Cholecystitis.pptx

For 2nd year B.Sc Nursing students

1. CHOLECYSTITIS Presented By: Mr . Nandish. S Asso. Professor Mandya Institute of Nursing Sciences

2. Definition : It is an inflammation of the gallbladder. More than 90% of cases are associated with cholelithiasis caused from blockage of cystic duct by gallstones. It may be acute calculous , acalculous or chronic cholecystitis .

3. Etiology / Types: Acute Calculous cholecystitis : More than 90% of cases are acute & caused due to gallbladder stones obstructing bile outflow. Bile remaining in the gallbladder initiates chemical reaction, autolysis and edema . Escherichia Coli is the most common bacteria involved. Other bacterias are Streptococci, Salmonella & Klebsiella may stimulate onset of inflammation.

4. 2. Acalculous cholecystitis : There is no stones in biliary duct & it accounts for 5 – 10% of cases. It is seen in people who are hospitalized & critically ill. It is associated with conditions like vasculitis , chemotherapy, major trauma, extensive burns and following surgery.

5. 3. Chronic C holecystitis : It occurs after repeated episodes of acute cholecystitis & is always due to gallstones. It may be asymptomatic. It leads to number of complications like gangrene, perforation, fistula formation.

6. Pathophysiology : Blockage of the cystic duct Increase pressure within the gallbladder Damage the gallbladder wall & becomes edematous Inflammation & swelling of gallbladder (bile / pus) Reduce normal blood supply & cell death

7. Clinical Manifestations : Asymptomatic in the beginning Abdominal pain in the right upper quadrant / epigastric region Murphy‘s sign : ask the patient to take in and hold deep breath, palpate the right subcostal area. If the pain occurs on inspiration (inflamed gallbladder comes in contact with examiner’s hand), then murphy’s sign is positive. Jaundice Fat intolerance Dyspepsia Dark coloured urine & stool Flatulence

8. Diagnostic studies : History collection & Physical examination Liver Function Test CBC ( Leucophilia ) C – reactive protein Serum Bilirubin Abdominal X-Ray Ultrasonography Endoscopic Retrograde Cholangiopancreatography

9. Complications : Subphrenic Abscess Cholangitis Pancreatitis Biliary cirrhosis Rupture of gallbladder Fistula

10. Management : Conservative therapy: Aim : to control pain, controlling further infection & maintenance of fluid & electrolyte balance. Treatment focuses on symptoms. NPO Gastric decompression to reduce nausea & vomiting. Antiemetics (promethazine / phenergan ) Analgesics ( Meperidine ) Administration of Fat Soluble Vitamins (A,D,E & K)

11. Anticholinergics E x : Dicyclomine , they decrease gallbladder stimulation. Antispasmodics Ex: scopolamine, they block acetylcholine, that signal muscle to contract. Antibiotics Ex: Ampicillin, Ciprofloxacin, imipenem , Levofloxacin.

12. Nursing Management : Acute pain, abdomen, related to discomfort. impaired gas exchange related to decreased thoracic excursion. Impaired skin integrity related to altered biliary drainage. Imbalanced nutrition, less than body requirement related to inadequate bile secretion Deficient knowledge related to poor self care activities.

13. Thank you