– removal of the gallbladder.
This is the treatment of choice.
The gallbladder along with the cystic
duct, vein and artery are ligated.
Assess the general condition of patient
Assess pain of patient.
Observe for bleeding.
Acute pain related to surgical procedure.
Impaired skin integrity Invasion of body
Ineffective breathing pattern Pain
Risk for deficient fluid volume related to
1. Acute pain related to surgery
Monitor and record vital signs.
administer medication as ordered.
assess the severity,frequency, and
characteristic of pain.
Provide divertional activities such as
2. Impaired skin integrity
Observe the color and character of the
Change dressings as often as necessary.
Place patient in low- or semi-Fowler’s
Monitor puncture sites (3–5) if endoscopic
procedure is done.
3. Ineffective breathing pattern
Observe respiratory rate, depth.
Auscultate breath sounds.
Assist patient to turn, cough, and deep
Show patient how to splint incision.
Instruct in effective breathing techniques.
Elevate head of bed, maintain low-
4. Risk for deficient fluid volume
Monitor vital signs. Assess mucous
membranes, skin turgor, peripheral
pulses, and capillary refill.
Monitor I&O, including drainage from NG
tube ,T-tube, and wound. Weigh patient
Observe for signs of bleeding:
hematemesis, melena, petechiae,
Administer IV fluids, blood products, as
What is it cholecystitis?
cholecystitis is an
inflammation of the
gallbladder wall and
TYPES OF CHOLECYSTITIS
Acute cholecystitis refers to acute
inflammation of the gallbladder wall.
Gall stone in cystic duct
Obstruction in cystic duct
Bacterial infection (gram positive and
gram negative aerobes and anaerobes:-
E. Coli, klebsiella, Clostredium and
PROGRESSION OF ACUTE
- Gallbladder has a
grayish appearance & is
-There is an obstruction
of the cystic duct and
the gallbladder begins
- It no longer has the
"robin egg blue"
appearance of a normal
- As acute
to become necrotic
and gets a speckled
appearance as the
wall begins to die.
and the wall
becomes very dark
green or black.
- This is the stage
SIGNS AND SYMPTOMS
Complain of pain
In right upper quadrant
In epigastric region
In right subscapular
Peak in 30min
Nausea and vomiting
Low grade fever
Repeated inflammation and infection of
SIGNS AND SYMPTOMS
Fibrosis of gall tissues
Inability to concentrate bile
to treat symptomatic causes
to prevent complication
Post Op - Cholesystectomy
1. Administer oral analgesics to facilitate movement
and deep breathing – and to stay ahead of pts pain.
2. Observe dressings frequently for exudate and hemorrhage.
3. Vitals are routinely checked.
4. Patient teaching:
-Must understand how to splint the abd. before
-Report any abnormalities such as,
severe pain, tenderness in RUQ, increase in
pulse, etc . .
-Instructed that they usually can return to work in 3
days & can resume full activity in 1 week.
5. Fluid balance is maintained IV –
potassium added to compensate
for loss from surgery.
1. Urine and stool should be observed for alterations
in the presence of bilirubin.
2. NG tube must be monitored for amount, color & consistency
Also, tube must be on LOW suction and nasal area should
be monitored for irritation and necrosis.
3. Anti-emetics may be administered if nausea persists.
4. I & O are measured and described carefully.
5. Pt. must understand how to splint the abdomen
for post op coughing, turning and deep breathing.
Interventions center on keeping patient comfortable by
carefully administering meds and watching for reactions.
Biliary disorders are extremely common
but diverse in nature.
Incidence rate of the disease is increasing
day by day.
Teaching and awareness is vital in
prevention and management of the
A 45 yr old obese lady, complaining of
epigastric pain, right sided subscapular
pain which last for 3-4 hrs associated with
nausea and vomiting. She has mild icterus
and bilirubin is 3.3mg/dl.
Guess what could be the diagnosis of