Acuestas, Rex Timothy B. Anatomy And Physiology Gall Bladder

ACUESTAS, REX TIMOTHY B.

3I—I2

Anatomy and Physiology Gall bladder

A pear-shaped organ that lies just below the liver and is attached to the visceral surface of the liver by the cystic duct. The main function of the gall bladder is to store the bile that is secreted by the liver. In the gall bladder, the bile is concentrated by the reabsorption of water from it. When fatty food is digested, the gall bladder contracts, thus delivering bile through the bile ducts to the small intestine where it is able to help dissolve fats. The most common disorder of the gall bladder is gallstones, which are composed of cholesterol crystals or pigment material.

What are the indications for cholecystectomy? Cholecystectomy is indicated in the presence of gallbladder trauma, gallbladder cancer, acute cholecystitis, and other complications of gallstones. More controversial are the indications for elective cholecystectomy. To properly determine the indications for elective cholecystectomy, the risk of the operation (taking into account the age and comorbid factors of the individual patient) must be weighed against the risk of complications and death without operation (taking into account the symptomatic status of the individual and the functional status of the gallbladder). Cholecystectomy (or some other form of gallstone therapy) is indicated in most patients with symptomatic cholelithiasis--especially those with non-functioning gallbladders. Cholecystectomy is not indicated in most patients with asymptomatic stones. Nursing Intervention ACTIONS/INTERVENTIONS Independent • Monitor I&O, including drainage from NG tube, T-tube, • and wound. Weigh patient periodically. • Monitor vital signs. Assess mucous membranes, skin • turgor, peripheral pulses, and capillary refill. • Observe for signs of bleeding, e.g. , hematemesis, melena, • petechiae, ecchymosis.

•

Use small-gauge needles for injections, and apply firm pressure for longer than usual after venipuncture. • Have patient use cotton/sponge swabs and mouthwash • instead of a toothbrush. Collaborative • Monitor laboratory studies, e.g., Hb/Hct, electrolytes, • prothrombin level/clotting time. • Administer IV fluids, blood products, as indicated; • Electrolytes; • Vitamin K.

•

Nursing Diagnosis Pre-op nursing diagnosis • Knowledge deficit Post-op nursing diagnosis • •

risk for impaired liver functioning related to gallbladder removal surgery acute pain related to gallbladder removal surgery