CHOLECYSTITIS

and

CHOLELITHIASIS
gastrointestinal disorder
A Cholecystitis and Cholelithiasis are most frequently
associated with women older than 40 years, ebisity,
multiparity and ingestion of a high-fat diet. Both these
conditions are seen with pregnancy. Pregnant women
are at an especially high risk because their bodies are
making more estrogen. Added estrogen in the body can
lead to an increased amount of cholesterol in the bile,
while also reducing gallbladder contractions.
 CHOLECYSTITIS
the inflammatory condition of the gallbladder. When the drainage pathway for the
bile stored in the gallbladder becomes blocked, usually by a gallstone and rarely
by a tumor – the gallbladder becomes swollen and may become infected.
Obstruction of the cystic duct results in the gallbladder becoming distended with
bile, an inflammatory exudate or even pus.

ACUTE CHRONIC
A stone has obstructed the cystic duct for a prolonged Lower intensity inflammation of the gallbladder
period, resulting in a vicious cycle of increased that lasts a long time. May cause intermittent mild
secretion of fluid, causing distension, mucosal abdominal pain, or no symptoms at all
damage and the release of chemical mediators of the
inflammatory process.
 CHOLELITHIASIS
presence of gallstones which are concretions that form in the biliary tract, usually
in the gallbladder. Gallstones are collections of cholesterol, bile pigment, or a
combination of two which can form in the gallbladder or within the bile ducts of
the liver.

CHOLESTEROL MIXED PIGMENTE

D
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P
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Risk factors for cholecystitis mirror those
for

cholelithiasis which includes:

Ø Increasing age

Ø Female sex

Ø Certain ethnic groups

Ø Obesity or rapid weight loss

Ø Drugs

Ø Pregnancy

Ø Sedentary lifestyle

Ø Multiparity

Ø Birth control pills

Ø Family history

Ø Diabetes

Ø Liver disease

Ø Fertility
 CHOLECYSTITIS Signs and Symptoms
Ø intense itching (most common symptom in pregnant women)

Ø Severe pain in your upper right or center abdomen

Ø Signs of peritoneal irritation may be present, and the pain may radiate to the right shoulder or scapula

Ø Tenderness over your abdomen when it's touched

Ø Positive Murphy’s sign

Ø Nausea and vomiting are generally present, and fever may be noted

Ø Fever, tachycardia, and tenderness in the RUQ or epigastric region, often with guarding or rebound

Ø Palpable gallbladder or fullness of the RUQ (30%-40% of patients)

Ø Jaundice (~15% of patients)

Cholecystitis signs and symptoms often occur after a meal, particularly a large or fatty one.
 CHOLELITHIASIS Signs and Symptoms

Ø Sporadic and unpredictable episodes

Ø Pain that is localized to the epigastrium or right upper quadrant, sometimes radiating to the right
scapular tip
Ø Pain that is constant; not relieved by emesis, antacids, defecation, flatus, or positional changes;
and sometimes accompanied by diaphoresis, nausea, and vomiting
Ø Nonspecific symptoms (eg, indigestion, dyspepsia, belching, or bloating)
Ø Fever and shivering
Ø Severe nausea and vomiting
Ø Jaundice
Ø Stool containing fat (steatorrhea)
Ø Clay colored stools or dark urine
DIAGNOSTIC/
LABORATORY TESTS
Ø History of patient
Ø Physical Examination
Ø Laboratory test for
Ø Fecal studies
Ø Ultrasound of the gallbladder
Ø Radiography
Ø MRI
Ø CT scan
Ø HIDA (hepato-iminoacetic acid)
Ø ERCP (endoscopic retrograde
cholangiopancreatography)
Ø MRI
 Nursing Responsibilities
GALLBLADDER

Ø GI rest
Ø Analgesics and Antiemetics
Ø Low fat diet when recovered
Ø Large bore IV for fluids
Ø Breathing in stopped by patient
Ø Laboratory tests
Ø Antibiotics for infection
Ø Drain care
Ø Deterioration Signs and Symptoms
Ø ERCP – endoscopic retrograde cholangiopancreatogyaphy
Ø Removal of Gallbladder – cholecystectomy
TREATMENT REGIMEN
Medications/Suppl
ements/Vaccines Surgery Diet or Nutrition Physical Therapy IV Fluids Palliative

