Medical Surgical Exam
Medical Surgical Exam
Medical Surgical Exam
ACUTE CHOLECYSTISIS
- It is an acute inflammation of the gallbladder which causes pain, tenderness, and rigidity in the
right upper abdomen which may radiate to the right shoulder and is associated with nausea and
vomiting.
- It is the cystic duct blockage which causes the inflammation. Normally, the bile is made from the
liver which travels down the bile duct and will be restored in the gallbladder. If a person eats
spicy or greasy foods, the gallbladder will be stimulated to empty the bile of the gallbladder
through the cystic duct and down the bile duct into the duodenum. This process aids in food
digestion. The gallbladder also helps concentrate bile which is susceptible to precipitation
forming stones when homeostasis is disrupted. Furthermore, when a cystic duct blockage is
caused by a stone, it is called acute calculous Cholecystitis. Patients with this condition can
experience pain due to the temporary blockage of the gallstone. Moreover, about 95% of
people with acute Cholecystitis have gallstone.
Age
o 40 years old and above has risk of developing the disease. It is extremely rare in
children.
Gender
o It is three times more common in women than men
Hormonal changes
o Specially to women using birth control pills
Family history/ genetics
o Mostly common to patients with positive family history of the disease
Blockage
o May be caused by stone, scars, or infection. When this occurs, it can lead to chronic
cholecystitis.
Obesity
o Cholesterol levels are increased in body fats which makes a patient more at risk to
develop gallstones and risks of gallstone-related complications
Diabetes mellitus
o Patients with diabetes mellitus have increased risk of developing cholecystitis and tend
to have more complicated course of disease it is because they have higher levels of
triglycerides which encourages formation of gallstone
Initial treatment
In order to prevent Cholecystitis from recurring and reduce the risk of developing a more serious
complications. Options are:
- Surgery (Cholecystectomy)
o Removal of gallbladder
- Alternative procedure (Percutaneous cholecystectomy)
o Patients who is unfit for surgery
o Needle is inserted through the abdomen to drain fluid that builds up in gallbladder
- Once patient had a cholecystectomy or removal of gallbladder, they can be discharged the same
day.
o Pain from surgical procedure can be managed with over-the-counter analgesics
o Ambulation can dissipate pain
o Patient is advised on possible intolerance to greasy foods which can cause bloating or
diahrrea.
o Follow-up between 3-4 weeks from procedure
- Managing Self-care
o Resume ADLs
o Care for wound, check for any signs of infection and clean properly
o Resume eating normal diet, and if have fat intolerance, gradually add fat back to diet
o Call physician if experiencing redness, tenderness, swelling, heat, or drainage in surgical
site.
o Call physician if experiencing fever for more than 2 consecutive days
o Call physician if experiencing nausea and vomiting, or abdominal pain.
- If disease develops into a chronic or more advanced disease, healthcare workers focus on
palliative treatments.
o Manage signs and symptoms
Pain medications to reduce pain
O2 therapy
o Non-pharmacological interventions
Emotional and spiritual support
o Family and Patient education
what should be expected during this times
address questions and concerns
provide emotional support and guidance
Reference/s:
Mahdi, B. M. (2017, April 26). Immunogenetic basis of cholecystitis. IntechOpen. Retrieved October 26,
2022, from https://www.intechopen.com/chapters/54231
Jones, M., Genova, R., O’Rourke, M.(2022). Acute cholecystitis - statpearls - NCBI bookshelf. (n.d.).
Retrieved October 26, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK459171/
NHS inform. (2020). Acute cholecystitis symptoms and treatments. Illnesses & conditions | Retrieved
October 26, 2022, from https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-
gastrointestinal-tract/acute-
Mayo Foundation for Medical Education and Research. (2022, September 9). Cholecystitis. Mayo Clinic.
Retrieved October 26, 2022, from
https://www.mayoclinic.org/diseases-conditions/cholecystitis/symptoms-causes/syc-20364867
cholecystitis#:~:text=Preventing%20acute%20cholecystitis&text=You%20should%20therefore
%20control%20your,your%20risk%20of%20developing%20gallstones.
Berry, P. & Griffie, J. (2010). Planning for the actual death. In B.R. Ferrell & N. Coyle (Eds.), Oxford
Textbook of Palliative Nursing (pp. 629-644). New York: Oxford University Press.