SOUTHWESTERN UNIVERSITY PHINMA

Urgello St. Sambag 2 Cebu City, Cebu

Name: Añana, Jaylah Mae Year/Section:

BSN 3-C7

SELF DIRECTED LEARNING (SDL)

CHOLECYSTITIS
Is a redness and swelling (inflammation) of the gallbladder. It happens
when a digestive juice called bile gets trapped in your gallbladder. The
gallbladder is a small organ under your liver. It stores bile which is
made in the liver.

PATHOPHYSIOLOGY
Occlusion of the cystic duct or malfunction of the mechanics of
gallbladder emptying is the pathophysiology of this disease. Cases of
acute untreated cholecystitis could lead to perforation of the
gallbladder, sepsis, and death. Gallstones form from various materials
such as bilirubinate or cholesterol. These materials increase the
likelihood of cholecystitis and cholelithiasis in conditions such as sickle
cell disease where red blood cells are broken down forming excess
bilirubin and forming pigmented stones. Patients with excessive calcium
such as in hyperparathyroidism can form calcium stones. Patients with
excessive cholesterol can form cholesterol stones. Occlusion of the
common bile duct such as in neoplasms or strictures can also lead to
stasis of the bile flow causing gallstone formation.

SIGNS AND SYMPTOMS

In most cases, an attack of cholecystitis lasts 2 to 3 days. Each person’s
symptoms may vary. Symptoms may include:
•Intense, sudden pain in the upper right part of your belly
•Pain (often worse with deep breaths) that •spreads to your back or
below the right shoulder blade
•Nausea
•Vomiting
•Fever
•Yellowing of the skin and eyes (jaundice)
•Loose, light-colored bowel movements
•Belly bloating

DIAGNOSTIC AND LABORATORY TEST

Complete blood count (CBC). This test measures your white blood cell
count. You may have a high white blood cell count if you have an
infection.
Liver function tests. This group of special blood tests can tell if your liver
is working properly.

You may also have imaging tests, including:

Ultrasound (sonogram). This test creates images of your internal organs
on a computer screen using high-frequency sound waves. It is used to
see the liver and gallbladder and check blood flow through different
vessels.
Belly (abdominal) X-ray. This test makes pictures of internal tissues,
bones, and organs using X-rays.
CT scan. This is an imaging test that uses X-rays and a computer to make
detailed images of the body. A CT scan shows details of the bones,
muscles, fat, and organs. It is more detailed than a regular X-ray.
HIDA scan (nuclear scan, cholescintigraphy, or hepatobiliary
scintigraphy). This scan checks for any abnormal movements
(contractions) of your gallbladder. It also checks for blocked bile ducts. A
radioactive chemical or tracer is shot (injected) into your vein. It collects
in your liver and flows into your gallbladder. A special scanner watches
the tracer move through your organs. You will take medicine to make
your gallbladder contract.
PTC (percutaneous transhepatic cholangiography). A thin needle is put
through your skin and into the bile duct in your liver. A dye is then shot
(injected) through the needle. The dye lets your bile ducts be seen
clearly on the X-rays. A blocked duct will show up on the X-rays.
ERCP (endoscopic retrograde cholangiopancreatography). This is used
to find and treat problems in your liver, gallbladder, bile ducts, and
pancreas. It uses X-ray and a long, flexible tube (endoscope) with a light
and camera at one end. The tube is put into your mouth and throat
while you are sedated. It goes down your food pipe (esophagus),
through your stomach, and into the first part of your small intestine (the
duodenum). It then goes into your bile ducts. The inside of these organs
can be seen on a video screen. A dye is put into your bile ducts through
the tube. The dye lets the bile ducts be seen clearly on the X-rays.
MRCP (magnetic resonance cholangiopancreatography). This is a special
MRI test that gives details about the liver, pancreas, gallbladder, and
bile drainage area.

MEDICAL MANAGEMENT
The initial treatment includes bowel rest, intravenous hydration, correction of
electrolyte abnormalities, analgesia, and intravenous antibiotics. For mild
cases of acute cholecystitis, antibiotic therapy with a single broad-spectrum
antibiotic is adequate. (ampicillin/sulbactam or piperacillin/tazobactam)

SURGICAL MANAGEMENT
Laparoscopic surgery is usually the standard method for
cholecystectomy. Is surgical removal of the gallbladder
(cholecystectomy). In the US, standard care is laparoscopic
cholecystectomy, which is minimally invasive surgery performed via 3
small incisions in the abdomen to remove the gallbladder.

NURSING MANAGEMENT
•Include relieving pain
• Promoting rest
•Maintaining fluid and electrolyte balance
•Preventing complications
•Provision of information about the disease process, prognosis,
and treatment