Choesystitis disease of GIT for nursing student

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1. Subject : Adult Health Nursing Topics : Cholecystitis

2. Objectives At the end of this presentation the student will be able to: Define cholecystitis Describe Pathophysiology of cholecystitis. Identify types of cholecystitis. Enlist signs, symptoms and causes of cholecystitis. Discuss medical diagnosis and treatment cholecystitis. Make nursing diagnosis and nursing intervention for cholecystitis.

3. Cholecystitis Cholecystitis Cholecystitis refers to a painful inflammation of the gallbladder's wall.

4. Types Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain. Chronic Cholecystitis is long-standing swelling and irritation of the gallbladder. Calculous cholecystitis (90%) Acalculous cholecystitis (10%

5. Chronic Cholecystitis • The opened gall bladder contains about two dozen bright yellow cholesterol rich gallstones  • The remaining mucosa has a normal velvety appearance  • The cut edge of the gallbladder wall(arrow) is thickened indicative of chronic inflammation (Image Contrib. by:UCHC) (Description by: Martin Nadel, M.D.)

6. Gall stones cause stasis of bile (meaning bile is not moving (flowing)the way it should through the bile ducts) and infection will take over. Just like a small body of water that is stagnant, (not flowing) bacteria will sit and multiply. Pathophysiology

7. Conti…. Although the exact mechanism of acalculous cholecystitis is unclear, several theories exist. Injury may be the result of retained concentrated bile, an extremely noxious substance. In the presence of prolonged fasting, the gallbladder never receives a cholecystokinin (CCK) stimulus to empty thus, the concentrated bile remains stagnant in the lumen.

8. Etiology Calculous cholecystitis is mainly caused by cholelithiasis and include the following: Female sex Certain ethnic groups Obesity or rapid weight loss Drugs (especially hormonal therapy in women) Pregnancy Increasing age

9. Conti… Acalculous cholecystitis is caused due to Critical illness Major surgery or severe trauma/burns Sepsis Prolonged fasting Sickle cell disease Salmonella infections Diabetes mellitus

10. Sign and symptoms Pain it may be colic or referred Indigestion Nausea Fever Loss of appetite Murphy’s sign is positive

11. Medical Diagnosis Abdominal Ultrasound History and Physical Exam Abdominal CT Scan Blood Test

12. Treatments Administration of Intravenous Fluids Surgical Removal of Gallbladder Laparoscopic Cholecystectomy

13. Complications Enlarged gallbladder.  Empyema  Death of gallbladder tissue.  Perforation or rupture lead to peritonitis Cholangitis (destruction of biliary ducts) Emphysema

14. Nursing diagnosis Acute pain related to gallbladder inflammation or presence of stones . Impaired oral mucous membrane related to NPO status and possible NG suction. Ineffective breathing pattern related to pain from high abdominal incision. Risk for infection (postoperative) related to obstruction of external biliary drainage tube. Imbalanced nutrition less than body requirements related to altered lipid metabolism and increased nutritional needs during healing.

15. Nursing intervention Provide comfort measures and administer analgesics as ordered Monitor vital signs for signs of perforation. Administer antibiotics for infection as ordered. Advice the patient to eat low fatty foods Monitor nutritional intake and weigh patient regularly. Frequently turn the patient and encourage deep breathing to prevent pulmonary complications, to protect skin, and to promote comfort.

16. References Huffman JL, Schenker S. Acute acalculous cholecystitis - a review.  Clin Gastroenterol Hepatol . Sep 9 2009; [Medline] . Donovan JM. Physical and metabolic factors in gallstone pathogenesis.  Gastroenterol Clin North Am . Mar 1999;28(1):75-97.  [Medline] . Sitzmann JV, Pitt HA, Steinborn PA, et al. Cholecystokinin prevents parenteral nutrition induced biliary sludge in humans.  Surg Gynecol Obstet . Jan 1990;170(1):25-31.  [Medline] . Cullen JJ, Maes EB, Aggrawal S, et al. Effect of endotoxin on opossum gallbladder motility: a model of acalculous cholecystitis.  Ann Surg . Aug 2000;232(2):202-7.  [Medline] . Forbes LE, Bajaj M, McGinn T, et al. Perihepatic abscess formation in diabetes: a complication of silent gallstones.  Am J Gastroenterol . Apr 1996;91(4):786-8.  [Medline] .