16 cholecystitis

7/30/2019 16 cholecystitis

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Cholecystitis & Cholelithiasisby: Gari Glaser


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What is it?

By definition,cholecystitis is aninflammation of the

gallbladder wall andnearby abdominallining.

Abdominal wall

Gallbladder


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Etiology / Pathophysiology

Can be caused by an obstruction,gallstone or a tumor.

90% of all cases caused by gallstones.

The exact cause of gallstone formation is unknown .

When there is an obstruction, gallstone or tumor it prevents bile from leaving thegallbladder.

Bile gets trapped and acts as an irritant whichcauses cellular infiltration within 3 4 days.


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This infiltration causes aninflammatory process thegallbladder becomesenlarged and edematous.

Eventually thisocclusion along withbile stasis causes themucosal lining of thegallbladder to becomenecrotic.Bacterial growth

occurs due toischemia.

Necrotic Gallbladder


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Rupture of the gallbladder becomes a danger, along with spreadof infection of the hepatic duct and liver.If the disease is severe and interferes with the blood supply it

can cause the gallbladder to become gangrenous.

Gangrenous

gallbladder Gallstones


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Gallstones . .

The presence of gallstones in thegallbladder is called

cholelithiasis .


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Those who are most at risk.

These are all adjectives to describe the person most atrisk of developing symptomatic gallstones.

FAIR FAT FORTY FEMALE


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Something to think about.

Disorders of the biliary system areCOMMON in the U.S.

They are responsible for thehospitalization of more than h al f a m i l l i o n people each year.

The two most common conditions arecholecystitis & cholelithiasis.


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Signs and Symptoms.

Complaints of indigestion after eating high fat foods.Localized pain in the right-upper quadrant epigastric

region. Anorexia, nausea, vomitingand flatulence.

Increased heart and respiratory rate causing patient to become diaphoreticwhich in turn makes them think they

are having a heart attack.


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Signs and Symptoms.

Low grade fever.Elevated leukocyte count.

Mild jaundice.Stools that contain fat steatorrhea .Clay colored stools caused by a lack of

bile in the intestinal tract.Urine may be dark amber- to tea-colored.


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Diagnostics.

Fecal studies.

Serum bilirubin tests.

Ultrasound of thegallbladder.


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Diagnostics.

HIDA scan - imaging test used toexamine the gallbladder and the ductsleading into and out of the gallbladder - alsoreferred to as cholescintigraphy .

Oral cholecystogram - the patienttakes iodine-containing tablets by mouth -iodine is absorbed from the intestine into thebloodstream - removed from the blood bythe liver and excreted by the liver into thebile it is concentrated in the gallbladder -outlines the gallstones that are radiolucent(x-rays pass through them).

Operative cholangiography common bile duct is directly injected withradiopaque dye.


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Recap. Stages of Acute Cholecystitis.

- Gallbladder has a grayishappearance & is edematous.

-There is an obstruction of thecystic duct and thegallbladder begins to swell.

- It no longer has the "robinegg blue" appearance of anormal gallbladder.

- As acute cholecystitisprogresses, thegallbladder begins tobecome necrotic and getsa speckled appearance asthe wall begins to die.

- Gallbladder undergoes

gangrenous change andthe wall becomes verydark green or black.

- This is the stage whenperforation occurs.


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Medical Management.

Lithotripsyfor patients with only

a FEW stones.

If the attack of cholelithiasis is mild

bed rest is prescribed.

patient is placed onNPO to allow GI tractand gallbladder to rest.an NG tube is placed

on low suction.

fluids are given IV inorder to replace lostfluids from NG tubesuction.


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Medical Management.

Cholecystectomyor

Laparoscopic Cholecystectomy removal of the gallbladder.

This is the treatment of choice.The gallbladder along with the cystic

duct, vein and artery are ligated.


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Medical Management.

If stones are present in thecommon bile duct, anendoscopic sphincterotomy must be performed to removethem BEFORE acholecystectomy is done.

A number of variousinstruments are insertedthrough the endoscope inorder to "cut" or stretch thesphincter.Once this is done, additional

instruments are passed thatenable the removal of stonesand the stretching of narrowed regions of theducts.Drains (stents) can also beused to prevent a narrowedarea from rapidly returning to

its previously narrowed state.


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Nursing InterventionsPost Op - Cholesystectomy

1. Administer oral analgesics to facilitate movementand deep breathing and to stay ahead of pts pain.

2. Observe dressings frequently for exudate and hemorrhage.

3. Vitals are routinely checked.

4. Patient teaching:-Must understand how to splint the abd. before

coughing.-Report any abnormalities such as,

severe pain, tenderness in RUQ, increase inpulse, etc . .

-Instructed that they usually can return to work in 3days & can resume full activity in 1 week.

5. Fluid balance is maintained IV potassium added to compensate

for loss from surgery.


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Nursing Interventions

1. Urine and stool should be observed for alterationsin the presence of bilirubin.

2. NG tube must be monitored for amount, color & consistency

of output. Also, tube must be on LOW suction and nasal area shouldbe monitored for irritation and necrosis.

3. Anti-emetics may be administered if nausea persists.

4. I & O are measured and described carefully.

5. Pt. must understand how to splint the abdomenfor post op coughing, turning and deep breathing.

Interventions center on keeping patient comfortable by

carefully administering meds and watching for reactions.


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Will you survive?

Prognosis is usually excellent with prompttreatment.

Laparoscopic surgery has decreased thenumber of complications.

Prognosis is NOT favorable for those whodevelop pancreatitis.


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Now thats just scary.


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Ill leave you with these.

Eww!

16 cholecystitis

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