CHOLECYSTITIS with

CHOLECYSTOLITHIASIS
 Overview

The normal anatomy and physiology of the GB

 
GALLBLADDER

The GB which is a small pear-shaped organ that stores and concentrates the
bile. The gallbladder is connected to the liver by the hepatic duct. It is
approximately 3 to 4 inches (7.6 to 10.2 cm) long and about 1 inch (2.5 cm)
wide.

What is its Function?

The function of the gallbladder is to store bile and concentrate. Bile is a

digestive liquid continually secreted by the liver. The bile emulsifies fats and
neutralizes acids in partly digested food. A muscular valve in the common
bile duct opens, and the bile flows from the gallbladder into the cystic duct,
along the common bile duct, and into the duodenum (part of the small
intestine).

Cholecystitis

Cholecystitis is painful inflammation of the gallbladder, a small organ near

the liver that plays a part in digesting food. Normally, fluid called bile passes
out of the gallbladder on its way to the small intestine. If the flow of bile is
blocked, it builds up inside the gallbladder, causing swelling, pain, and
possible infection.

Cholecystolithiasis
 Overview

What are the symptoms?

The most common symptom of cholecystitis is pain in your upper right

abdomen that can sometimes move around to your back or right shoulder
blade. Other symptoms include:

Nausea or vomiting.
Tenderness in the right abdomen.
Fever.
Pain that gets worse during a deep breath.
Pain for more than 6 hours, particularly after meals.
Constant pain in the right upper abdomen. It is usually made worse by
moving.
Jaundiced skin

Older people may not have fever or pain. Their only symptom may be a
tender area in the abdomen.

Eating fatty foods will often make the symptoms worse. When the bacterial
infection sets in, many patients experience a higher fever and shaking chills.
 
 Overview
What causes it?

A gallstone stuck in the cystic duct, a tube that carries bile from the
gallbladder, is most often the cause of sudden (acute) cholecystitis. The
gallstone blocks fluid from passing out of the gallbladder. This results in
an irritated and swollen gallbladder. Infection or trauma, such as an
injury from a car accident, can also cause cholecystitis.

Who gets it?

Cholecystitis strikes:

Twice as many women than men, particularly those between the

ages of twenty and sixty.

Pregnant women, or those on birth control pills or estrogen

replacement therapy have a greater risk of developing cholecystitis.

People who are overweight, or who lose a large amount of weight

quickly are also at greater risk for developing the condition.
 PATIENT’S PROFILE
Name : Patient “X”
Birth date : 11-14-35
Nationality : Filipino
Religion : Roman Catholic
Occupation : Palay Buying Station (Self-proprietor)
Admission : 8-13-09
Admission time : 9:15 am
Physician : Dr. Lagunilla
Chief Complaint : Right Lower Quadrant pain
 
History of Present illness

One year prior to admission the patient experiences Right Lower

Quadrant pain but did not consult a doctor and chose to self medicate with
pain relievers.

Few hours PTA as RLQ pain with vomiting, weakness.

Genetics
Has family history of “gallstones” (-) Hypertension
First hospital confinement (-) diabetes
Non-smoker
 CHOLECYSTITIS
Is inflammation of the gallbladder, usually resulting from
a gallstone blocking the cystic duct.

Gallbladder inflammation usually results from a gallstone

blocking the flow of bile.

Typically, people have abdominal pain that lasts more than 6 hours,
fever, and nausea.

Ultrasonography can usually detect signs of gallbladder inflammation.

The gallbladder is removed, often using a laparoscope.

Is the most common problem resulting from gallbladder stones. It

occurs when a stone blocks the cystic duct, which carries bile from
the gallbladder.

Cholecystitis is classified as acute or chronic.

 CHOLECYSTITIS
Acute Cholecystitis:

Acute cholecystitis begins suddenly, resulting in severe,

steady pain in the upper abdomen.

At least 95% of people with acute cholecystitis have

gallstones.

The inflammation almost always begins without infection,

although infection may follow later.

Inflammation may cause the gallbladder to fill with fluid and its
walls to thicken.

Rarely, a form of acute cholecystitis without gallstones

(acalculous cholecystitis) occurs.
 
 CHOLECYSTITIS
Acalculous cholecystitis is more serious than other types of
cholecystitis. It tends to occur after the following:

Major surgery

Critical illnesses such as serious injuries, major burns, and

bodywide infections (sepsis)

Intravenous feedings for a long time

Fasting for a prolonged time

A deficiency in the immune system

It can occur in young children, perhaps developing from a viral or

another infection.
 
 CHOLECYSTITIS
Chronic Cholecystitis:

Chronic cholecystitis is gallbladder inflammation that has

lasted a long time. It almost always results from gallstones.

