CAUSES OF CHOLECYSTITIS
The causes of cholecystitis include:
Gallbladder stone. Cholecystitis is usually associated with gallstone impacted in
the cystic duct.
Bacteria. Bacteria plays a minor role in cholecystitis; however, secondary
infection of bile occurs in approximately 50% of cases.
Alterations in fluids and electrolytes. Acalculous cholecystitis is speculated to
be caused by alterations in fluids and electrolytes.
Bile stasis: Bile stasis or the lack of gallbladder contraction also play a role in
the development of cholecystitis.
CLINICAL MANIFESTATIONS
Cholecystitis causes a series of signs and symptoms which include:
Nausea and vomiting are common symptoms. They often show up after eating a
big or especially fatty meal.
Pain. Right upper quadrant pain occurs with cholecystitis. Pain may radiate to
the belly, back, or under the right shoulder blade.
Yellow skin or eyes (jaundice)
Bowel movements that are loose and light-colored
Leukocytosis. An increase in the WBC occurs because of the body’s attempt to
ward off pathogens.
Fever. Fever occurs in response to the infection inside the body.
Palpable gallbladder. The gallbladder becomes edematous as infection
progresses. gallbladder is occasionally palpable below the right costal margin in
the mid-clavicular line. If enlarged, it will be felt as a soft, rounded mass which,
like the liver, moves down on inspiration. Rolling the patient 45 degrees to the left
makes the gallbladder more visible and facilitates its palpation.
Sepsis. Infection reaches the bloodstream and the body undergoes sepsis.
TREATMENT
Treatment of acute cholecystitis depends on the severity of the condition and the
presence or absence of complications. Uncomplicated cases can often be treated on an
outpatient basis; complicated cases may necessitate a surgical approach. Patients
admitted for acute cholecystitis should receive nothing by mouth because of expectant
surgery. However, in uncomplicated cholecystitis, a liquid or low-fat diet may be
appropriate until the time of surgery.
Initial Therapy and Antibiotic Treatment
In acute cholecystitis, the initial treatment includes bowel rest, intravenous hydration,
correction of electrolyte abnormalities, analgesia, and intravenous antibiotics. For mild
cases of acute cholecystitis, antibiotic therapy with a single broad-spectrum antibiotic is
adequate. E.g
piperacillin/tazobactam (4.5 g IV q8h), ampicillin/sulbactam (3 g IV q6h), or
meropenem (1 g IV q8h). In severe life-threatening cases,
imipenem/cilastatin ( 500 mg IV q6h) is prescribed.
Promethazine or Prochlorperazine may control nausea and prevent fluid and
electrolyte disorders.
Oxycodone or Acetaminophen may control inflammatory signs and symptoms
and reduce pain.
Emesis can be treated with antiemetics and nasogastric suction
CHOLECYSTECTOMY
Cholecystectomy is most commonly performed by using a laparoscope and removing
the gallbladder.Laparoscopic cholecystectomy is the standard of care for the surgical
treatment of acute cholecystitis. Studies have indicated that early laparoscopic
cholecystectomy resulted in shorter total hospital stays with no significant difference in
the conversion rates or complications.
Nursing Management
Assess the vital signs frequently and inform the doctor if there is any abnormality.
Assess abdominal pain through physical examination, nausea, and vomiting.
Start IV fluid and pain medications as prescribed.
Prepare the patient for the operative room by keeping him NPO, teach the patient
about the procedure steps, and about the postoperative management.
Place the patient in a semi-fowlers position.
Monitor laboratory data and report if there is any abnormalities.
REFERENCES
MARIANNE BELLEZA, R.N.(JULY 2023), Cholecystitis https://nurseslabs.com/cholecystitis/
Minesh Khatri, MD (August 2022), Cholecystitis https://www.webmd.com/digestive-
disorders/what-is-cholecystitis
Vinay K Kapoor (July 2022) Acute Cholecystitis Treatment and Management
https://emedicine.medscape.com/article/171886-treatment
