Cholecystitis

Definition/Etiology:

Cholecystitis is an inflammation of the gallbladder

• Mostly caused by gallstones obstructing cystic or common bile duct
• Other causes include infectious agents or a tumor obstructing the biliary tract

Obstruction or acute inflammation of the bile ducts causes blockage of bile secretion and may possibly result in gangrene (dead tissue caused by an infection or lack of blood flow)

Risk Factors:

• The 4 Fs – forty (+), female, fertile (childbearing age), fluffy (carrying a little extra weight)

Clinical Presentation:

• Pain, cramping, bloating, guarding, rigidity
• Aggravated after deep breathing
• Often after fatty foods or large meal
• Fever, chills
• Jaundice, dark urine
  • Look for yellow discoloration in elastic tissue such as the sclera and hard palate (darker-skinned patients)
• Murphy sign*
  • Murphy sign – palpation of right subcostal area upon deep inspiration
  • A positive response= patient experiences pain with palpation upon inspiration and may experience inspiratory arrest
  • Pain= inflamed gallbladder descends toward the examiner’s fingers, which irritates the peritoneum

Collaborative Management:

Assessment:

• CBC — leukocytosis
• Liver function — elevated ALT and bilirubin
• Abdominal US

Interventions:

• IV access
• Antiemetics, Analgesics, Antibiotics
• NPO, gastric tube insertion
• Cholecystectomy (Commonly laparoscopic, sometimes with this episode but may be later)

Evaluation | Patient Monitoring | Education:

Education:

• Educate patient/significant others
  • Low-fat diet and medications
  • Avoid causative factors

Monitoring:

• Hemodynamic status
• Pain relief
• Bowel sounds

Linchpins: (Key Points)

• Gallstones
• Blockage
• Back up of bile
• Inflammation/Gangrene
• Surgery