2. Cholecystitis ; Inflammation of gallbladder or
cystic duct
>90% due to calculous cholecystitis.
10% acalculous cholecystitis.
It can be
Acute (middle age)
Chronic (elderly people)
3. Cholelithiasis ; Obstruction caused by
gallstones; gall stone formation.
Cholesterol (most common)
Pigmented occurs later in life, associated
with cirrhosis.
4. Obesity
High calorie, high cholesterol diet
Middle age
Female gender
American Indian ancestry
Gallbladder, pancreatitis, diabetic mellitus,
ileal disease, liver disease, blood disorders.
Hormonal contraceptives, HRT or pregnancy
Use of clofibrate, an antilipemic drug.
5. The obstruction in gallbladder distension,
edema of the cells lining the gallbladder.
Ischemia spurs on inflammatory mediators.
Prostaglandins aggravates the inflammation.
The lining wall of the gallbladder may
eventually undergo necrosis and gangrene,
which is known as gangrenous cholecystitis.
6. The inflammation of the gallbladder wall may
be bacterial or sterile in some cases.
In bacterial, normally super-infection with
gas forming organisms.
formation of gas in the wall or the lumen of
the gallbladder leads to a condition known as
emphysematous cholecystitis.
7. Enzymatic defect increases cholesterol
synthesis
Decreased secretion of bile acids to emulsify
fats
Decreased reasorption of bile acids from
ileum
Gallbladder smooth muscle hypomotility and
stasis
Genetic predisposition
Combination of any or all of the above
8. Sharp, cramping, or dull ,steady or intermittent
epigastric and right hypochondrium pain,
radiating to mid upper back.
worse during a deep breath.
More than 6 hours, particularly after meals.
Heartburn; flatulence, Intolerance to fatty food
Clay-colored stools
Fever
Nausea and vomiting
Yellowing of skin and whites of the eyes
(jaundice)
10. Uncomplicated ; Nonsurgical treatment
CDCA (Chenodeoxycholic acid) and UDCA (Ursodeoxycholic
acid) to dissolve cholesterol gallstones.
Antibiotics to fight infection
Low-fat diet (when food can be tolerated)
Pain medicines, antiemetic etc.
Complicated ; a surgical approach.
Percutaneous transhepatic cholecystostomy drainage
.Laproscopic cholecytectomy or open cholestectomy.
ERCP for choledocholithiasis
11. Patient education to reduce anxiety and
depression
Preoperative and post operative care.
Pain management
Fluid and electrolyte balance
Nutritional status: avoid fatty foods and
fluids, : Encourage fluid intake. Modified
diet provision, balance, and bowel routine.
Prevention of complications.
12. Empyema (pus in the gallbladder)
Gangrene (tissue death) of the gallbladder
Injury to the bile ducts draining the liver (an
occasional complication of cholecystectomy)
Pancreatitis
Peritonitis (inflammation of the lining of the
abdomen) due to Gallbladder perforation.
13. In this section I would like to share my experience taking care
of a patient, she is my own aunt, even though, I have worked
with patients with cholecystitis. I used to work in ER in Nepal.
We used to get most of patients with abdominal pain or acute
abdomen cases. Patients who were diagnosed cholecystitis or
cholelithiasis, usually presents with sudden severe pain to
right upper gastric pain with nausea and vomiting, jaundice in
some cases. The lab test and ultrasound were main
diagnostic tools for those patients, elevated WBC and LFT’s
and positive for gall stones or cholecystitis in abdominal
ultrasound. During my 7 years work experience back home, I
used to get floated to surgical floor sometime, most of
surgical cases used to be related to GI.
continued
14. Open cholecystectomy and laparoscopic cholecystectomy were very
common and simple surgical operations. Length of stay was also
short, only 2-4 days. Common complications was infection of
surgical site and I had witnessed death of one patient due to internal
bleeding in immediate post operative period.
Last year, I went my country for vacation, I got opportunity to take care
of my aunt during her treatment of cholecystitis, who was scheduled
for elective cholecystectomy after 3 months because she was
asymptomatic and stable. One early morning I received call that she
was brought to ER due to severe abdominal pain. I went to see her in
ER, She was weak and complaining of intermittent pain to epigastric
area. My cousin told me that she had vomited several times at home,
had mild fever for few days. She was already given antiemetic
promethazine and IM diclofenac sodium for pain and also IV fluid
was in progress. After physical examination and history taking ,MD
ordered stat abdominal ultrasound and x ray of abdomen and chest.
continued
15. ER physician recommended surgical consult and she got
admitted for emergency surgery. Open cholecystectomy was
done within an hour. My aunt and her whole family were very
anxious, they were not ready for surgery yet ,she was expecting
after three month only. But I had to teach her the possible
complications for waiting longer .eventually she signed the
consent. After surgery, while waiting out side operation theater,
surgeon showed us the gall bladder with gall stones with pus. He
said she was lucky that we took her to ER on time because the
gallbladder was full of pus and about to perforate. She could
have peritonitis due to perforation.
After two hours of post operative care, she got transferred to
surgical floor again. She had penrose drain tube in place to drain
pus.
continued
16. She was hospitalized for 7 days, longer than usual due to her
condition. She was discharged home with oral antibiotic and
pain medication. I provided health education to her and her
family regarding
incision care to prevent infection,
activities at home including ambulation to prevent post
operative complications,
encouraged to avoid fatty diet, to increase fluid intake,
medication regimen to complete antibiotic course
Follow up with MD on scheduled date.
Nutritional diet to promote healing of incision.
17. McCance, K.L., Huether, S.E., Brashers, V.L., & Rote, N.S.
(Eds.). (2006). Struture and Function of Digestive
System. Pathophysiology: The Biologic Basis for
Diseases in Adults and Children (5th ed.). St. Louis, MO:
Elsevier Mosby.
Margaret Eckman, Debra Share(Eds.)
(2013).Gastrointestinal System. Pathophysiology made
Incredibly Easy (5thed.) Wolters Kluwer, Lippincott
Williams & Wilkins
18. Alan A Bloom, MD; Chief Editor: Julian Katz, MD. Retrieved
from http://emedicine.medscape.com/article/171886-
overview
Dr. Sumaiya Khan. Retrieved from
http://www.buzzle.com/articles/cholecystitis-
pathophysiology.html
Retrieved from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001310/
Retrieved from http://www.webmd.com/digestive-
disorders/tc/cholecystitis-overview
Notas del editor
Treatment of cholecystitis depends on the severity of the condition and the presence or absence of complications.
