2. CHOLECYSTITIS
Cholecystitis is inflammation of the gallbladder.
The gallbladder is a small, pear-shaped organ on the
right side of the belly (abdomen), beneath the liver.
The gallbladder holds a digestive fluid (bile) that's
released into the small intestine.
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INCIDENCE
• The incidence of acute cholecystitis is approximately 6,300 per
100,000 in individuals under 50 years age and 20,900 per 100,000 in
individuals over 50 years age worldwide. The prevalence of acute
cholecystitis is approximately 369 per 100,000 individuals in the
United States. It is estimated from the population-based statistics,
based on a comprehensive survey in the U.S. Acute cholecystitis is
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INCIDENCE CONT’
• The mortality rate of acute cholecystitis is approximately 0.6%. Acute
cholecystitis usually affects individuals of the North American Indian
race. Females are more commonly affected by acute cholecystitis
than males. Acute cholecystitis cases are reported worldwide. Acute
cholecystitis accounts for 700,000 cholecystectomies and costs of
∼$6.5 billion annually only in the United States.
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AETIOLOGY
Calculous cholecystitis (caused
by a stone)
Acalculous cholecystitis (not
caused by a stone)
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CALCULOUS CHOLECYSTITIS
Calculous cholecystitis is the most common, and usually
less serious, type of acute cholecystitis.
It develops when the main opening to the gallbladder,
called the cystic duct, gets blocked by a gallstone or a
substance known as biliary sludge (thickened bile).
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CALCULOUS CHOLECYSTITIS CONT’
The blockage in the duct causes bile to build
up in the gallbladder. This increases the
pressure inside it, causing it to become
inflamed. The inflamed gallbladder can also
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ACALCULOUS CHOLECYSTITIS
Acalculous cholecystitis is a less common. But
it is usually a more serious, type of acute
cholecystitis. It usually develops as a
complication of a serious illness, infection or
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RISK FACTORS
Increasing age
Female sex
Pregnancy
Certain ethnic groups (eg, Native American
Indians)
Obesity or rapid weight loss
Drugs (especially hormonal therapy in
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PATHOPHYSIOLOGY
• Ninety percent ( 90%) of cases of cholecystitis involve stones in the
gallbladder (ie, calculous cholecystitis), with the other 10% of cases
representing acalculous cholecystitis.
• Acute calculous cholecystitis is caused by an obstruction of the cystic
duct, leading to distention of the gallbladder. As the gallbladder
becomes distended, blood flow and lymphatic drainage are
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PATHOPHYSIOLOGY CONT’
• 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 does not
receive a cholecystokinin (CCK) stimulus to empty; thus, the
concentrated bile remains stagnant in the lumen.
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PATHOPHYSIOLOGY CONT’
• A study by Cullen et al demonstrated the ability of
endotoxins to cause necrosis, hemorrhage, areas of fibrin
deposition, and extensive mucosal loss, consistent with
an acute ischemic insult. Endotoxins also abolish the
contractile response to CCK, leading to gallbladder stasis.
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CLINICAL MANIFESTATION
Right upper quadrant abdominal pain: Often severe and may
radiate to the right shoulder or back. It can be intermittent or
constant and may worsen after meals, especially fatty ones.
Nausea and vomiting: Especially after consuming fatty foods.
Fever and chills: Due to inflammation and possible infection of
the gallbladder.
Tenderness over the gallbladder: Palpation of the right upper
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CLINICAL MANIFESTATION
CONT’
Murphy's sign: Pain elicited upon inspiration during
palpation of the right upper quadrant, indicating
inflammation of the gallbladder.
Jaundice: If the common bile duct becomes obstructed
due to gallstones or inflammation, jaundice may occur,
leading to yellowing of the skin and eyes.
