CHOLECYSTITIS

CHOLECYSTITI
S
NCM 116 MIDTERM
Cholecystitis
Cholecystitis is a swelling and irritation of your gallbladder, a small organ in
the right side of your belly near your liver.
Cholecystitis is an inflammation of the gallbladder. It normally happens

because a gallstone gets stuck at the opening of the gallbladder.
Cholecystitis, or inflammation of your gallbladder, occurs when a gallstone

blocks bile from exiting the organ.
Classification
Calculous cholecystitis. In calculous cholecystitis, a gallbladder stone obstructs
bile outflow.
Acalculous cholecystitis. Acalculous cholecystitis describes acute inflammation in

the absence of obstruction by gallstones.
Causes
● Gallbladder stone. Cholecystitis is usually associated with gallstone
impacted in the cystic duct.
● Bacteria. Bacteria plays a minor role in cholecystitis; however,
secondary infection of bile occurs in approximately 50% of cases.
● Alterations in fluids and electrolytes. Acalculous cholecystitis is
speculated to be caused by alterations in fluids and electrolytes.
● Bile stasis. Bile stasis or the lack of gallbladder contraction also play
a role in the development of cholecystitis.
Risk Factors
● Being female- increases biliary cholesterol secretion
● Pregnancy- increase hormones during pregnancy causes high cholesterol levels
and delayed gallbladder emptying
● Hormone therapy- estrogen increases biliary cholesterol secretion
● Older age- decreased gallbladder contractility
● Obesity- increases the amount of cholesterol in the bile
● Losing or gaining weight rapidly- causes bile to over concentrate
● Diabetes- bile acid and lipid composition are usually increased in diabetic
patients
● Eat a diet high in fat and cholesterol.
Clinical Manifestation
● Tenderness in your abdomen when it's touched.
● Nausea and bloating.
● Vomiting.
● Fever above 38 C. Fever may not be present in older adults
and usually doesn’t occur in people with chronic cholecystitis.
● Chills.
● Abdominal pain that gets worse when taking a deep breath.
● Abdominal pain and cramping after eating – especially fatty
foods.
● Jaundice (a yellowing of skin and eyes).
Nursing Diagnoses
● Acute pain secondary to biliary obstruction
● Ineffective coping related to nausea
● Deficient knowledge related to diagnosis
● Impaired gas exchange related to high abdominal surgical incision.
● Impaired skin integrity related to altered biliary drainage after surgical
incision.
● Imbalanced nutrition related to inadequate bile secretion.
Nursing Intervention
Provide nursing interventions during an acute gallbladder attack.
Intervene to relieve pain; give prescribed analgesics
Promote adequate rest
Administer IV fluids, monitor intake and output
Monitor nasogastric tube and suctioning
Administer antibiotics if prescribed.
Provide adequate nutrition.
Assess nutritional status. Encourage a high-protein, high-carbohydrate,
low-fat diet.
Diagnostic Examination
● Ultrasound: This can highlight any gallstones and may show the condition of the
gallbladder.
● Blood test: A high white blood cell count may indicate an infection. High levels of
bilirubin, alkaline phosphatase, and serum aminotransferase may also help the doctor
make a diagnosis.
● Computerized tomography (CT) or ultrasound scans: Images of the gallbladder may reveal
signs of cholecystitis.
● Hepatobiliary iminodiacetic acid (HIDA) scan: Also known as a cholescintigraphy,
hepatobiliary scintigraphy or hepatobiliary scan, this scan creates pictures of the liver,
gallbladder, biliary tract and small intestine.
Management
● Fasting, to rest the gallbladder.
● IV fluids to prevent dehydration.
● Pain medication.
● Antibiotics to treat infection.
● Removing the gallbladder. This surgery, called cholecystectomy , is usually
performed by making tiny cuts (incisions) through the abdomen to insert a
laparoscope (tiny camera) to see inside the abdomen and surgical instruments
to remove the gallbladder. The gallbladder is usually removed within 24 to 48
hours of admission if you have a confirmed case of acute cholecystitis.
● Draining the gallbladder to treat and prevent the spread of infection. This
procedure, called percutaneous cholecystostomy, is usually reserved for those
who are too ill to undergo surgery.
● Removing gallstones in the area blocking the common bile duct. This procedure,
done by an endoscopist, called ERCP, is reserved for patients with a suspected
or confirmed blocked common bile duct, and can clear the duct of stones and
Complication
● Severely Infected gallbladder: A blocked gallbladder that is extremely
uncomfortable and painful. Without treatment, it could lead to an
overwhelming infection, or even gangrene of the gallbladder.
● Cholangitis: An acute infection of the main bile ducts and liver that can
be extremely life-threatening if not promptly treated.
● Inflamed pancreas (Pancreatitis): Your common bile duct and the
pancreatic duct share the same “valve” into the duodenum. If a gallstone
blocks that valve, the potent pancreatic enzyme juice excreted by the
pancreases gets backed up causing pancreatitis, which can also be severe
and life threatening.
Prevention
● avoiding saturated fats
● keeping to a regular breakfast, lunch and dinner times and not skipping meals
● exercising 5 days per week for at least 30 minutes each time
● losing weight, because obesity increases the risk of gallstones
● avoiding rapid weight loss as this increases the risk of developing gallstones

CHOLECYSTITIS

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CHOLECYSTITI

Cholecystitis is an inflammation of the gallbladder. It normally happens

Cholecystitis, or inflammation of your gallbladder, occurs when a gallstone

Acalculous cholecystitis. Acalculous cholecystitis describes acute inflammation in

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