It is characterized by repeated attacks of pain (biliary colic). In

chronic cholecystitis, the gallbladder is damaged by repeated
attacks of acute inflammation, usually due to gallstones, and may
become thick-walled, scarred, and small.

The gallbladder usually contains sludge (microscopic particles of

materials similar to those in gallstones), or gallstones that either block its
opening into the cystic duct or reside in the cystic duct itself.

Gallstones (choleliths) are crystalline bodies formed within the body by

accretion or concretion of normal or abnormal bile components.
CHOLECYSTOLITHIASIS
 
 CHOLECYSTOLITHIASI
CHOLECYSTOLITHIASIS

The presence of one or more gallstones in the gallbladder.

 
 DIAGNOSTIC PROCEDU
DIAGNOSTIC PROCEDURES

ASSESSMENT and DIAGNOSTIC METHODS

Abdominal radiograph ultrasonography or

cholecytography radionuclide imaging or
cholescintigraphy. (ERCP) Percutaneous transhepatic
cholangiography (PTC)
 
ULTRA- SOUND RESULTS
 
The gallbladder is normal in size. The wall is thick,
thickness measures 8mm. There is a large highly
echogenic density inside with acoustic shadow at the
neck measures 24 mm
 DIAGNOSTIC PROCEDU
CD and CND are normal in caliber. No billiary
obstruction.

The liver is not enlarged. The echo texture is

uniform. No focal lesion.

The pancreas, spleen and both kidneys are

unremarkable.

The urinary bladder shows smooth wall no intraluminal

echo.

The uterus is atropic.

 DIAGNOSTIC PROCEDU
BLOOD TEST
 DIAGNOSTIC PROCEDU
IV FLUIDS
TAKEN
 DIAGNOSTIC PROCEDU
URINALYS
IS
 DIAGNOSTIC PROCEDU
DIAGNOSTIC SONOGRAPHY (ULTRASONOGRAPHY)
Is an ultrasound-based diagnostic imaging technique used
to visualize subcutaneous body structures including tendons,
muscles, joints, vessels and internal organs foe possible
pathology or lesions.

CHOLESCINTIGRAPHY
Is a test done by nuclear medicine physicians to
diagnose obstruction of the bile ducts (foe example, by a
gallstone or a tumor), disease of the gallbladder, and bile leaks.
It sometimes is referred to as a HIDA scan or a GALLBLADDER
scan.
 
PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY
(PTHC or PTC)
Is a radiologic technique used to visualize the anatomy
of the biliary tract. A contrast medium is injected into a bile
 PATHOPHYSIOLOGY
Risk Factors
Heredity, age over
40, gender,obesity

Bile is The solute Crystals come

supersaturated precipitate from together and
with cholesterol solution as solid fuse to form
and calcium crystals stones

Gallstones

Obstruction of the cystic duct and

common bile duct

Sharp pain in
the right lower Jaundice
Distention of the
part of the gall bladder
abdomen

Venous and lymphatic Proliferation Localized

drainage is impaired of Bacteria cellular
Irritation

The gall bladder gets

inflammed
 PATHOPHYSIOLOGY
Cholelithiasis is the presence of stones in the gallbladder.

Cholecystitis is acute or chronic inflammation of the

gallbladder.

Most gallstones result from supersaturation of cholesterol in the

bile, which acts as an irritant, producing inflammation in the
gallbladder, and which precipitates out of bile, causing stones.

Risk factors include :

gender (women four times as like to develop cholesterol stones

as men),
age (older than age 40),
multiple parity, obesity,
use of estrogen and cholesterol-lowering drugs,
bile acid malabsorption with GI disease,
genetic predisposition, rapid weight loss.

Pigment stones occur when free bilirubin combines with calcium.

These stones occur primarily in patients with cirrhosis, hemolysis,
MEDICAL MANAGEMEN
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 SURGICAL INTERVENTI
CHOLECYSTECTOMY

is the surgical removal of the gallbladder. The

operation is done to remove gallstones or to remove
an infected or inflamed gallbladder.

BENEFITS and RISK

Gallbladder removal will relieve pain, treat infection, and in most

cases stop gallstones from coming back. The risks of not having
surgery are the possibility of worsening symptoms, infection, or
bursting of the gallbladder.

Possible complications include bleeding, bile duct injury, fever,

liver injury, infection, numbness, raised scars, hernia at the
incision, anesthesia complications, puncture of the intestine, and
death.
 NURSING MANAGEMEN
Discharge planning:

Advise patient to continue medication as ordered by the

physician.

Instruct the patient to do exercise as tolerated such as

walking.

Encourage the patient to increase fluid intake

Encourage the patient to have enough and adequate rest

Instruct patient to attend follow up checkups to the

physician.

Advised patient to a diet as tolerated but preferably low salt

and low fat diet.
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