2. Objectives
• At the end of this presentation the student will be
able to:
• Define cholecystitis
• Describe Pathophysiology of cholecystitis.
• Identify types of cholecystitis.
• Enlist signs, symptoms and causes of cholecystitis.
• Discuss medical diagnosis and treatment
cholecystitis.
• Make nursing diagnosis and nursing intervention for
cholecystitis.
4. Types
• Acute cholecystitis is a sudden
inflammation of the gallbladder
that causes severe abdominal
pain.
• Chronic Cholecystitis is long-
standing swelling and irritation of
the gallbladder.
• Calculous cholecystitis (90%)
• Acalculous cholecystitis (10%
5. Chronic Cholecystitis
• The opened gall bladder contains
about two dozen bright yellow
cholesterol rich gallstones
• The remaining mucosa has a
normal velvety appearance
• The cut edge of the gallbladder
wall(arrow) is thickened indicative
of chronic inflammation
(Image Contrib. by:UCHC)
(Description by: Martin Nadel,
M.D.)
6. • Gall stones cause stasis of bile (meaning
bile is not moving (flowing)the way it
should through the bile ducts) and
infection will take over.
• Just like a small body of water that is
stagnant, (not flowing) bacteria will sit
and multiply.
Pathophysiology
7.
8. Conti….
Although the exact mechanism of acalculous
cholecystitis is unclear, several theories exist.
• Injury may be the result of retained concentrated
bile, an extremely noxious substance.
• In the presence of prolonged fasting, the
gallbladder never receives a cholecystokinin (CCK)
stimulus to empty thus, the concentrated bile
remains stagnant in the lumen.
9. Etiology
Calculous cholecystitis is mainly caused by
cholelithiasis and include the following:
• Female sex
• Certain ethnic groups
• Obesity or rapid weight loss
• Drugs (especially hormonal therapy in
women)
• Pregnancy
• Increasing age
10. Conti…
Acalculous cholecystitis is caused due to
• Critical illness
• Major surgery or severe trauma/burns
• Sepsis
• Prolonged fasting
• Sickle cell disease
• Salmonella infections
• Diabetes mellitus
11. Sign and symptoms
• Pain it may be colic or
referred
• Indigestion
• Nausea
• Fever
• Loss of appetite
• Murphy’s sign is positive
14. Complications
• Enlarged gallbladder.
• Empyema
• Death of gallbladder tissue.
• Perforation or rupture lead to peritonitis
• Cholangitis (destruction of biliary ducts)
• Emphysema
15. Nursing diagnosis
• Acute pain related to gallbladder inflammation or
presence of stones.
• Impaired oral mucous membrane related to NPO
status and possible NG suction.
• Ineffective breathing pattern related to pain from
high abdominal incision.
• Risk for infection (postoperative) related to
obstruction of external biliary drainage tube.
• Imbalanced nutrition less than body
requirements related to altered lipid metabolism
and increased nutritional needs during healing.
16. Nursing intervention
• Provide comfort measures and administer
analgesics as ordered
• Monitor vital signs for signs of perforation.
• Administer antibiotics for infection as ordered.
• Advice the patient to eat low fatty foods
• Monitor nutritional intake and weigh patient
regularly.
• Frequently turn the patient and encourage deep
breathing to prevent pulmonary complications, to
protect skin, and to promote comfort.
17. References
• Huffman JL, Schenker S. Acute acalculous cholecystitis - a review. Clin
Gastroenterol Hepatol. Sep 9 2009;[Medline].
• Donovan JM. Physical and metabolic factors in gallstone
pathogenesis. Gastroenterol Clin North Am. Mar 1999;28(1):75-
97. [Medline].
• Sitzmann JV, Pitt HA, Steinborn PA, et al. Cholecystokinin prevents
parenteral nutrition induced biliary sludge in humans. Surg Gynecol
Obstet. Jan 1990;170(1):25-31. [Medline].
• Cullen JJ, Maes EB, Aggrawal S, et al. Effect of endotoxin on opossum
gallbladder motility: a model of acalculous cholecystitis. Ann Surg. Aug
2000;232(2):202-7. [Medline].
• Forbes LE, Bajaj M, McGinn T, et al. Perihepatic abscess formation in
diabetes: a complication of silent gallstones. Am J Gastroenterol. Apr
1996;91(4):786-8. [Medline].