Antiemetics Laparoscopic Fasting

(Promethazine, cholecystectomy Pain medicines and
Prochlorperazine) Eating a healthy, drugs (as
low-fat diet during mentioned above)
Percutaneous as prescribed by
Analgesics your pregnancy
transhepatic physician to control
(Meperidine, cholecystostomy nausea or itching
Avoid fatty meats,
Hydrocodone and
drainage fried food, and any Management
acetaminophen) Regular exercise
high-fat foods A small tube or a
includes IV fluids to
Endoscopic (may also reduce catheter can be put
Antibiotics help maintain fluid
retrograde Nutrition advanced the frequency of into the bile duct or
and electrolyte
Gallstone cholangiopancreato per physician’s cholecystectomy) the gallbladder to
status
Dissolution Agent graphy (ERCP) order – clear help the bile drain
liquids, full liquids, out.
soft bland foods etc biliary bypass allow
bile to drain from
High intake of fresh the liver and
fruits and gallbladder
vegetables
PREVENTION AND PROGNOSIS
Primary prevention - primary prevention starts with preventing gallstones. Physical activity has a protective effect with a
decreased prevalence of gallstone disease in people engaging in moderate physical activity compared with those engaging
in low levels of physical activity, independent of body mass index. Two cohort studies indicate that high fiber intake is
associated with decreased incidence of symptomatic gallstone disease

Secondary prevention – patients with symptomatic gallstones should be offered elective cholecystectomy to prevent
development of acute cholecystitis.

Cholecystitis Cholelithiasis

Uncomplicated cholecystitis has an excellent Less than half of patients with gallstones become
prognosis, with a very low mortality. Most patients with symptomatic. The mortality rate for an elective
acute cholecystitis have a complete remission within 1- cholecystectomy is 0.5% with less than 10% morbidity.
4 days. However, 25%-30% of patients either require The mortality rate for an emergent cholecystectomy is
surgery or develop some complication. 3%-5% with 30%-50% morbidity.Following
cholecystectomy, stones may recur in the bile duct.
 1
Nursing Diagnosis: Acute Pain related to obstruction

• Note response to medication, and report to physician if pain is not being relieved.

• Promote bedrest, allowing patient to assume position of comfort.

• Use soft or cotton linens; calamine lotion, oil bath; cool or moist compresses as indicated.

• Encourage use of relaxation techniques. Provide diversional activities.

• Make time to listen to and maintain frequent contact with patient.

As prescribed by doctor

• Sedatives: phenobarbital

• Narcotics: meperidine hydrochloride (Demerol), morphine sulfate Smooth muscle relaxants: papaverine
(Pavabid), nitroglycerin, amyl nitrite

• Chenodeoxycholic acid (Chenix), ursodeoxycholic acid (Urso, Actigall)

 2
Nursing Diagnosis: Ineffective Breathing pattern related to
Abdominal incision pain
• Assess rate and depth of respirations.

• Auscultate lung sounds at least every 4 hours postoperatively.

• Observe for splinting.

• Elevate head of bed at least 30 degrees.

• Encourage the pt to do deep breathing exercises.

• Administer oxygen as prescribed

• Help the pt splint the abdominal incision by using hands or pillow.

 3
Nursing Diagnosis: Risk for Deficient Fluid Volume
• Maintain accurate record of I&O, noting output less than intake, increased urine specific
gravity. Assess skin and mucous membranes, peripheral pulses, and capillary refill.

• Monitor for signs and symptoms of increased or continued nausea or vomiting, abdominal
cramps, weakness, twitching, seizures, irregular heart rate, paresthesia, hypoactive or absent bowel
sounds, depressed respirations.

• Eliminate noxious sights or smells from environment.

• Perform frequent oral hygiene with alcohol-free mouthwash; apply lubricants.

• Use small-gauge needles for injections and apply firm pressure for longer than usual after
venipuncture

• Assess for unusual bleeding: oozing from injection sites, epistaxis, bleeding gums,
ecchymosis, petechiae, hematemesis or melena.

• Insert NG tube, connect to suction, and maintain patency as indicated.

 4
Nursing Diagnosis: Risk for infection, related to potential
bacterial contamination of abdominal cavity

• Instruct the pt and caregiver to wash hands before contact with the postoperative pt.

• Teach use aseptic technique during dressing change, or handling or manipulating of tubes
and drains.

• Ensure the surgical tubes and drains are not inadvertently interrupted (opened). Securely tape
connectors and pin extension or drainage tubing to the pt.'s clothing.

• Instruct the patient and caregiver in administration of antibiotics and antipyretics as

prescribed.

• Administer antibiotics and antipyretics as prescribed.

·
Nursing Diagnosis: Deficient Knowledge related to lack of 5
knowledge as evidenced by questions

• Explain reasons for test procedures and preparations as needed.

• Review disease process and prognosis. Discuss hospitalization and prospective treatment as
indicated. Encourage questions, expression of concern.

• Review drug regimen, possible side effects.

• Discuss weight reduction programs if indicated

• Instruct patient to avoid food/fluids high in fats, gas producers, or gastric irritants

• Review signs and symptoms requiring medical intervention: recurrent fever; persistent nausea
and vomiting, or pain; jaundice of skin or eyes, itching; dark urine; clay-colored stools; blood in urine,
stools, vomitus; or bleeding from mucous membranes.

• Recommend resting in semi-Fowler’s position after meals.