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a.Ê ?ame of Client - Salas, Andnan Mendoza
b.Ê Age - 33
c.Ê Gender - Male
d.Ê Religion ± Roman Catholic
e.Ê Civil status - Married
f.Ê Operation performed - Cholecystectomy
g.Ê Type of surgery ± Open Chole
h.Ê Surgeon ± Dr. J. Centeno
i.Ê Date of operation/case no. - 1
j.Ê Type of anesthesia ± Spinal tetracaine
k.Ê Anesthesiologist ± Dr. Dennis S. Lazaro

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Ê
Ê cs the surgical removal of the gallbladder. ct is the most common method for treating
symptomatic gallstones. Surgical options include the standard procedure, called
laparoscopic cholecystectomy, and an older more invasive procedure, called open
cholecystectomy
Ê
Ê
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Ê
Ê A traditional open cholecystectomy is a major abdominal surgery in which the
surgeon removes the gallbladder through a 10-18 inch (41-72 cm) incision. Patients
usually remain in the hospital overnight and may require several additional weeks to
recover at home.

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Ê
Ê Cholecystectomy may be performed if the gallbladder contains gallstones
(cholelithiasis), is inflamed or infected (cholecystitis), or is cancerous.

Gallbladder inflammation or infection may cause pain which may be described as follows:

ëÊ is generally located on the right side of the upper abdomen

ëÊ may be constant or may become more severe after a heavy meal
ëÊ at times, may feel more like fullness than pain
ëÊ may be experienced in the back and in the tip of the right shoulder blade

Other symptoms of gallbladder inflammation or infection include, but are not limited to,
nausea, vomiting, fever, and chills.

The symptoms of gallbladder problems may resemble other medical conditions or problems.
cn addition, each individual may experience symptoms differently. Always consult your
physician for a diagnosis.
There may be other reasons for your physician to recommend a cholecystectomy.

 





A cholecystectomy may be performed on an outpatient basis or as part of your stay in a

hospital. Procedures may vary depending on your condition and your physician's practices.
A cholecystectomy is generally performed while you are asleep under general anesthesia.
Generally, a cholecystectomy follows this process:

1.Ê £ou will be asked to remove any jewelry or other objects that may interfere with the
procedure.
2.Ê £ou will be asked to remove clothing and be given a gown to wear.
3.Ê An intravenous (c ) line will be inserted in your arm or hand.
4.Ê £ou will be positioned on the operating table on your back.
5.Ê The anesthesiologist will continuously monitor your heart rate, blood pressure,
breathing, and blood oxygen level during the surgery.
6.Ê The skin over the surgical site will be cleansed with an antiseptic solution.
Ê
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7.Ê An incision (open method) will be made. The incision may slant under the ribs on the
right side of the abdomen, or it may be an up-and-down incision in the upper part of
the abdomen.
8.Ê The gallbladder is removed.
9.Ê cn some cases, one or more drains may be inserted through the incision to allow
drainage of fluids or pus.

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Ê The gallbladder is a small pear-shaped organ that stores and concentrates bile. The
gallbladder is connected to the liver by the hepatic duct. ct is approximately 3 to 4
inches (7.6 to 10.2 cm) long and about 1 inch (2.5 cm) wide.Ê





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]Ê The epithelium, a thin sheet of cells closest to the inside of the gallbladder
]Ê The lamina propria, a thin layer of loose connective tissue (the epithelium plus the
lamina propria form the mucosa)
]Ê The muscularis, a layer of muscular tissue that helps the gallbladder contract, squirting
its bile into the bile duct
]Ê The perimuscular ("around the muscle") fibrous tissue, another layer of connective
tissue
]Ê The serosa, the outer covering of the gallbladder that comes from the peritoneum, which
is the lining of the abdominal cavity

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The function of the gallbladder is to store bile and concentrate. Bile is a digestive liquid
continually secreted by the liver. The bile emulsifies fats and neutralizes acids in partly
digested food. A muscular valve in the common bile duct opens, and the bile flows from the
gallbladder into the cystic duct, along the common bile duct, and into the duodenum (part
of the small intestine).

    


"


Sometimes the substances contained in bile crystallize in the gallbladder, forming

gallstones. These small, hard concretions are more common in persons over 40, especially
in women and the obese. They can cause inflammation of the gallbladder, a disorder that
produces symptoms similar to those of indigestion, especially after a fatty meal is
consumed. cf a stone becomes lodged in the bile duct, it produces severe pain. Gallstones
may pass out of the body spontaneously; however, serious blockage is treated by removing
the gallbladder surgically.


"


cn some cases, the gallbladder must be removed. The surgery to remove the gallbladder is
called a cholecystectomy. cn a cholecystectomy, the gallbladder is removed through a 5- to
8-inch long cut in your abdomen.

Once the gallbladder is removed, bile is delivered directly from the liver ducts to the upper
part of the intestine.

 "




Complications are rare. When complications occur, they may be in the form of: bleeding,
infection and injury to the duct (tube) that carries bile from your gallbladder to your
stomach.

Some patients also experience diarrhea. The cause of diarrhea after gallbladder removal
isn't clear.

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ëÊ pxcessive loss of bile

MÊ Bile aids in the process of digestion of lipids in the small intestine.
ëÊ Biliary Fistula
MÊ ct is a type of fistula where bile leaks from the bile ducts into outside areas.
ëÊ ëemorrhage
MÊ pxcessive loss of blood (750ml ± 2000ml)

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ëÊ cncisional cnfection
ëÊ ëemorrhage
ëÊ Bile Duct cnjury
ëÊ Persistent Pain
ëÊ Fever
ëÊ ?ausea and omiting
ëÊ Anorexia
ëÊ Abdominal Distention
MÊ ct is a sensation of feeling uncomfortably full and the presence of abdominal
rumbling sounds. ct is not associated with pain but mild cramps may occur. Air
and fluid accumulates in the abdomen and creates a sensation of fullness.
ëÊ Jaundice
MÊ ct is a yellowish pigmentation of the skin, the conjunctival membranes over
the sclerae (whites of the eyes), and other mucous membranes caused
by hyperbilirubinemia (increased levels of bilirubin in the blood).
ëÊ Adhesions
MÊ These are fibrous bands that form between tissues and organs, often as a result
of injury during surgery. They may be thought of as internal scar tissue.
ëÊ Postcholecystectomy syndrome
MÊ Describes the presence of abdominal symptoms after surgical removal of
the gallbladder (Cholecystectomy). Symptoms include gastrointestinal distress
and persistent pain in the upper right abdomen.

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    * Abdominal
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     * Supine position
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- * Spinal Anesthesia
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   * Transverse incision
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