 Welcome to Nursing School Explained, and this video on cholelithiasis and cholecystitis. If we look at the terminology here, so usually chole refers to cholesterol or relating to bile, and then lith is a stone where cholecystitis means in reference to the gallbladder itself. So the cyst is the actual bladder itself. And let's look here a quick review of the anatomy and physiology. So we have several digestive organs that work together in helping us break down foods. And those are the liver, the gallbladder, small intestine and pancreas here are of most importance. The gallbladder is kind of hidden behind the liver here, and then through the common bile duct empties its contents, which is bile, into the small intestine. And then the pancreas here is also closely related, and the pancreas releases digestive enzymes as well as insulin and glucagon to help us with our blood sugar regulation. But in terms of digestion, the pancreas is in charge of releasing the enzymes that help us break down proteins, fats and carbohydrates. And the best explanation I've ever heard for the function of the gallbladder is if you imagine a pan that you've just used and you've cooked something fatty, and then you are ready to wash it. So you put water in the pan, and the fat will usually swim on the top. If you squirt a couple of drops of soap in there, dishwash soap or whatever soap you have, instantly that fat will kind of dissolve. And that's kind of what the function of the gallbladder does. It helps us to break down fats mostly through the secretion of bile. Now when they are, when it's not functioning, then certainly it can cause certain signs and symptoms and have to do with digestion. And risk factors for either gallstones as well as gallbladder disease are the four Fs. So females are at a higher risk who are fertile, so usually young females in or around their 40s, and then fat meaning a high fat diet and also kind of having a lot of other post-tissues. Those are risk factors here. As well as being on oral contraceptive pills, these actually increase the cholesterol production and therefore can lead to cholestitis and choleletitis. And in terms of the pathophysiology here, so to develop gallstones, there's an altered balance of bile salts and calcium, which leads to increase cholesterol in the system. And then that cholesterol forms stones in the gallbladder that then can obstruct this common bile duct over here. Now when it's obstructed then the bile cannot be released into the small intestine and then things back up which make the gallbladder inflamed leading to cholestitis. And overall the gallstones also cause a change in the composition of the bile, which then makes the stones more likely to recur. So once you find gallstones, unfortunately you're more likely to develop them again. And then for cholestitis, so the actual inflamed gallbladder, other risk factors include immobility, prolonged periods of fasting, as well as patients who are on TPA for prolonged periods of time and diabetes. And once the gallbladder becomes inflamed, it is again more likely to recur and then it becomes scarred, which decreases the function because the scarred organ just can't function the way it usually would. And then again the patient is usually more likely to develop gallstones or gallbladder disease again in the future. And for signs and symptoms, there is a term called a biliary colic, which is basically meaning that the bile can't be released from the gallbladder, which causes a spasm, which causes severe pain, that will be the sign and symptom that the patient will present with. Certainly it causes right upper quadrant pain, right above the liver and gallbladder here, that radiates to the flank, or it can also radiate to the shoulder or the shoulder blade. So there is a pretty common symptoms here. The patient also might present with dark colored urine, and that is because now we can't release the bile during normal digestion through the digestive tract, but it's now being attempted to be released through the urinary system, and therefore we see that bilirubin in the urine. So the kidney is filtering out that bilirubin. Patients with color cystitis might have fever and chills from this inflammation and maybe even infection of the gallbladder, certainly as with any abdominal complaint that might be nausea and vomiting. And jaundice, if we build up the bilirubin in the body, jaundice is what will occur. Now for complications so that inflamed gallbladder can turn gangrene or necrotic, it can form an abscess, it can lead to further inflammation of the other organs here, including the pancreas, which is pretty significant, it can lead to biliary cirrhosis, it can lead to fistulas, which are abnormal openings between two organs that are not supposed to be there, and it can rupture. If it gets so inflamed, maybe gangrene is in necrotic, then it can rupture, and so all the contents that would usually be sitting in that gallbladder now spill into the abdominal cavity causing peritonitis, and we know that peritonitis can further lead to sepsis and septic shock if it's not called early or not treated appropriately. In terms of diagnostic tests, an abdominal ultrasound is usually the preferred method to evaluate