CHOLECYSTITIS

CHOLECYSTITIS – Etiology, Risk Factors, Signs and Symptoms, Diagnostic Evaluations and Management

DEFINITION

Cholecystitis is inflammation of the gallbladder

ETIOLOGY

  • Gallstones: the vast majority of cholecystitis cases are the result of gallstones that block the cystic duct, causing bile to build up and resulting in gallbladder inflammation
  • Tumor: a tumor may prevent bile from draining out of gallbladder properly, causing bile buildup that can lead to cholecystitis
  • Bile duct blockage: kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis

RISK FACTORS

  • Gallstones: most cases of cholecystitis are linked to gallstones
  • Sex: women have a greater risk of gallstones than men do. This makes women more likely to develop cholecystitis
  • Age: older people are at high risk of gallstones

SIGNS AND SYMPTOMS

  • Severe, steady pain in the upper righ part of abdomen
  • Pain that radiates from abdomen to right shoulder or back
  • Tenderness over abdomen when it is touched
  • Sweating
  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Abdominal bloating

COMPLICATIONS

  • Enlarged gallbladder: if gallbladder becomes inflamed due to bile buildup, it may stretch and swell beyond its normal size, which can cause pain and increase the risk of a tear (perforation) in gallbladder, as well as infection  and tissue death
  • Infection within the gallbladder: if bile builds up within gallbladder, causing cholecystitis, the bile may become infected
  • Gangrene: untreated cholecystitis can cause tissue in the gallbladder to die (gangrene), which, in turn, can lead to a tear in the gallbladder
  • Perforation: a tear (perforation) in gallbladder may be caused by an enlarged or infected gallbladder that occurs as a result of cholecystitis

DIAGNOSTIC EVALUATION

  • Blood tests: blood tests are done to look for signs of an infection or of gallbladder problems
  • Imaging tests: imaging tests, such as abdominal ultrasound or a computerized tomography (CT) scan can be used to create pictures of gallbladder that may reveal signs of cholecystitis
  • HIDA: a hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile from liver to small intestine and shows if bile is blocked at any point along the way.

MANAGEMENT

  • Antibiotics: to treat the infection
  • Analgesics: to help control pain until the inflammation in gallbladder is relieved

Surgical Interventions

  • Cholecystectomy
  • Laparoscopic laser cholecystectomy
  • Cholecystectomy
  • Choledochotomy (incision of common bile duct)
  • Choledocholithotomy (incision of common bile duct and removal of gallstones)

NURSING MANAGEMENT

Nursing Assessment

  • Obtain history and demographic data that may indicate risk factors for biliary disease
  • Assess mental status through interview and interaction with patient
  • Perform abdominal examination for ascites
  • Assess the client’s bowel elimination pattern, noting the number of stools and their color and also the presence of blood
  • Assess the client’s abdomen for bowel sounds and the location of pain
  • Assess the complete nutritional status of diseased patient
  • Observe for any bleeding
  • Monitor for temperature and WBC counts for indicating inflammation of infection
  • Assess the emotional status, coping skills, verbal and nonverbal behaviors

Nursing Diagnosis

  • Risk for injury related to medication during retrograde endoscopy for stone removal
  • Knowledge deficit related to oral dissolution agents
  • Pain related to stone obstruction
  • Fluid volume deficit related to nausea and vomiting
  • Activity intolerance related to fatigue, general discomfort
  • Anxiety-related inflammatory disease of gallbladder
  • Imbalanced nutrition less than body requirement related to pain
  • Ineffective coping related to feeling of rejection
  1. Risk for injury related to medication during retrograde endoscopy for stone removal

Interventions

  • Assess for signs and symptoms of GI bleeding, e.g. check all secretions for frank or occult blood. Observe color and consistency of stools, NG drainage, or vomitus
  • Observe for presence of petechiae, ecchymosis, bleeding from one or more sites
  • Monitor pulse, BP (and CVP, if available)
  • Note changes in mentation and level of consciousness
  • Avoid rectal temperature, be gentle with GI tube insertions
  • Encourage use of soft toothbrush, electric razor, avoiding straining for stool, forceful nose blowing, and so forth
  • Use small needles for injections. Apply pressure to small bleeding and venipuncture sites for longer than usual
  • Recommend avoidance of aspirin-containing products
  • Knowledge deficit related to oral dissolution agents

Interventions

  • Inform patient of altered effects of medications with cholecystitis and the importance of using only drugs prescribed or cleared by a health care provider who is familiar with patient’s history
  • Assist patient in identifying the support person
  • Emphasize the importance of good nutrition. Recommend avoidance of high-protein and salty foods, onions and strong cheeses. Provide written dietary instructions.
  • Discuss sodium and salt substitute restrictions and necessity of reading labels on food and OTC drugs
  • Encourage scheduling activities with adequate rest periods
  • Promote diversional activities that are enjoyable to the patient
  • Recommend avoidance of persons with infections, especially upper respiratory tract infection
  • Identify environmental dangers, e.g. carbon tetrachloride-type cleaning agents, exposure to hepatitis
  • Pain related to stone obstruction

Intervention

  • Assess the pain location, severity and characteristics
  • Administer medications or monitor patient-controlled analgesia
  • Assist in attaining position of comfort and maintain bed rest
  • Fluid volume deficit related to nausea and vomiting

Interventions

  • Administer IV fluids and electrolytes as prescribed
  • Administer antiemetic as prescribed to reduce vomiting
  • Maintain nasogastric decompression until nausea and vomiting subside
  • Begin food and fluids as tolerated by the client
  • Observe and record amount of T tube drainage, if applicable
  • Activity intolerance related to fatigue, general discomfort

Interventions

  • Encouraging alternating periods of rests and ambulation
  • Maintain some periods of rest
  • Encourage and assist with gradually increasing periods of exercise
  • Imbalanced nutrition less than body requirement related to pain

Interventions

  • Encourage a diet that is low in residue fiber and fat and high in calories, protein and carbohydrates with vitamin and mineral supplements
  • Monitor weight daily
  • Provide small frequent feeding to prevent distension
  • Have the patient participate in meal planning to encourage compliance and increased knowledge
  • Prepare the patient for elementary diet
  • Restart oral fluid intake gradually. Offer clear liquids hourly; avoid cold fluids
  • Ineffective coping related to feeling of rejection

Intervention

  • Assess the level of fear and note nonverbal communication
  • Ask the patient’s usual coping pattern
  • Assure patient he/she will be closely monitored
  • Allow patient to verbalize fear of dying
  • Provide diversional materials, such as newspapers, music and television
  • Offer family support

COMPLICATIONS

  • Acute cholangitis: acute cholecystitis is a condition indicated by a sudden attack of pain in the upper abdomen that lasts more than 12 hours
  • Acute biliary pancreatitis: pancreatitis is a potentially serious disorder that occasionally develops in people with gallstones
  • Gallstone ileus
  • Obstructive jaundice or cholestasis
  • Gallbladder cancer
CHOLECYSTITIS – Etiology, Risk Factors, Signs and Symptoms, Diagnostic Evaluations and Management
CHOLECYSTITIS – Etiology, Risk Factors, Signs and Symptoms, Diagnostic Evaluations and Management

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