CHOLECYSTITIS AND

CHOLELITHIASIS

S U B M I T T E D T O : S A N C H I TA T R I PAT H I
S U B M I T T E D B Y : S H I VA N G I K U L B H A S K A R
 INTRODUCTION
• Gall bladder concentrates bile formed in the liver and stores it until needed for
digestion of fat.
• Cholecystitis involves the inflammation of gallbladder usually due to a ;low grade
chronic infection.
• Such an infection affects the absorptive power of the gall bladder mucosa, in turn
affecting the solubility ratios of the bile ingredients. Thus cholesterol may precipitate
out causing gall stones to form.
• Gall stone formation or cholelithiasis may occur with cholesterol bile pigments ,bile
salt , calcium, and other substances precipitates out of the bile
 ETIOLOGY
Gall stone formation includes factors are like Stasis ,infection and several metabolic
changes
High dietary fat intake over a long period of time .
Family history
Obesity
High abdominal fat deposition
Advancing age are other factors
Diabetes
Cholesterol – lowering drugs ,rapid weight loss ,fasting and being females are more
prone to gall stone than men .
Risk of gall stones in female because of sex hormones, pregnancy, postmenopausal
women and oral contraceptives .
 SYMPTOMS
• Sudden and rapidly intensifying pain in the upper right portion of your abdomen.
• Feeling of fullness.
• Distension after eating and particular difficulty in fatty food.
• Vomiting
• Nausea
• Fever
 MANAGEMENT
• Treatment of this disorder usually involves surgical removal of the gall bladder ,
cholecystectomy.
• Surgical may have to be withheld till the acute infection subsides . Till then patients is
kept in bed and suitable analgesics and antibodies are administrated.
• Other methods are :
Extracorporeal shockwave lithotripsy(ESWL)
Laparoscopic surgery
 NUTRIONAL MANGEMENT
• The main aim of dietary treatment is to reduce discomfort by providing a diet restricted
in fat or negligible fat.
• After the surgery , a liquid diet given as hourly or two hours feeds daily for a few days .
• When condition is settles down , clear soups ,weak tea ,milk, refined cereals may be
added.
• Pending surgery , some weight loss may be desirable in obese patients .In such
cases, energy restriction as under obesity would apply.
• Hepatic herbal supportive , antioxidants ,liver cells membrane protective and
maintenances of adequate calorie, fluid and electrolytes , vitamins , especially fat
soluble vitamins are routinely recommended.
• Fats intake is major cause of pain , the energy needs should mainly be met from
carbohydrates and not from fat sources.
• Fat intake may be limited to 20-30 g /day and later increased to 40 -45g/ day.
• High intake of soluble fibre through pulses , vegetables , fruits oilseeds , like flax seed
and methi seeds help the body to get rid of bile acid sterols out of the guts.This is also
gives a desirable microflora to favour inhibiting endogenous cholesterol production.
DIET AND FEEDING PATTERN
• Food which precipitate or aggravate symptoms should be avoided .
• The tolerance to specific foods may be highly individual .
• The most likely intolerance are fried foods , fatty meats eggs or legumes.
• Low fat options like tone /skim milk and their products , lean meats like fish and
chicken are better tolerated
• Large meal should be avoided and plenty of fluids should be taken early in the
morning ,late in the night and in between the meals
• FOODS ALLOWED:
 Bread and chapatis from wheat , maize, jowar , bajra or ragi
 Breakfast cereals of wheat , rice , oatsmeal, maize.
 Pulses( washed )
 Fish or chicken
 Milk and milk products.
 vegetables,
 Fresh fruits
 Beverages etc.
• FOODS TO BE AVOIDED:
 Fried foods
 Fatty meats
 Dried fruits
 Nuts
 Sweets
 Condiment and spices
 Papad
 Pickles ,chutneys
 Thick soups
 Gravies
 Whole milk /khoya