these abdominal organs to see what the cause is of the pain. Certainly we'll need a CBC to look at the patients overall white count and HNH and so forth. And the CMP will be specifically interested in electrolytes as well as liver function and bilirubin levels, and then amylase and lipase are usually drawn with any abdominal pain because we don't know if it's also affecting the pancreas or maybe it's referred pain from the pancreas that the patient is feeling in that right upper quadrant. And then there is a diagnostic procedure called ERCP, which is quite a mouthful endoscopic retrograde chole angiopancreatography. So endoscopic meaning with a scope through the mouth, the performing provider will move that scope all the way into the digestive tract so they can visualize the gallbladder and the pancreas and all these ducts that here work together specifically the common bile duct. And this is a nice diagnostic test because they can diagnose, they can also remove stones during the procedure, they can dilate any strictures or narrowings that might be going on, they can biopsy if there is a suspicion or they can place a stint which then will help to open up the common bile duct or whatever the stricture or the obstruction is and therefore help the gallbladder empties contents into the digestive tract. And then there is another procedure called the procutaneous trans hepatic chole angiography, so that procutaneous meaning through the skin and through the liver to the gallbladder and then visualizing it so there's there's a needle inserted into the gallbladder and bile can be removed in contrast can be injected to detect any filling of the ducts and see where this obstruction might be occurring or what really the cause is of the patient's acute symptoms. In terms of treatment if it's just gallstones there are medications that can dissolve the stones. These are not usually commonly used because the laparoscopic colisectomy is a pretty low risk procedure that is very curative of the stones and like we discussed earlier if the patient has had gallstones or gallbladder inflammation in the past they are very likely to get the same condition again so a lot of times the treatment for either one of them is the laparoscopic colisectomy and if it's just gallstones and it might be the first occurrence the patient might have this ERCP where they take a look a closer look to see what's going on with the gallbladder. And then for colisocytus it can be very very painful condition antibiotics are indicated if there's an infection or an abscess clearly pain management is important there and then we need to treat any fluid and electrolyte imbalances that occur from maybe vomiting, diarrhea, unable to keep fluids down and then we need to give the patient anti-immanics until something more concrete can be done about the stones or the gallbladder itself. And the laparoscopic colisectomy like I already mentioned is a very commonly used procedure where they usually have two or three to four different insertion sites and then with the use of a scope the gallbladder can be removed fairly quickly and uneventfully and because it's the laparoscopically there's not so much scar tissue to deal with for healing immediately but also going down the road or down the line from scar tissue formation and the tissues and any of those complications that can occur. As for nursing care when we encounter a patient who just has maybe that first episode of a gallstone we won't certainly encourage them to decrease the fat in their diet as well as eat small frequent meals and lose weight because all of these three are related to obesity and animal fats in particular produce or are the delivery mechanism for cholesterol and so the more cholesterol there is in our diet the more these stones these cholesterol stones can build and then leading to the stones and maybe even the inflamed gallbladder. So always you know we should always be encouraging our patients to eat a healthy diet that is low in cholesterol and low in animal products and animal fats because of the associated risks and that does not only apply to their digestive or gallbladder issues that applies for overall health the cardiovascular health in terms of arthrosclerosis as well as just overall well-being and if they have a healthy weight they're going to be overall have much less risks for other more severe kind of chronic medical issues. If the patient undergoes a laparoscopic callous estectomy we want to like in any post-op patient encourage a clear liquid and then advance as indicated and as the patient can tolerate it and then they should adhere to a low fat diet for four to six weeks while the gallbladder recovers and then thereafter we need to include and teach them to eat a healthy diet high in vegetables, greens, source good sources of fiber, whole grains and all those things that we know are not just good for the digestive system but for our overall health and overall well-being. So thank you for watching this video on choline lethiasis and choline cystitis. Please also watch the other videos on pancreatitis as well as cirrhosis and peritonitis where I go into more details about those disorders. Thanks for watching Nursing School Explains see you soon.