CHOLECYSTITIS

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Definition :
👉Acute and chronic inflammation of the gallbladder.

Causes/Predisposing factors:
⛄Cholelithiasis (gall stones or calculi).
⛄Obstruction of cystic duct.
⛄Trauma
⛄Massive burns
⛄Surgery
⛄Infection 
⛄Obesity
⛄Hereditary 
⛄Sedentary life style
⛄DM.

 Note ✏The main cause of cholecystitis is Gall stones

Pathophysiology:
🌞Due to any of the above listed causes (I'm using gall stones,tho),the gall bladder will be lodged/obstructed and hidering the flow of bile.
🌞Accumulation of bile due to the obstruction,irritates the gallbladder causing it to be inflamed and distended,and signs of JAUNDICE are seen.
🌞Inflammation and distention of the gall bladder would manifest in the cardinal signs of inflammation including PAIN,TENDERNESS,FEVER,along side NAUSEA and VOMITING.

 🌞The obstruction of bile flow hinders fat metabolism in the duodenum (cuz that's where the bile acts).
🌞Presence of fat in the duodenum will stimulate contraction of gall bladder which further increases pain.
🌞Accumulation of fat and bile might promote the breeding of bacteria(usually E.coli) which may contribute to the inflammation process and leading to EDEMA which further obstructs the flow of bile.
🌞The presence of bacteria leads to formation of pus (EMPYEMA) and accumulation of fluid(HYDROPS);all these mechanisms lead to GANGRENE which results in PERFORATION,PERITONITIS AND PANCREATITIS.

Clinical Manifestations:
🐒N&V
🐒Pain at the RUQ
🐒Tenderness(felt on palpation)
🐒Fever
🐒Fat intolerance 
🐒Signs of jaundice(.e.g.yellowish coloration of the skin and stool)
🐒Heart burn
🐒Flatulence
🐒Indigestion.

Diagnostic Evaluation:
✔Ultrasonography (May visualize stones or inflammation).
✔Elevated conjugated bilirubin(due to obstruction).
 ✔Elevated WBC counts(due to infection by bacteria).
✔Elevated serum alkaline phosphate.
✔Endoscopic Retrograde Cholangiopancreatography(ERCP)May reveal inflamed bile duct,gallbladder and gall stones.
✔Percutaneous Transhepatic Cholangiograph(PTC)can identify gall stones within the bile ducts.

 Mgt:
👠Medical mgt:
💊Supoortive mgt including I.V fluids,NG sunction,analgesics for pain,antibiotics(to combat m.orgs),synthetic bile salts(To complement the unavailable bile at the duodenum).
💊Chemodeoxycholic acid is administered to dissolve gallstones.
🔪Surgical procedures such as
✏Lithotripsy(Extracorporeal shock wave to dissolve stones)
✏Cholecystomy(surgical openingof the gall bladder for removal of stones,bile or pus after which drainage is done).
✏Choledochostomy(An incision into the common bile duct for calculi removal).

Nursing mgt:
💉Promote adequate rest.
💉Administer I.V fluids and monitor intake and output.
💉Monitor NG tube and sunctioning.
💉Assess nutritional status,encourage a high protein,high-carbohydrate and low fat diet.
💉Monitor signs of complications of surgical mgt.
💉Observe for bleeding around incision site.
💉Report any change in drainage.
💉Instruct pt on care of any tube or catheter that may be in place at discharge.
💉Encourage follow-up as indicated.

Nursing Diagnoses:
👉Pain rt biliary colic/obstruction from stone eb pt's verbalization of pain.
👉Hyperthermia rt alteration in thermoregulating centre eb T of 38.3°C.
👉Deficient fluid volume rt inability to retain fluids(nausea and vomiting)and decreased intake eb decreased skin tugor/slow capillary refill time/weight loss/pale skin.
👉Risk for electrolytes imbalance rt excessive loss of nutrients from vomiting.

Complications:
⚠Necrosis 
⚠Empyema
⚠Gall stone ileus 
⚠Adenocarcinoma of the gallbladder 
⚠Cholangitis
⚠Perforation.

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