What is Cholecystitis?

Cholecystitis refers to the inflammation of the gallbladder. This inflammation arises due to the trapping of bile, a digestive juice, within the gallbladder. Situated beneath the liver, the gallbladder plays the crucial role of storing bile produced by the liver. Normally, bile is expelled from the gallbladder into the small intestine; however, a blockage results in bile accumulation, leading to inflammation and potential infection. Cholecystitis can present in two forms: acute or chronic.

Pathophysiology

The predominant cause of cholecystitis is the entrapment of bile in the gallbladder. This typically happens because of the gallstone blockage of the bile drainage tube. Gallstones, composed of bile, develop within the gallbladder and can hinder bile flow, causing irritation, increased pressure, and possible infection in the gallbladder.

However, there are other causes of cholecystitis which include:

• Bacterial infections within the bile duct system
• Tumors in the pancreas or liver obstructing bile drainage
• Reduced blood supply to the gallbladder, often associated with diabetes
• Accumulation of gallbladder sludge, predominantly seen in pregnant women or those who undergo rapid weight loss

Risk Factors

• Formation of gallstones in the gallbladder
• Bacterial infections in the bile duct system
• Existence of tumors in the pancreas or liver
• Conditions like diabetes which can reduce blood supply to the gallbladder
• Rapid weight loss or pregnancy leading to gallbladder sludge

Signs and Symptoms

Typical cholecystitis flare-ups last between 2 to 3 days. Common symptoms include:

• Severe and sudden pain in the upper right portion of the abdomen
• Pain radiating to the back or below the right shoulder blade
• Nausea and vomiting
• Fever
• Jaundice (yellowing of the skin and eyes)
• Pale-colored bowel movements
• Abdominal bloating

Diagnosis

The diagnostic procedure involves a physical examination, review of medical history, and certain tests:

• Blood Tests: These might include a Complete Blood Count (CBC) and liver function tests
• Imaging Tests: Ultrasound, abdominal X-ray, and CT scans can offer visualizations of the gallbladder and associated organs; a HIDA scan, PTC, and ERCP can provide detailed insights into the function and health of the gallbladder and bile ducts

Medications and Treatment

Patients diagnosed with cholecystitis often require hospitalization. Typical treatments include:

• Antibiotics to combat infection
• Administering fluids and pain relief intravenously
• Keeping the stomach empty alleviates symptoms

If gallstones are the root cause, gallbladder removal (cholecystectomy) becomes necessary. The human body can function without a gallbladder. Depending on the patient’s health, immediate surgery or delayed surgery post-symptom alleviation might be recommended.

Alternative treatments could be:

• Oral dissolution therapy to break down the stones
• Medications to hinder gallstone formation
• A prescribed low-fat diet upon the resumption of normal eating

Nursing Interventions

Nursing interventions for cholecystitis aim to optimize patient outcomes, manage symptoms, reduce complications, and enhance patient comfort. Here’s a detailed look:

1. Pain Management:
   • Assess pain levels regularly using standardized pain scales.
   • Administer prescribed pain relief medications in a timely manner.
   • Position the patient for comfort, often semi-Fowler’s position is preferred.
   • Use non-pharmacological pain relief methods such as deep breathing exercises and distraction techniques if applicable.
2. Vital Signs Monitoring:
   • Monitor blood pressure, heart rate, respiratory rate, and temperature to detect any abnormalities.
   • Observe for signs of increased pain, fever, or changes in heart rate which might suggest complications or worsening of the condition.
3. Fluid and Nutritional Support:
   • Administer intravenous fluids as ordered to maintain hydration, especially if the patient is nil per os (NPO).
   • Monitor input and output ratios to assess for dehydration or fluid overload.
   • Educate patients on the importance of a low-fat diet once regular food intake is resumed.
   • Collaborate with dieticians to ensure an appropriate diet is provided postoperatively.
4. Wound Care (Post-surgery):
   • Inspect surgical site for signs of infection such as redness, warmth, discharge, or swelling.
   • Change dressings as ordered, maintaining aseptic technique to prevent contamination.
   • Instruct patients on wound care post-discharge, including when to seek medical help for potential complications.
5. Patient Education:
   • Inform the patient about the nature of cholecystitis, its causes, and implications.
   • Educate about the importance of medication adherence, dietary restrictions, and lifestyle modifications.
   • Instruct on signs of complications such as jaundice, clay-colored stools, or increased abdominal pain, signaling them to seek medical attention.
6. Safety Precautions:
   • Ensure bed rails are up to prevent falls, especially if the patient is dizzy from medication or the condition itself.
   • Provide assistance with ambulation as needed.
7. Emotional Support:
   • Recognize the psychological impacts of the diagnosis and potential surgery.
   • Offer a listening ear, answer questions, and address concerns the patient may have.
   • If needed, refer the patient to counseling or support groups.
8. Discharge Planning:
   • Collaborate with multidisciplinary teams to ensure smooth transitions to home or further care.
   • Provide written instructions regarding medications, dietary restrictions, activity levels, and follow-up appointments.
   • Ensure the patient understands potential complications and when to seek emergency care.

In all interventions, nurses should utilize evidence-based practices and maintain open communication with the healthcare team to ensure optimal care and patient outcomes.

Resources:
Johns Hopkins Medicine
WebMD
Medscape