Bloating and indigestion: Due to impaired bile flow and
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DIAGNOSTIC
INVESTIGATION
Leukocytosis with a left shift may be observed
Alanine aminotransferase (ALT) and aspartate aminotransferase
(AST) levels may be elevated in cholecystitis or with common
bile duct (CBD) obstruction
Bilirubin assays may reveal evidence of CBD obstruction
Amylase/lipase assays are used to assess for acute pancreatitis;
amylase may also be mildly elevated in cholecystitis
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DIAGNOSTIC INVESTIGATION CONT’
Plain X-ray of the abdomen
Ultrasonography (US)
Computed tomography (CT)
Magnetic resonance imaging
(MRI)
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MEDICAL MANAGEMENT
Pain management: Nonsteroidal anti-inflammatory drugs
(NSAIDs) or acetaminophen can help relieve pain
associated with cholecystitis.
Antibiotics: If there is evidence of infection, antibiotics may
be prescribed to treat the infection and prevent
complications.
Nausea and vomiting control: Medications such as
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MEDICAL MANAGEMENT
CONT’
Bowel rest: Patients may be advised to avoid solid foods and stick to
a clear liquid diet to reduce strain on the inflamed gallbladder.
Gallbladder contraction suppression: Medications such as
anticholinergics may be used to prevent the gallbladder from
contracting, which can reduce pain.
Observation: In some cases, especially if symptoms are mild and
there are no signs of complications, patients may be monitored
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NURSING MANAGEMENT
• Pain management: Administering analgesics as prescribed to alleviate
discomfort and pain.
• Monitoring vital signs: Regularly assessing temperature, heart rate,
blood pressure, and respiratory rate to detect any signs of
complications.
• Nutrition management: Providing dietary education, emphasizing
low-fat and easily digestible foods to prevent exacerbation of
symptoms.
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NURSING MANAGEMENT CONT’
• Patient education: Educating patients about their condition, treatment
plan, signs of complications, and the importance of adherence to
medications and lifestyle modifications.
• Monitoring for complications: Keeping a close eye on signs of
complications such as jaundice, pancreatitis, or sepsis, and promptly
reporting any concerning findings to the healthcare provider.
• Emotional support: Offering emotional support and reassurance to patients
experiencing discomfort and anxiety due to their condition
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COMPLICATIONS
Gangrenous cholecystitis: Severe inflammation
can lead to tissue death (gangrene) in the
gallbladder.
Empyema: Pus accumulates in the gallbladder,
leading to infection.
Perforation: The gallbladder can rupture, causing
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COMPLICATIONS CONT’
Abscess formation: Pus can collect in the area
around the gallbladder.
Biliary obstruction: Inflammation and swelling can
block the bile ducts, leading to jaundice and
potential liver damage.
Gallstone pancreatitis: Gallstones can block the
pancreatic duct, leading to inflammation of the
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PREVENTION
Maintain a healthy weight: Obesity is a significant risk
factor for cholecystitis. Aim to achieve and maintain a
healthy weight through a balanced diet and regular
exercise.
Eat a balanced diet: Focus on consuming a diet rich in
fruits, vegetables, whole grains, lean proteins, and
healthy fats.
Stay hydrated: Drink plenty of water throughout the day
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PREVENTION CONT’
• Avoid rapid weight loss: Losing weight too
quickly can increase the risk of gallstone
formation and cholecystitis. Aim for gradual
weight loss through healthy eating and regular
exercise.
• Be cautious with cholesterol-rich foods: Limit
your intake of high-cholesterol foods, such as
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PREVENTION CONT’
• Include fiber in your diet: Fiber helps regulate digestion and may
help prevent gallstone formation. Include plenty of fiber-rich foods,
such as fruits, vegetables, legumes, and whole grains, in your diet.
• Exercise regularly: Engage in regular physical activity to maintain a
healthy weight and promote overall well-being.
• Limit alcohol consumption: Excessive alcohol consumption can
increase the risk of gallstone formation and cholecystitis. Limit your
alcohol intake to moderate levels or avoid it altogether
