Cholecystitis – Pathophysiology, Podcast & Nursing Care Plan

Gallstones

What is Cholecystitis:

 

Cholecystitis is defined as inflammation of the gallbladder. Usually due to a gallstone that blocks the cystic duct. Once the duct is blocked, the bile builds up which will cause irritation and swelling of the gallbladder. This can cause infection.

Gallstones

 

 

The other causes include:

  • Tumors
  • Blockage due to scarring or kinking of cystic duct.
  • Diabetes
  • HIV

Risk Factors:

  • Female
  • Pregnancy
  • Older age
  • Hormone therapy
  • Hispanic
  • Native American
  • Obesity
  • Rapid weight loss or weight gain
  • Diabetes

Types of Cholecystitis:

Cholecystitis can be acute or chronic.

Acute Cholecystitis:

Acute cholecystitis starts off suddenly. It is an acute inflammation of the gallbladder that is caused by gallstones. The obstruction of the gallbladder neck or cystic duct by a gallstone causes the pressure to increase in the gallbladder. The severity of acute cholecystitis is dependent upon the degree of obstruction and the duration of the obstruction.

Chronic Cholecystitis:

Chronic cholecystitis is a type of chronic inflammation of the gallbladder which has carried on for a long period of time. The chronic irritation that occurs in the gallbladder will eventually become hard and thick causing the gallbladder not to release bile as efficiently.

 

 Sign and Symptoms:

The main symptom of cholecystitis is serious abdominal pain. This pain is usually located in the middle or right side of the upper abdomen under the ribs. It may also travel to your right shoulder or back. The other symptoms include:

  • Pain under right shoulder blade
  • Fever
  • Nausea
  • Upper right-side abdominal pain
  • Biliary colic after a fatty meal
  • Vomiting
  • Gas
  • Jaundice
  • Shrinking or thickening of gallbladder
  • Gallbladder inflammation
  • Back pain
  • Itching skin
  • Pale stool
  • Indigestion

 

Complications

This complications of a cholecystitis can include:

  • Gallbladder infection. If bile builds up within your gallbladder, this can cause infection (cholecystitis).
  • Necrosis of  gallbladder tissue- if you do not treat your cholecystitis, then this can cause the death of gallbladder tissue. As a result, the gallbladder can burst.
  • Gallbladder tear – A tear in gallbladder may result from gallbladder infection or swelling.
  • Pancreatitis
  • Perforation
  • Peritonitis

Diagnosis

After the physician preforms a physical assessment the following may be ordered to assist with the diagnosis:

  • Lab test: CBC, Lipase, Amalyse, Bilirubin, LFT’s (Liver function tests)
  • Abdominal ultrasound
  • Abdominal CT
  • Abdominal X-ray
  • Cholecystogram
  • HIDA scan – able to track production and flow of bile from the patients liver to the small intestine – this exam will show if there is a blockage. This scan does involve placing radioactive dye into the body.

 

 Treatment:

The essential treatments are:

  •  NPO (nothing by mouth)
  • IV fluids
  • Bed rest
  • Antibiotics
  • Pain medications
  • Laparoscopic cholecystectomy
  • Surgical gall bladder removal (cholecystectomy)
  • Low-fat diet once diet is reintroduced
  • Percutaneous drainage of the gallbladder – Used in patients who may not be able to tolerate surgery.

Nursing Care Plan

Nursing Diagnosis

1. Acute pain related to inflammatory process of the Cholecytitis as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

InterventionsRationals
InterventionsRationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.Analgesics are helpful in relieving pain and helping in the recovery process.
Have patient maintain limited bedrest and activityThis will help to minimize pancreatic secretions and pain.
Incorporate nonpharmacologic measures to assist with control of pain.Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Risk for Infection related to development of inflammatory process or worsening Cholecytitis.

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

Other possible nursing diagnosis:

Risk for imbalanced fluid volume

Impaired gas exchange

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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