Analysis of Medical and Surgical Articles

This assignment requires the analysis of multiple medical and surgical articles from reputable sources. The articles cover a range of topics, including endoscopic interventions for pancreatic pseudocyst and walled-off necrosis, bile duct evaluation and exploration, and gallbladder disease. The student is expected to read and understand the content of each article, identifying key points and applying them to their analysis. This assignment promotes critical thinking, research skills, and the ability to synthesize complex information.

Evaluate the effectiveness of
appropriate interventions for
CHOLELITHIASIS

Cholelithiasis
Cholelithiasis refers to formation of gallstones or presence of solid concretions in the gall
bladder which is small organ under liver. The stones present in gallbladder can be as small as a
grain of sand or may be large as golf ball (Khan and et. al., 2017). However, it is necessary to
diagnose particular problem and them implement appropriate treatment procedure in order to
make an individual healthy. The present report is will focus on evaluation of effectiveness of
interventions and management of Cholelithiasis (Mukai and et. al., 2015).
Cholelithiasis can be described as a medical situation in which hard pebble like structures
deposition takes place in gallbladder of a person (Maplanka, 2014). These stones are known as
gallstones and gallbladder refer to a small organ which is located in abdominal cavity in human
beings and conduct a function to store bile (Gil and et. al., 2014). However, when gallstones
generated then they give rise to excruciating pain along with jaundice so that immediate
treatment is must to prevent further complications (Bagla, Sarria and Riall, 2016). In addition to
this, nursing interventions are required to be followed which facilitate to gain better outcomes of
managing Cholelithiasis (Martin and et. al., 2016). Moreover, it is observed that most of people
have gallstones which are asymptomatic so that treatment interventions depends upon symptoms
of an individual with help of imaging test findings. An individual with asymptomatic
cholelithiasis requires treatment due to risk of developing gallbladder carcinoma or gallstones
and higher complications in which case of prophylactic cholecystectomy is performed (Saber and
et. al., 2017).
At the other hand, interventions are necessary to be followed as they are helpful to conduct
diagnosis of specific health problem appropriately so that accurate medication can be provided
for better patient outcomes respectively (Farooq, Reso and Harvey, 2018). As per

recommendations of NICE, several guidelines are provided for diagnosing gallstones which
render help to conduct correct treating process in more effective as well as efficient manner.
Initially, liver function test and ultrasound should be carried out with suspected gallstone
disease and abdominal or gastrointestinal symptoms (Chavin and et. al., 2017). Secondly,
magnetic resonance cholangiopancreatography is required to be considered if gallstones in
common bile duct are not detected by ultrasound but the bile duct is dilated and liver function
test results are abnormal (Easler and Sherman, 2015). Thirdly, endoscopic ultrasound should
be conducted if magnetic resonance cholangiopancreatography does not allow required
diagnosis. However, pathophysiology is needed to be done in terms of analysing obstruction,
chemical reaction and compression which facilitate to evaluate actual problem (Jovani and et. al.,
2015). Moreover, after diagnosing appropriate problems and presence of gallstones, it is
necessary to provide accurate medication to solve it.
Apart from diagnosing procedures, it has been analysed that more than 90% of patients are
suffering from acute cholecystitis during middle age whereas chronic form is usually found in
old age people (Santarpia and et. al., 2014). There are several complications which can takes
place due to presence of cholelithiasis that consists empyema, gangrene and cholangitis. An
empyema of bladder develops when the gall bladder becomes filed with purulent fluid (Cha and
et. al., 2018). Additionally, gangrene may takes place due to not receiving sufficient amount of
oxygen and nourishment by tissues. Cholangitis can be defined as an infection progresses as it
reaches the bile duct (Bingener, 2016). Meanwhile, it is observed that cholecystitis causes a
series of symptoms such as pain, leukocytosis, fever, palpable gallbladder and sepsis. However,
Endoscopic retrograde cholangiopancreatography (ERCP) is required to be carried out as it
is appropriate method to visualise biliary tree with the help of cannulation of common bile duct

through duodenum (Beňová, Boledovičová and Bowles, 2016). Moreover, it is necessary to
conduct medical management of particular situation of an individual by taking certain effective
actions which are discussed here. Firstly, Fasting is prefer as the patient may not be allowed to
drink or eat at first in respect of taking stress of inflamed gallbladder and IV fluids are prescribed
for rendering temporary food for cells (Tazuma and et. al., 2015). Secondly, supportive medical
care that consist of restoration of haemodynamic stability and antibiotic coverage for gram
negative enteric flora (Andrén-Sandberg and Deng, 2014). Thirdly, gallbladder stimulation
should be conducted daily to manage contraction by the help of IV cholecystokinin that may
supportive to prevent formation of gallbladder sludge in patients receiving TPN (Total Parenteral
Nutrition).
The treatment of Cholelithiasis is required to be conducted in more effective as well as efficient
manner in order to gain accurate patient outcomes. It includes several pharmacological
therapies and procedures which provide support to sort out the given problem appropriately
(Dudric and et. al., 2016). Initially, Antibiotic therapy can be used including Levofloxacin and
Metronidazole for prophylactic antibiotic coverage against most common organisms. Secondly,
Promethazine or Prochlorperazine can be utilised for controlling nausea, preventing fluid and
other electrolytic disorders accordingly (Patil and et. al., 2014). Thirdly, Oxycodone or
Acetaminophen can be considered as useful in order to control inflammatory symptoms as well
as reducing pain respectively. However, surgical management is required when removal of
gallbladder is needed due to some contingency which consists cholecystectomy and Endoscopic
retrograde cholangiopancreatography (ERCP). Moreover, nursing management is very
effective in order to provide proper care to patient and make them disease free (Saensak and et.
al., 2014).

