I. PATHOPHYSIOLOGY: Acalculous cholecystitis is defined as acute inflammation of the gallbladder in the absence of gallstones.

The presentation of acalculous cholecystitis may be insidious, characterized by unexplained fever, leukocytosis, hyperamylasemia, or abnormal

aminotransferases, and patients often lack right upper quadrant tenderness. It is related to conditions associated with biliary stasis, including debilitation, major surgery, severe trauma, sepsis, long-term total parenteral nutrition (TPN), and prolonged fasting. Other causes of acalculous cholecystitis include cardiac events; sickle cell disease; Salmonella infections; diabetes mellitus; and cytomegalovirus, cryptosporidiosis, or microsporidiosis infections in patients with AIDS. Nonmodifiable Factor:  61 years old  Male Modifiable Factor:  Diet (often have skipped meals)  Hypertensive

Precipitate release of chemical mediators

Invasion of bacteria

Promote inflammatory process

Decrease in the perfusion of the gall bladder

Gallbladder wall ischemia occurs decrease or absence of cholecystokinin-induced gallbladder contraction
SIGNS & SYMPTOMS:  Moderate to severe pain is experienced in the right upper quadrant and epigastrium  Tenderness, usually along the right costal margin, often associated with rebound tenderness and spasm  Nausea and vomiting

Slow the activity of the gall bladder resulting into the stasis of the bile and increased lithogenicity of bile

Lead to the inflammation of the gall bladder

750 mg every q8o.With Medical Intervention Without Medical Intervention Increased bile viscosity Antibacterial medicines:  Cefuroxime. IVTT  Metronidazole. cholecystectomy or removal of the gallbladder Rapid deterioration and gallbladder perforation Extrabiliary abscess formation occur Severe occurrence of infection (client becomes clinically ill) or sepsis DEATH Prevent further occurrence of infection Relieve further pain due to infected gallbladder . 500mg IVTT q8° NST Surgical intervention.

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