Cholecystitis and Cholelithiasis

• Cholecystitis is the inflammation of the gallbladder.
• Cholelithiasis refers to small stones, typically made of cholesterol, that form in the gallbladder or common bile duct.

Potential Complications

• Acute pancreatitis can occur if a gallstone blocks the pancreatic duct, leading to inflammation.
• Bile duct infection (cholangitis) is the inflammation of the bile duct caused by a bacterial infection due to blockage.
• Prolonged bile duct obstruction can result in liver damage.

Risk Factors for Cholecystitis

• Being a female client over 40 years of age increases the risk.
• Multiparous women, those who have given birth to more than one child, are at higher risk.
• The use of oral contraceptives, containing estrogen and progesterone, elevates the risk of gallstones by increasing cholesterol levels in bile.
• Elevated serum cholesterol levels can contribute to this condition.
• Increased estrogen in the body, which increases cholesterol secretion in the biliary duct, is also a factor.
• Family history of cholecystitis raises one's susceptibility.

Common Signs and Symptoms

• Colicky pain in the right upper quadrant (RUQ) is due to the gallbladder attempting to contract to release bile.
• Pain may radiate to the right shoulder and the back.
• The pain intensifies approximately 30 minutes after the gallbladder attempts to release bile.
• Experience of nausea and vomiting are common.
• Localized guarding in the abdomen may be present.
• Positive Murphy Sign is indicative of cholecystitis; pain occurs upon palpation of the right side of the rib cage during a deep breath if the gallbladder is inflamed.
• Fever and tachycardia (fast heart rate) may occur.
• Leukocytosis, an elevated white blood cell count, can be present.

Perforation

• A complication is peritonitis, characterized by diffuse abdominal tenderness and rigidity, requiring immediate medical attention.
• Perforation of the gallbladder causes bile leakage into the abdominal cavity, irritating muscles and causing rigidity, with a high risk of bacterial growth leading to sepsis.
• Patients report a history of indigestion when consuming fatty foods.
• Symptoms of indigestion include bloating, heartburn, or flatulence.

Nursing Intervention

• An abdominal ultrasound is used to confirm the diagnosis.
• Surgery, known as cholecystectomy (either laparoscopic or open), is performed.

Pre-Operative Care

• Pain Management with prescribed opioids, or NSAIDs.
• Administer fluids and electrolytes, especially if vomiting.
• Administer IV antiemetics.
• IV antibiotics prophylaxis may be given.
• The client should be kept on NPO (nothing by mouth).

Postoperative Care

• Ambulation is encouraged to reestablish peristalsis and prevent bowel obstruction.
• Increase fluid intake when appropriate.
• Start with a low-fat diet initially, progressing to a regular diet after a few weeks.