CHOLECYSTITIS

Overview of the Existing Health Problem gallbladder is a pear-shaped, hollow structure

Cholecystitis (is a redness and swelling located under the liver and on the right side of the
(inflammation)of the gallbladder. abdomen
It happens when a digestive juice called bile gets The gallbladder is a small, pear-shaped hollow
trapped in your gallbladder. organ. It is approximately an inch wide and 3 inches
long,1 and is tapered at one end where it connects to
Cholecystitis, or gallbladder inflammation, occurs the cystic duct. It can store approximately 30 to 50
when bile can’t circulate out of the gallbladder as it cubic centimeters (cc) of bile.
normally does.
The gallbladder's main function is to store bile, a
When bile builds up, it causes the gallbladder to fluid that helps with digestion
thicken, harden, swell, and become irritated.
The gallbladder is a small organ that holds bile from
When gallstones block this tube, bile builds up in the liver and releases it into the small intestine to
your gallbladder. This causes irritation and pressure help with digestion.
in the gallbladder. It can cause swelling and Pathophysiology
infection.
Predisposing factors:
Etiology/Causes 40y/o and older
Cholecystitis happens when a digestive juice called Female
bile gets trapped in your gallbladder. Diabetes meilltus

In most cases, this happens because lumps of solid Precipitating factors”

material (gallstones) are blocking a tube that drains Diet:
bile from the gallbladder. Increased cholesterol intake

When gallstones block this tube, bile builds up in Laboratory Study or Confirmatory tests
your gallbladder. This causes irritation and pressure
in the gallbladder. It can cause swelling and Complete blood count: A high white blood cell
infection. count may indicate an infection. High levels of
bilirubin, alkaline phosphatase, and serum
The gallbladder stores bile. Gallstones are formed in aminotransferase may also help the doctor make a
your gallbladder. They are made from bile. diagnosis
CT scans or ultrasound: Images of the gallbladder
Bacterial infection in the bile duct system. The bile may reveal signs of cholecystitis.
duct system is the drainage system that carries bile
from your liver and gallbladder into the first part of Surgical Management
your small intestine (the duodenum).
A cholecystectomy is surgery to remove your
Cholecystitis most frequently occurs when gallbladder.
gallstones (stones that form within the bile coming
down from the liver) block the tube leading out of There are 2 types of surgery to remove the
the gallbladder. This results in a build-up of bile, gallbladder:
which causes inflammation.
Open (traditional) method. In this method, 1 cut
(incision) about 4 to 6 inches long is made in the
Signs & Symptoms upper right-hand side of your belly. The surgeon
severe and sudden pain in the upper right part of the finds the gallbladder and takes it out through the
abdomen incision.
Pain that spreads to your right shoulder or back
Pain after eating a meal Laparoscopic method. This method uses 3 to 4 very
An abdomen that’s tender to the touch Nausea small incisions. It uses a long, thin tube called a
Vomiting laparoscope. The tube has a tiny video camera and
Fever surgical tools. The tube, camera and tools are put in
Chills through the incisions. The surgeon does the surgery
Belly bloating while looking at a TV monitor. The gallbladder is
removed through 1 of the incisions.
When your gallbladder is inflamed and swollen, it
irritates your phrenic nerve. Your phrenic nerve
stretches from the abdomen, through the chest, and Nursing Management
into your neck. Each time you eat a fatty meal, it - Assess vital signs
aggravates the nerve and causes referred pain in -Provide adequate nutrition by Assessing nutritional
status. Encourage a low salt low fat diet
your right shoulder blade.
-Observe and document location, severity (0-10
scale), and character of pain.
- Relieve pain and promote rest.
Anatomy and Physiology
- Activity. Promote bedrest, allowing the patient to Sudden and rapidly intensifying pain in the center
assume a position of comfort. of your abdomen, just below your breastbone
- Administer IV fluids, monitor intake and output
Back pain between your shoulder blades

Drug Study Pain in your right shoulder

CHOLELITHIASIS Nausea or vomiting

Cholelithiasis or gallstones are hardened deposits of yellowing of the skin and whites of the eyes
digestive fluid that can form in your gallbladder (jaundice)
Anatomy and Physiology
Gallstones are usually made up of cholesterol or
bilirubin that collect at the bottom of your
gallbladder until they harden into “stones.” gallbladder is a pear-shaped, hollow structure
located under the liver and on the right side of the
Cholesterol gallstones: This most common type of abdomen
gallstone often appears yellow in color and is The gallbladder is a small, pear-shaped hollow
composed mainly of undissolved cholesterol. organ. It is approximately an inch wide and 3 inches
long,1 and is tapered at one end where it connects to
Pigment gallstones: These dark brown or black the cystic duct.
stones form when bile contains too much bilirubin
(a brownish yellow substance produced when the It can store approximately 30 to 50 cubic
liver breaks down red blood cells). centimeters (cc) of bile.

