Cholecystitis

inflammation of the gallbladder

role of the gallbladder

The liver creates the bile and the gallbladder stores the bile

bile - helps digests fats (vit ADEK), also vehicle of bilirubin to exit the body
through stool

When a person eats a meal, the stomach will digest it. When the food leaves
the stomach, it is now called chime. Then it will go down to your small
intestines into the duodenum. In the duodenum, there is a duct that can
sense that there is fat in the chime then it signals the gallbladder to contract
and release bile to assist into digesting the fats.

When you have an issue with the gallbladder (bile cant leave), the fat will not
be digested and it will be excreted out. Fatty stool will then appear
(steatorrhea)

Bilirubin is a brown orangish color and it exits your body through your stool
that is why your stool is brownish. So if you have a gallbladder problem, the
bile cant go to your small intestines so is the bilirubin leading to patient
manifesting jaundice (bilirubin is stuck in your body), Stool is clay colored
and urine is dark.

Cause:

obstruction

dysfunction of the gallbladder (pts who are severely sick)

gallstones (main cause)

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 Risk Factors

Female

Obesity

Older Age

Family History

Pregnant

Native or Mexican American

Signs and symptoms

severe nausea and vomiting that the patient will need NGT with GID
compression (removes stomach contents with intermittent suction so the
gallbladder wont be stimulated) (patient will be given anti nausea
medication)

dehydration d/t severe nausea and vomiting (management would be IV

Severe pain in the epigastric region and radiates to the right scapula
(shoulder) and worsens after patient consumes heavy greasy (fatty) meal.

Positive Murphy sign - lay the patient back and tell them to breathe out and
breathe in. While the patient is breathing in, you will palpate under the ribs
(assess whether the patient stops breathing etc due to pain). If there is pain
cues, then the patient has positive murphy sign.

bloating

fever and increase HR

Jaundice

Dark urine

light colored stools

steatorrhea

DX:

abdl utz

HIDA SCAN - they will inject radioactive tracer to a patients vein and it will
light up the whole area and assess the gallbladder

CT SCAN

Nursing Interventions

G - GI rest

NPO until recovered

Nutrition advanced per physician’s order:

Clear liquid, full liquid and soft bland foods

Provide routine mouth care

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 A - Analgesics and Antiemetics

L - Low fat diet when recovered

Avoid greasy, spicy and gassy foods (gassy foods: cauliflower, beans,
broccoli etc.)

L - Large bore IV for fluids

Many patients become dehydrated from nausea and vomiting

B - Breathing in stopped by patient (positive Murphy’s sign) (RUQ)

L - Labs

Electrolytes

Bilirubin (high)

WBC

Renal function (super dehydrated)

A - Antibiotics for infection

D - Drain care

Cholesystostomy tube “C tube” - placed through abdominal wall and into

It drains infected fluid from the gallbladder and help it heal

Drain care:

Keep drainage bag lower than insertion site (below waist level)

Empty bag regularly, note color and amount

Make sure its draining properly

Change dressing and keep skin dry/clean

D - Deterioration signs and symptoms:

Mental status changes

Tachycardia

Hypotension (may indicate sepsis)

Hyperthermia

High WBC

Steatorrhea

Jaundice

Increased nausea and vomiting

Increased abdominal pain

E - ERCP (Endoscopic Retrograde CholangioPancreatography)

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 Remove gallstones in the bile duct so that bile can go out to the
duodenum

Endoscope is inserted through the mouth and into the stomach, small
intestine and into the bile duct

R - Removal of gallbladder (CHOLECYSTECTOMY)

bile will be drained from the liver into the bile duct and into the
duodenum.

monitor for infection

shoulder pain with laparoscopic

mgt: side lying with knees bent, analgesics

Ambulation

Incentive Spirometer

T-tube care

Works as a drain and for testing with dye to assess biliary tree for
any stones

keep tubing and drainage bag below insertion site (Make sure
draining properly and tubing free from kinks and patient in semi
fowler’s)

Do not flush or clamp unless ordered by the physician

Empty and measure the drainage (assess the color and amount. no
greater than 500 cc/day (notify). bloody to greenish

Monitor surrounding skin for breakdown (bile is harsh to the skin)

The drainage is measured as output. The amount of expected

If have order to clamp: may be required to clamp 1 hour BEFORE

Assess how patient tolerates (tube is being clamped)

Bad sign: nausea and vomiting, abdl pain

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