What is Cholecystitis?

Cholecystitis is a chronic or acute inflammation of the gallbladder, an organ that stores and releases bile into the duodenum to help digestion. Gallstones may cause this condition in the duct, which may block the flow of bile and cause an infection. This can cause nausea, vomiting, and severe abdominal pain. Cholecystitis may be treated using antibiotics to remove the infection and surgery to remove the gallbladder.

Classification of Cholecystitis

Cholecystitis is classified into two:

• Calculous Cholecystitis

Calculous Cholecystitis is a usual form caused by gallstones in the gallbladders, causing a blockage of bile flow and leading to inflammation. The symptoms of Calculous Cholecystitis include fever, nausea, pain in the right upper abdomen, jaundice, and vomiting. Surgical removal of the gallbladder is a standard treatment.

• Acalculous Cholecystitis

Acalculous Cholecystitis is a less common type of Cholecystitis occurring without the presence of gallstones. The leading cause of Acalculous Cholecystitis includes trauma, bacteria infection, prolonged fasting, and reduced blood flow to the gallbladder. It may pose similar symptoms to Calculous Cholecystitis; however, more severe, leading to serious complications if left untreated. In extreme cases, treatment usually involves clearing the infection using antibiotics and removing the gallbladder via surgery. In either case, timely diagnosis and treatment are vital to curb the spread of the illness and minimize the risk of complications.

Pathophysiology of Cholecystitis

Acalculous and Calculous Cholecystitis do not have a similar origin.

• Chemical reaction. Edema and autolysis occur via a chemical reaction initiated by bile that remains in the gallbladder.
• One of the causes of Calculous Cholecystitis is when a gallstone obstructs bile flow from the gallbladder to the small intestines.
• Compression. The vascular supply of blood becomes compromised due to constriction of the blood vessels in the gallbladder.

Statistics and incidences of Cholecystitis

Cholecystitis is among the most cause of gallbladder surgeries. In most cases, Cholecystitis is associated with Cholelithiasis; it is estimated that around 90% of Acute Cholecystitis patients have a gallstone. During middle age, Acute Cholecystitis is the most common form, while Chronic Cholecystitis is the most common among elderly patients.

Causes of Cholecystitis

• Bile stasis. Refers to lack of gallbladder contraction and plays a significant role in Cholecystitis development.
• Bacterial infections play a minor role in the development of Cholecystitis; however, it causes about 50% of secondary infection cases of bile infection.
• Fluid and electrolyte alterations. Alterations in electrolytes and fluids are believed to cause Acalculous Cholecystitis.
• Gallbladder stone. Cholecystitis, in most cases, is associated with gallstones that block the normal flow of bile in the cystic duct.

Clinical Manifestation of Cholecystitis

There are a series of signs and symptoms of Cholecystitis; the most common includes:

• When the Cholecystitis infection gets into the bloodstream, the body experiences sepsis.
• Elevated body temperature is a response to the infection that gets into the body.
• Cholecystitis causes intense and sudden pain in the right upper quadrant of the abdomen and may spread to the right shoulder blade.
• Is the increase in White blood cell count which is an indicator of an infection.
• Palpable gallbladder. Severe cases of Cholecystitis may cause the gallbladder to become heavier in the right upper quadrant of the abdomen.

Complications of Cholecystitis

Untreated Cholecystitis infections can lead to complications like:

• is the swelling of the bile duct due to Cholecystitis. This condition may lead to severe illness and sepsis.
• is the collection of pus in the gallbladder due to Cholecystitis. This condition is also associated with sepsis.
• When the Cholecystitis condition is not treated, gangrene makes the gallbladder gangrenous and necrotic, leading to perforation and quick spread of infection in the body tissue.

Cholecystitis Assessment and Diagnostic Findings

There are various studies that are used in Cholecystitis diagnosis, including:

• Oral Cholecystography (OCG). OCG is best in determining the gallbladder’s overall functions and appearance, including defects and stones. If oral intake is not possible due to vomiting/nausea, or if gallbladder cannot be seen on OCG, it can be done intravenously (IVC). IVC can be performed before surgery to examine ducts, check surgical complications or detect any remaining gallstones after treatment. After surgery, Dye can be injected via T-Tube.
• ERCP (Endoscopic Retrograde Cholangiopancreatography). Assesses biliary tree by inserting scope to the common bile duct via small intestines.
• Chest X-rays. It is a significant diagnosis that excludes breathing causes of referred pain.
• PTC (Percutaneous Transhepatic Cholangiography). When jaundice is present, fluoroscopic imaging aids in differentiating between gallbladder disease and pancreas cancer. It helps in the diagnosis of obstructive jaundice and indicates calculi in ducts.
• Cholecystography (for chronic Cholecystitis). Shows the gallstones in the bile system. It is not recommended for Acute Cholecystitis because the patient cannot take the Dye orally due to sickness.
• Nonnuclear CT scan. It is vital in detecting enlarged bile ducts and gallbladder cysts and distinguishing between obstructed and unobstructed jaundice.
• HIDA/PIPIDA scan. When barium tests are impossible, HIDA/PIPIDA scan may be used to confirm Cholecystitis. With cholecystokinin injection, HIDA/PIPIDA scans can show abnormal gallbladder function.
• Abdominal X-rays. It is used to show calcified gallstones in about 10% to 15% of Cholecystitis cases and changes in the gallbladder.
• CT scan. It is a second imaging test that aids in confirming extra-biliary disorders and acute Cholecystitis.
• Indicates gallstones in the bile system.
• CBC. Indicates a moderate increase in WBC
• Prothrombin levels. It is reduced when bile flow is blocked, and Vitamin K absorption is diminished.
• A significant test for initial diagnosis of acute Cholecystitis. The preferred alternative is Scintigraphy.
• Serum liver enzymes (ALT, AST, LDH, ALP). It is moderately increased with an increased 5-nucleotidase and alkaline phosphatase in bile duct blockage.
• is a secondary test for acute Cholecystitis.
• Serum Bilirubin and Amylase.
• Biliary ultrasound. It is the initial diagnostic procedure for Cholecystitis and helps indicates the presence of Calculi with bile duct and gallbladder distention.