Cholesterol stones are usually yellow-green in color The gallbladder's main function is to store bile, a
and are made of mostly hardened cholesterol. In fluid that helps with digestion
some countries, cholesterol stones make up about
75 percent of gallstones.
Pathophysiology
Pigment stones are dark in color and are made of
bilirubin. Some people have a mix of both kinds of
stones. Made of a yellowish pigment called
bilirubin Laboratory Study or Confirmatory tests
Complete blood count: A high white blood cell
count may indicate an infection. High levels of
bilirubin, alkaline phosphatase, and serum
Etiology/Causes aminotransferase may also help the doctor make a
diagnosis. However, these markers may notTrusted
gallbladder doesn't empty correctly. If your Source be present in the chronic version.
gallbladder doesn't empty completely or often CT scans or ultrasound: Images of the gallbladder
enough, bile may become very concentrated, may reveal signs of cholecystitis.
contributing to the formation of gallstones.

Your bile contains too much cholesterol. Normally, Surgical Management

your bile contains enough chemicals to dissolve the A cholecystectomy is surgery to remove your
cholesterol excreted by your liver. But if your liver gallbladder.
excretes more cholesterol than your bile can
dissolve, the excess cholesterol may form into There are 2 types of surgery to remove the
crystals and eventually into stones gallbladder:

Open (traditional) method. In this method, 1 cut

Types of gallstones Types of gallstones that can (incision) about 4 to 6 inches long is made in the
form in the gallbladder include: Cholesterol upper right-hand side of your belly. The surgeon
gallstones. The most common type of gallstone, finds the gallbladder and takes it out through the
called a cholesterol gallstone, often appears yellow incision.
in color. These gallstones are composed mainly of
undissolved cholesterol, but may contain other Laparoscopic method. This method uses 3 to 4 very
components. Pigment gallstones. These dark brown small incisions. It uses a long, thin tube called a
or black stones form when your bile contains too laparoscope. The tube has a tiny video camera and
much bilirubin surgical tools. The tube, camera and tools are put in
through the incisions. The surgeon does the surgery
Signs & Symptoms while looking at a TV monitor. The gallbladder is
Sudden and rapidly intensifying pain in the upper removed through 1 of the incisions.
right portion of your abdomen
Which is better laparoscopy or open surgery for A combination of risk factors may lead to
gallbladder? acalculous cholecystitis, including accidental
damage to the gallbladder during major surgery,
According to reports, a laparoscopic approach serious injuries
generally causes less blood loss, less trauma, and or burns, sepsis,severe malnutrition or dehydration.
provides a faster recovery with reduced
hospitalization as compared to open surgery.
However, laparoscopic does require general Your liver produces bile, which is mostly made of
anesthesia, and it costs more than open surgery. cholesterol, bile salts, and bilirubin. Your
gallbladder stores the bile until it’s needed. When
Nursing Management you eat, your body signals your gallbladder to
Low salt low fat diet empty bile into your duodenum to mix with food.
The bile ducts carry the bile from your gallbladder
Avoid fatty foods to the duodenum.

Assess general condition of the patient What are the 4fs in cholecystitis?
Closely monitor vital signgs It seemed appropriate to answer the question
whether 4 x F canon (forty--the age over 40 years of
Provide a comfortable and restful environment. age; female--sex; fertile--fertility; fat--obesity) still
remains the basic canon among risk factors that
Keep the patient on bed rest and assist in a position determine the development of cholecystolithiasis.
of comfort such as low-Fowler’s, knee-to-chest, or
side-lying position.

Administer prescribed medications

Assess vital signs

-Provide adequate nutrition by Assessing nutritional
status. Encourage a low salt low fat diet
-Observe and document location, severity (0-10
scale), and character of pain.
- Relieve pain and promote rest.
- Activity. Promote bedrest, allowing the patient to
assume a position of comfort.
- Administer IV fluids, monitor intake and output

Calculous cholecystitis
Calculous cholecystitis is the most common, and
usually less serious, type of acute cholecystitis. It
accounts for around 95% of all cases.

Calculous cholecystitis develops when the main

opening to the gallbladder, the cystic duct, gets
blocked by a gallstone or a substance known as
biliary sludge.

Biliary sludge is a mixture of bile, a liquid produced

by the liver that helps digest fats, and small
cholesterol and salt crystals.

The blockage in the cystic duct causes bile to build

up in the gallbladder, increasing the pressure inside
it and causing it to become inflamed. An inflamed
gallbladder can sometimes become infected by
bacteria.

Acalculous cholecystitis
Acalculous cholecystitis is gallbladder
inflammation without gallstones. It's less common,
but usually more serious, than calculous
cholecystitis.

The exact cause of acalculous cholecystitis is not

known, but it's usually a complication of a serious
illness, infection or injury that damages the
gallbladder.