CHOLECYSTITIS  Diabetics: Higher risk due to metabolic

changes.
A condition characterized by the  Rapid weight loss: Losing weight too
inflammation of gallbladder, a small, pear- quickly can lead to gallstones.
shaped organ on the right side of the  Certain ethnic groups: Native
abdomen, below the liver. Americans and Hispanics have a higher
risk of developing gallstones, a
common cause of cholecystitis.

Causes

In most cases, cholelithiasis

(gallstones) blocking the tube leading out of
the gallbladder cause cholecystitis. Other
causes include:

 Bacterial infection in the bile duct

system. The bile duct system is the
drainage system that carries bile from
your liver and gallbladder into the first
part of your small intestine (the
duodenum).
 Tumors of the pancreas or liver. A
tumor can stop bile from draining out
of your gallbladder.
 Reduced blood supply to the
Incubation Period gallbladder. This may happen if you
have diabetes.
Cholecystitis does not have a  Gallbladder sludge. This is a thick
defined incubation period like infectious material that can’t be absorbed by bile
diseases. Instead, it typically develops in your gallbladder. The sludge builds
quickly, often within hours to days after the up in your gallbladder. It happens
onset of gallbladder inflammation or mainly to pregnant women or to people
blockage, usually due to gallstones. who have had a very fast weight loss.
Symptoms can appear suddenly after a
triggering event, such as a fatty meal. Signs and Symptoms

Who are at Risk?  Severe pain in your upper right or

center abdomen
 Women: More common in women,  Pain that spreads to your right shoulder
especially those on hormone therapy or or back
taking birth control pills.
 People over 40: Risk increases with age.  Tenderness over your abdomen when
 Obesity: Being overweight or obese it's touched
raises the risk.
 Pregnant women: Due to hormonal  Nausea
changes.
 Vomiting
 Individuals with a high-fat, low-fiber
diet: Poor eating habits contribute to  Fever
gallstone formation.
 People with a family history of  Jaundice
gallstones: Genetics can increase
susceptibility.  Loos, light-colored bowel
 Belly bloating  HIDA Scan: Assesses gallbladder
function and can confirm if it is
Cholecystitis symptoms often occur inflamed.
after a meal, particularly a large or fatty one.  Endoscopic Retrograde
Cholangiopancreatography (ERCP):
Pathophysiology Sometimes used if there’s a suspicion
of blockage in the bile ducts.
 Physical examination: to check for
tenderness, mass, and other signs.

