cholecystitis

1. CHOLECYSTITIS

2. DEFINITION
 Inflammation of gall bladder

3. PATHOPHYSIOLOGY
When Gallstones Form
 Most gallbladder problems are caused by
gallstones.
 These form when substances in the bile
crystallize and become solid. In some cases,
the stones don't cause any symptoms.
 In others, they irritate the wall of the
gallbladder. Most serious problems occur if the
stones move into nearby ducts and cause
blockages.

5. CHOLECYSTITIS
obstruction of the neck of the gallbladder or cystic duct caused by stones
impacted in Hartmann's pouch
Direct pressure of the calculus on the mucosa
ischemia, necrosis, and ulceration with
swelling, edema, and impairment of venous return.
increase and extend the intensity of the inflammation.

6. RISK FACTORS
 Obesity
 Women
 Frequent changes in weight
 Rapid weight loss
 Treatment with high dose estrogen
 Cystic fibrosis
 Diabetes mellitus

7. CLINICAL MANIFESTATIONS
 Pain & biliary colic
 felt in the right hypochondrium and often
radiates through the back close to tip of
the right scapula
 Changes in urine & stool colour
 Vitamin deficiency

8. DIAGNOSIS
 General appearance
 The patient is distressed by pain and lies quietly.
 Shallow breathing.
 Tachycardia and pyrexia …
 Jaundice may be present and the patient may be
sweating.

9.  Inspection
 Zackary Cope’s sign
 Palapation
 Murphy’s sign
 Empyema
 Boa’s sign

10.  Percussion
 Guarding
 Auscultation
 Infracted or ruptured gallbladder and
caused billiary peritonitis absent
bowel sound.

11.  Investigation
 LFT
 U/S : it is the most diagnostic and it shows wall
thickening, pericholecystic fluid, CBD evaluation .
 C/T : Sensitivity for gallstones = 55-65% .
 Cholangiography Mapping of the bile ducts by
instilling contrast into the biliary tree :
ERCP
MRCP
PTC
 CBC : shows infection by an elevated white blood
cell count.

12. MEDICAL MANAGEMENT
 Nutritional & supportive therapy
 Pharmacologic therapy

13. SURGICAL MANAGEMENT
A- Laparoscopic cholecystectomy : early
(w/in 2 days after onset of symptoms)
B- Elective cholecystectomy : Delayed
(6-8 wks to allow “cool off” of GB)
give him antibiotics and after 6 weeks we
do it .

16.  Advantage of laparoscopy :
1- less post-operation pain .
2- short hospital stay .
3- rapid return to activity and work .
4- less post-operation adhesion .

17. NURSING MANAGEMENT
 Relieving pain
 Improving respiratory status
 Promoting skin care & biliary drainage
 Improving nutritional status
 Monitoring and managing potential
compications