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Cholecystitis

Submitted by, Mrs Bibi Baby 2 nd year MSc Nursing Medical Surgical Nursing PION.

Submitted to, Mrs. Prasanna Balaji HOD of Medical Surgical Nursing PION.

Cholecystitis Introduction Gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into small intestine. Definition Cholecystitis is the inflammation of the gall-bladder. Incidence The disease is more common in women than in men, and it occurs most frequently after the age of 40. Risk factors

1. Gallstones. Most cases of cholecystitis are linked to gallstones. 2. Being female. Women have a greater risk of gallstones than men do. This makes
women more likely to develop cholecystitis.

3. Increasing age. As the person becomes older, risk of gallstones increases, as does
the risk of cholecystitis Etiology
1.

Gallstones. The vast majority of cholecystitis cases are the result of gallstones that block the cystic duct the tube through which bile flows when it leaves the gallbladder causing bile to build up and resulting in gallbladder inflammation.

2.

Tumor. A tumor may prevent bile from draining out of your 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. Infection or trauma, such as an injury from a car accident.

3.

4.

Types There are two types of cholecystitis: 1. Acute cholecystitis, which comes on suddenly. Acute acalculous cholecystitis, though rare, is most often seen in critically ill people in hospital intensive care units. In these cases there are no gallstones. Complications from another severe illness, such as HIV or diabetes, cause the swelling. 2. Chronic cholecystitis, which is longstanding and persistent.Long-term (chronic) cholecystitis is another form of cholecystitis. It occurs when the gallbladder remains swollen over time, causing the walls of the gallbladder to become thick and hard. Pathophysiology Due to etiological factors. Inflammation that may be confined to the mucus lining or involved the entire wall of the gall bladder. Gall bladder is edematous and hyperemic. May be distended with bile or pus. Cystic duct may also be involved and occluded. Wall of the gall bladder becomes scarred after the first attack. Decreased functioning occurs if large amount of tissues are fibrosed. Clinical manifestation Signs and symptoms of Cholecystitis include:

Severe, steady pain in the upper right part of your abdomen Pain that radiates from your abdomen to your right shoulder or back Tenderness over your abdomen when it's touched Sweating Nausea Vomiting

Fever Chills Abdominal bloating

Cholecystitis signs and symptoms usually occur after a meal, particularly a large meal or a meal high in fat. Diagnosis

Physical examination: while palpation , feel right upper abdomen to look for tenderness. Blood tests.: to look for signs of an infection or signs 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.

A scan that shows the movement of bile through your body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile from your liver to your small intestine and shows if bile is blocked at any point along the way. A HIDA scan involves injecting a radioactive chemical into your body. The chemical binds to the bile-producing cells, so it can be clearly seen as it travels with the bile through the bile ducts.

Medical management

The patient may not be allowed to eat or drink at first in order to take stress off inflamed gallbladder. Administer intravenous fluid to prevent dehydration. Administer antibiotics to fight against the infection. Administer analgesics to prevent pain.

Surgical management Surgical removal of the gallbladder (cholecystectomy) is usually done using a flexible viewing tube called a laparoscope. After small incisions are made in the abdomen, the laparoscope and other tubes are inserted, and surgical tools are passed through the incisions and used to remove the gallbladder.

Complications
1.

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.

2.

Infection within the gallbladder. If bile builds up within gallbladder, causing cholecystitis, the bile may become infected. Death of gallbladder tissue. Untreated cholecystitis can cause tissue in the gallbladder to die (gangrene), which in turn can lead to a tear in the gallbladder, or it may cause gallbladder to burst.

3.

4.

Torn gallbladder. A tear (perforation) in gallbladder may be caused by an enlarged or infected gallbladder that occurs as a result of cholecystitis.

Nursing management 1. Administer analgesics and antibiotics as per physicians order. 2. Keep the patient nil orally. And provide I V fluids. 3. Teach the patient relaxation techniques such as deep breathing exercise. 4. Provide fowlers position because it reduces the intra abdominal pressure. 5. Provide oral hygiene before any meal. 6. Advice patient to limit fat in diet : Limiting fat content reduces stimulation of gallbladder and pain associated with incomplete fat digestion and is helpful in preventing recurrence. 7. Restrict gas-producing foods (e.g., onions, cabbage, stimulation of the gallbladder. popcorn) and foods/fluids high in fats (e.g., butter, fried foods, nuts). 8. Monitor laboratory studies, e.g., BUN, prealbumin, Provides information about nutritional albumin, total protein, transferrin levels.

Nursing diagnosis 1. Acute Pain related to Biological injuring agents: obstruction or ductal spasm, inflammatory process, tissue ischemia and necrosis.

2. Fluid Volume Deficient related to vomiting.

3. Imbalanced nutrition , less than body requirements related to self-imposed or

prescribed dietary restrictions, nausea/vomiting, dyspepsia, pain Loss of nutrients; impaired fat digestion due to obstruction of bile flow

4. Knowledge deficit related to condition, prognosis, treatment, self-care, and discharge

needs. Bibliography

1) Suzanne C, Brend G. Medical surgical nursing. 10th edition. Philadelphia: Lippincott

William & Wilkins; 2004 .

2) Lewis, Heitkemper, Dirksen, OBrien, Bucher. Medical surgical nursing. 7th edition.
Missouri: Elsevier; 2008.

3) Ignatavicius D, Workman L, Mishler A. Medical surgical nursing. 2nd edition.

Philadelphia: W.B Saunders company; 2000.

4) Doenges E, Moorhouse F, Murr C. Nursing care plans. 7th edition. New delhi: Jaypee
Brothers; 2007.