Diagnostic Findings

PATIENT HISTORY
 Symptom Onset: Details about
abdominal pain (usually in the right
upper quadrant), nausea, vomiting, and
any recent episodes of similar pain.
 Dietary Habits: Recent consumption of
fatty or heavy meals, which may trigger
symptoms.
 Medical History: Previous episodes of
gallstones, cholecystitis, or pancreatitis,
Gallstones block the cystic duct, and any history of liver disease.
causing build up of bile and trauma to the  Medications: Use of medications that
gallbladder wall. This causes irritation and can affect gallbladder function, such as
elevated gallbladder lumen pressure, which hormone replacement therapy or
leads to stimulation of phrenic and foregut cholesterol-lowering drugs.
autonomic nerves, that leads to pain in the  Family History: Any family history of
abdomen and radiating pain to the right gallbladder disease or related
shoulder and back. As the intraluminal conditions.
pressure exceeds arterial pressure, blood  Comorbidity: Presence of conditions
flow to the gallbladder decreases, leading to like obesity, diabetes, or
gallbladder ischemia. The inflammation, hyperlipidemia that may increase risk.
and loss of gallbladder mucosal integrity
activates systemic inflammatory response, PHYSICAL EXAMINATION
leading to manifestation of fever, nausea,  Abdominal Tenderness: Particularly in
and vomiting. This may also further lead to the right upper quadrant, which may
bacterial invasion, and transmural increase with palpation.
inflammation, leading to irritation of the  Murphy's Sign: Pain and an abrupt halt
peritoneum that stimulates the somatic in inhalation when pressure is applied
nerves. This can be manifested by the to the right upper quadrant.
persistent pain in the upper right quadrant of  Guarding or Rigidity: Muscle tension
the abdomen. in the abdominal wall may indicate
inflammation.
Diagnosis  Fever: Possible elevated temperature
reflecting infection or inflammation.
 Blood Tests: These can check for signs  Bowel Sounds: Assessment for normal
of infection or inflammation, such as or decreased bowel sounds, which may
elevated white blood cell count and indicate gastrointestinal involvement.
liver enzyme levels.
 Ultrasound: the most common initial LABORATORY TEST
test, it can detect gallstones and signs Blood test:
of inflammation in the gallbladder.  Complete Blood Count (CBC)-
 CT Scan: Provides detailed images and Elevated white blood cell count
can help identify complications. (indicative of infection).
 Liver Function Tests (LFTs)- Increased placement. It's often used for patients who
levels of ALT, AST, alkaline are too sick for surgery, providing relief
phosphatase, and bilirubin (suggestive from symptoms while reducing infection.
of liver or bile duct involvement). It’s a temporary solution until the patient is
 Amylase and Lipase- Possible elevation well enough for further treatment.
in cases of pancreatitis.
 C-Reactive Protein (CRP)- Elevated Nursing Dignosis
levels indicating inflammation.
Imaging Tests:  Acute Pain related to inflammation of
 Ultrasound- Gallstones, thickened the gallbladder and gallstones.
gallbladder wall (≥3 mm), and  Risk for Infection related to gallbladder
pericholecystic fluid. inflammation and possible bile
 CT Scan- Thickening of the gallbladder blockage.
wall, potential complications like  Knowledge Deficit related to the
abscess or perforation. condition, treatments, and dietary
 HIDA Scan- Reduced or absent management.
gallbladder visualization if inflamed.
 ERCP- Can reveal blockages in the bile Nursing Interventions
ducts and allow for therapeutic
interventions.  Administer prescribed pain
medication and monitor its
effectiveness.\
Medical Management  Use non-pharmacological methods
like positioning, heat application (if
The best treatment for cholecystitis appropriate), and relaxation
is a laparoscopic cholecystectomy, which techniques to reduce discomfort.
offers a quick recovery with low risk. If  Encourage a low-fat diet to reduce
laparoscopic surgery isn't suitable, an open gallbladder stimulation and ease
surgery can be done. For critically ill digestion.
patients who can't undergo surgery,  Monitor for signs of malnutrition
percutaneous drainage of the gallbladder and provide dietary education on
may be used. In milder cases, dietary what foods are safe to eat.
changes (low-fat, low-spice) can help,  Monitor vital signs and watch for
though results vary. Medical treatment with signs of infection (fever, chills,
ursodiol may sometimes dissolve gallstones. elevated white blood cell count).
 Teach the patient about the
Laparoscopic cholecystectomy- is a
importance of dietary changes, such
minimally invasive surgery to remove the
as low-fat meals, to prevent flare-
gallbladder. During the procedure, the
ups.
surgeon makes a few small cuts in the
 Educate them on signs of
abdomen and uses a thin tube with a camera
complications like severe pain,
(laparoscope) to guide the removal. It’s a
jaundice, or fever, and when to seek
common, low-risk operation with quicker
medical attention.
recovery and less pain than traditional open
surgery. Most patients can go home the  Explain the procedure (laparoscopic
same day or within 24 hours, resuming cholecystectomy) in simple terms.
normal activities in a few days.  Help alleviate anxiety by answering
questions and providing emotional
Percutaneous drainage - is a minimally support.
invasive procedure used to remove fluid or
infection from the gallbladder when surgery
isn't an option. A thin needle or tube is
inserted through the skin into the
gallbladder to drain the fluid, using imaging
like ultrasound or CT scans to guide the
REFERENCES

 https://www.hopkinsmedicine.org/health/conditions-and-
diseases/cholecystitis#:~:text=What%20causes%20cholecystitis%3F,builds%20up%2
0in%20your%20gallbladder.
 https://calgaryguide.ucalgary.ca/acute-cholecystitis/
 https://www.ncbi.nlm.nih.gov/books/NBK568804/
 https://www.mayoclinic.org/diseases-conditions/cholecystitis/symptoms-causes/syc-
20364867