CHOLECYSTITIS

WHAT IS
CHOLECYSTITIS

Is a redness and swelling

(inflammation) of the
gallbladder.

 Severe pain in your upper right or center

abdomen.

Pain that spreads to your right shoulder

or back.
SYMPTOMS OF
CHOLECYSTITIS Tenderness over your abdomen when it's

touched.

Nausea.

Vomiting.

Fever.
STATISTICAL The incidence of acute cholecystitis is

approximately 6,300 per 100,000 in

DATA individuals under 50 years age and

20,900 per 100,000 in individuals

over 50 years age worldwide.

The prevalence of acute cholecystitis

is approximately 369 per 100,000

individuals in the United states. It is

estimated from the population-based

statistics, based on a comprehensive

survey in the U.S

The mortality rate of Acute

cholecystitis is approximately 0.6%

Females are more commonly affected

by acute cholecystitis than males.

ETIOLOGY is the result of hard particles that

develop in your gallbladder

(gallstones). Gallstones can block

the tube (cystic duct) through

which bile flows when it leaves the

gallbladder. Bile builds up in the

gallbladder, causing inflammation.

 PATHOPHYSIOLOGY

Gallstones are hard, pebble-like structures that

obstruct the cystic duct. The formation of

gallstones is often preceded by the presence of

biliary sludge, a viscous mixture of glycoproteins,

calcium deposits, and cholesterol crystals in the

gallbladder or biliary ducts

 Cholecystogram, cholangiogram; celiac

axis arteriography

Laparoscopy

Ultrasonography; EUS
ASSESSMENT AND
DIAGNOSTIC METHODS Helical CT scans and MRI; ERCP

Serum alkaline phosphatase; gamma-

glutamyl (GGT), gamma-glutamyl

transpeptidase (GGTP), LDH

Cholesterol levels
 Major objectives of medical

therapy are to reduce the

incidence of acute episodes of

gallbladder pain and cholecystitis

MEDICAL
by supportive and dietary

management and, if possible, to

MANAGEMENT
remove the cause by

pharmacotherapy, endoscopic

procedures, or surgical

intervention.
 Nutritional and Supportive Therapy Pharmacologic Therapy

• Achieve remission with rest, IV fluids,

• Ursodeoxycholic acid (UDCA [Urso,

nasogastric suction, analgesia, and

Actigall]) and chenodeoxycholic acid

antibiotics. (chenodiol or CDCA [Chenix]) are

effective in dissolving primarily

• Diet immediately after an episode is

cholesterol stones.
usually low-fat liquids with high protein

and carbohydrates followed by solid soft

• Patients with significant, frequent

foods as tolerated, avoiding eggs,

symptoms; cystic duct occlusion; or

cream, pork, fried foods, cheese, rich

pigment stones are not candidates for

dressings, gas-forming vegetables, and

therapy with UDCA.
alcohol.

MEDICAL MANAGEMENT
 Nonsurgical Removal of Gallstones

In addition to dissolving gallstones,

they can be removed by other

instrumentation (eg, catheter and

instrument with a basket attached

MEDICAL
are threaded through the T-tube

tract or fistula formed at the time of

MANAGEMENT
T-tube insertion, ERCP endoscope),

intracorporeal lithotripsy (laser

pulse), or extracorporeal shock wave

therapy (lithotripsy or extracorporeal

shock wave lithotripsy [ESWL]).

 Laparoscopic cholecystectomy:

performed through a small incision or

puncture made through the abdominal wall

in the umbilicus.

SURGICAL
MANAGEMENT

Cholecystectomy:

Gallbladder is removed through an

abdominal incision (usually right subcostal)

after ligation of the cystic duct and artery

 • Minicholecystectomy:

Gallbladder is removed through a small

incision.

• Choledochostomy:
SURGICAL
MANAGEMENT incision into the common duct for stone

removal.

• Cholecystostomy (surgical or percutaneous):

Gallbladder is opened, and the stone, bile, or

purulent drainage is removed.

 ASSESSMENT

Assess health history: Note history of smoking or

prior respiratory problems.

Assess respiratory status: Note shallow

respirations, persistent cough, or ineffective or

adventitious breath sounds.

Evaluate nutritional status (dietary history, general

examination, and laboratory study results)

 DIAGNOSIS

Acute pain and discomfort related to surgical

incision

Impaired gas exchange related to high

abdominal surgical incision

Impaired skin integrity related to altered biliary

drainage after surgical incision

 DIAGNOSIS

Imbalanced nutrition, less than body

requirements, related to inadequate bile secretion

Deficient knowledge about self-care activities

related to incisional care, dietary modifications (if

needed), medications, reportable signs or

symptoms (fever, bleeding, vomiting)

 PLANNING AND INTERVENTION

Relieving Pain
Improving Respiratory Status
Maintaining Skin Integrity and Promoting

Biliary Drainage
Improving Nutritional Status
Monitoring and Managing Complications
Promoting Home and Community Based

Care
 EVALUATION

Expected Patient Outcomes:

Reports decrease in pain
Demonstrates appropriate respiratory

function
Exhibits normal skin integrity around biliary

drainage sites
Obtains relief from dietary intolerance
Absence of complications
THANK YOU