Nursing management consists assessment which involves to diagnose integumentary system by
assessing skin and mucous membranes. It include to conduct accurate assessment of circulatory
system in terms of analysing peripheral pulses and capillary refill (Sharaiha and et. al., 2017).
Meanwhile, abnormal bleeding i.e., oozing from injection sites, epistaxis, bleeding gums,
petechiae, ecchymosis, hematemesis or melena (Orenstein, Marks and Hardacre, 2014).
Moreover, it also involve gastrointestinal system in respect of assessing abdominal distension,
guarding, frequent belching and reluctance to move (Chang and et. al., 2014). However, nursing
diagnosis should be conducted on the basis of assessment information which majorly consists an
acute pain related to inflammatory process and risk for imbalanced nutrition related to self
imposed dietary restrictions & pain. In addition to this, nursing plan should be prepared with
goals of nursing care plan in which major objectives are relive pain & promote rest, maintain
fluid & electrolyte balance, prevent precautions and render knowledge regarding disease
procedure, prognosis & treatment requirements (Sninsky and et. al., 2014).
Nursing plan consists interventions which are required to be followed while providing care to
patients through giving medication accordingly. It include pain assessment, promote bed rest,
allow patient to assume position of comfort and diversion by motivating people for utilising
relaxation methods along with giving diversion-al events (El-Messidi and et. al., 2018).
Meanwhile, it is necessary to make regular communication with patient and listen to them for
analysing their actual problem in order to regain their comfort zone. However, it consist to
measure caloric intake of person in respect of determining actual nutritional deficiencies or needs
in proper manner. In addition to this, food planning of patient is must which is healthier for them
and fulfil all nutrition deficiencies accurately. Moreover, it is important to promote appetite
through providing pleasant environment at mealtime as well as remove noxious stimuli.

Furthermore, laboratory studies should be monitored in terms of BUN, pre albumin, albumin,
transferrin levels and total protein (Cho and Sahakian, 2018).
There are several medications which are helpful to dissolve gallstones ursodiol or chenodiol,
which helps to thinning the bile that facilitate to dissolve the gallstones. Extracorporeal shock-
wave lithotripsy (ECSWL) helps to break up gallstone through sending shock waves through
soft tissue of body which is only effective in solitary gallstones (Portincasa and et. al., 2016).
Methyl tertiary-butyl ether (MTBE) can also facilitate to dissolve gall stones but consists a
side of severe burning pain. Moreover, endoscopic drainage, percutaneous cholecystectomy,
transmural drainage and acute cholecystectomy are helpful to solve problem of gallstone
(Sanjay and et. al., 2015). However, ERCP is used to treat bile and pancreatic ducts for treating
several problems respectively. It is much effective to solve issues like gallstones, acute or
chronic pancreatitis surgical complications, pancreatic pseudocysts and tumour or cancer in bile
duct & pancreas (Minaga and et. al., 2017). It has been evaluated that patient get relief from pain,
gallstones dissolved and recovery is also improved. The management of Cholelithiasis can be
known as uniquely multidisciplinary including several specialities and treatment options in order
to solve the same problem. Additionally, antibiotics are effected to to dissolve gallstones but in
severe condition surgical process should be prefer for immediate removal of the same to make
patient disease free. In contrary to this, ERCP has few of limitations as it consist certain risks
including pancreatitis, infection in bile ducts or gallbladder, hemorrhage, abnormal reaction to
sedative, tissue damage and rarely death of patient (Ruangsin and et. al., 2015).
The above report conclude that Cholelithiasis can be described as a presence of solid concretions
in the gall bladder. It consists several symptoms which should be diagnosed properly and prepare
plan of action to treat the same accurately in order to attain better patient outcomes. Moreover,

diagnosis can be done by liver function test & magnetic resonance cholangiopancreatography
which facilitate to provide correct medication.

REFERENCES
Books and journals
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Bingener, J., 2016. The Use of Randomized Clinical Trials in the Evaluation of Innovative
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Online
Gallbladder disease. 2019. [Online]. Available through:
<https://drhoffman.com/article/gallbladder-disease-2/>.