Medical Management for Cholecystitis

The management of Cholecystitis may include controlling its signs and symptoms. The following are some management procedures.

• Medical supportive. This management procedure involves restoring pf hemodynamic stability and providing gram-negative enteric bacteria.
• Patient fasting. The patient may be restricted from drinking or eating to minimize stress on the gallbladder. To nourish the cells, the patient is provided with IV fluids.
• Gallbladder stimulation. The patient is infused with daily IV Cholecystokinin to stimulate gallbladder contraction to prevent sludge buildup in patients receiving TPN.

Pharmacologic Therapy for Cholecystitis Patients

• Oxycodone or Acetaminophen. Reduce pain and controls inflammation signs and symptoms.
• Prochlorperazine or Promethazine. Prevent electrolytes and fluid disorders and control nausea.
• Antibiotic therapy. Metronidazole and levofloxacin help in prophylactic antibiotics to prevent prevalent organisms.

Surgical Management of Cholecystitis

• ERCP (Endoscopic Retrograde Cholangiopancreatography). Assesses biliary tree by inserting scope to the common bile duct via small intestines.
• It is preferred to perform using laparoscopes and gallbladder surgery.

Nursing Management of Cholecystitis

The nursing management of Cholecystitis involves the following:

Nursing Assessment of Cholecystitis

• Determines unusual bleeding: epistaxis, oozing from injection sites, bleeding gums, hematemesis, petechiae, melena, or ecchymosis.
• Gastrointestinal system. Evaluated frequent belching, reluctance to move, guarding, and abdominal distension.
• Circulatory system. Determine capillary refill and peripheral pulses.
• Integumentary system. Evaluate mucous membranes and skin.

Nursing Diagnosis of Cholecystitis

• Acute pain is associated with the gallbladder inflammatory process.
• Risk for malnutrition-associated pain and self-impost dietary restrictions.

Nursing Care Planning and Goals for Cholecystitis

The significant patient goals include:

• Encourage relation and alleviate discomfort.
• Prevent potential issues.
• Educate the patient on the nature of the disease and treatment plans.
• Ensure adequate levels of fluids and electrolytes.

Nursing Interventions for Cholecystitis

Treatment of Cholecystitis depends on the absence or presence of complications and their severity.

• Pain assessment. Note the location, nature of pain, and intensity (on a 0-10 scale)
• Encourage bed rest and let patient find their comfortable position.
• Provide relation mechanisms and engaging activities.
• Spend some time with patients listening and communicating with them regularly.
• Evaluate the intake of calories to determine nutritional requirements.
• Food planning. Consult the client about their food preferences, preferred meal times, dislikes, and triggering food.
• Promote appetite. Provide a pleasant atmosphere when eating and prevent unpleasing stimuli.
• Laboratory test. Monitor laboratory tests like BUN, albumin, transferring levels, total proteins, and pre-albumin.

Nursing Evaluation of Cholecystitis

The expected outcome includes:

• Achieved homeostasis.
• Relieved pain
• Prevented/reduced complications.
• Therapeutic regimen, disease process, and prognosis understood.

Discharge and Home Care Guidelines

Discharge and home care guidelines for Cholecystitis mainly focus on education:

• Establish patient nutritional needs by consulting nutritional or seeking dietitian support.
• Maximize tolerated activities and ambulate.
• Education. Educate the patient on the causes of Cholecystitis, its complications when not treated, and surgical and medical options.

Documentation Guidelines

Documentation guidelines for Cholecystitis focus on the following:

• Caloric intake.
• Previous medication.
• Pain inventory specifics
• Patient’s response to pain
• Levels of acceptable pain.
• Religious and cultural restrictions of the patient and individual preferences.
• Care plan.
• Pain management expectations.
• Plan of care modifications.
• Progress or achievement toward desired results.
• Teaching plan.
• Response to teaching, inventions, and actions taken.
• Resource availability and utilization.