A CASE STUDY

ABOUT
CHOLECYSTITIS

Submitted to:
Mr. Maynard Agustin RN, MSN
Submitted by:
Janry-Mae E. Tumaneng
BSN-III

Introduction

Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining.
Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects the
gallbladder to the hepatic duct. Acute acalculous cholecystitis, though rare, is most often seen in
critically ill people in hospital intensive care units. In these cases there are no gallstones.
Complications from another severe illness, such as HIV or diabetes, cause the swelling. Long-
term (chronic) cholecystitis is another form of cholecystitis. It occurs when the gallbladder
remains swollen over time, causing the walls of the gallbladder to become thick and hard. The
presence of gallstones in the gallbladder is called cholelithiasis.

Cholelithiasis is the pathologic state of stones or calculi within the gallbladder lumen. In
US where 75-80% of gallstones are cholesterol type, and approximately 10-25% of gallstones are
bilirubinate of either black or brown pigment. In Asia, pigmented stones predominate, although
recent studies have shown an increase in cholesterol stones in Far East. Gallstones are crystalline
structures formed by concretion or hardening accretion of normal or abdominal bile constituents.
According to various theories, there are four possible explanations for stone formation. First, bile
may undergo change in composition. Second, gallbladder stasis may lead to bile stasis. Third,
infection may predispose a person to stone formation. Fourth, genetics and demography can
affect stone formation.

Risk Factors:
Heredity
Obesity
Rapid Weight Loss
Age over 60
Women with high Estrogen Levels
Native American or Mexican American
Very Low Calorie Diet
Prolonged Fasting
Low fiber and High Cholesterol Diet

Manifestation:
Frequent Bouts of Indigestion
Nausea and Bloating
Right Upper Quadrant Pain in the abdomen
Jaundice






Medical and Surgical Management:
1. Chest X-Ray
o This is used to rule out respiratory causes of referred pain
2. Measurement of Intake and Output
o An other means of assessing fluid balance. This data provide insight into the
cause of imbalance such as decrease fluid intake or increase in fluid loss.
3. Oxygen Inhalation
o Oxygen therapies are used to provide more oxygen to the body into order to
promote healing and wealth
4. Intravenous Rehydration
o When the fluid loss is severe of or life threatening, IV flids are used for
replacement
5. Ultrasound
o A diagnostic imaging technique which uses high frequency sound waves to
create n image of the internal organs.
6. Hepatobilliary Scintigraphy
o An imaging technique of the liver, bile ducts, gallbladder and upper parts of the
small intestine
7. Cholangiography
o X-ray examinantion of the bile ducts using an intravenous dye contrast
8. Percutaneous Transheaptic Cholangiography
o A needle is introduces through the skin into the lives where dye contrast is
deposited and the bile duct structure can be viewed by X-ray












Anatomy and Physiology

Gallbladder, muscular organ that serves as a reservoir for bile, present in most vertebrates. In humans, it
is a pear-shaped membranous sac on the under surface of the right lobe of the liver just below the lower
ribs. It is generally about 7.5 cm (about 3 in)long and 2.5 cm (1 in) in diameter at its thickest part; it has a
capacity varying from 1
to1.5 fluid ounces. The body (corpus) and neck (collum) of the gallbladder extend backward, upward,
and to the left. The wide end (fundus) points downward and forward, sometimes extending slightly
beyond the edge of the liver. Structurally, the gallbladder consists of an outer peritoneal coat (tunica
serosa); a middle coat of fibrous tissue
andunstriped muscle (tunica muscularis); and an inner mucous membrane coat (tunicamucosa).The
function of the gallbladder is to store bile, secreted by the liver and transmitted from that organ via the
cystic and hepatic ducts, until it is needed in the digestive process. The gallbladder, when functioning
normally, empties through the biliary ducts into the
duodenum to aid digestion by promoting peristalsis and absorption, preventing putrefaction, and
emulsifying fat. Digestion of fat occurs mainly in the small intestine, by pancreatic enzymes called
lipases. The purpose of bile is to; help the Lipases to Work, by emulsifying fat into smaller droplets to
increase access for the enzymes, Enable intake of fat, including fat-soluble vitamins: Vitamin A, D, E, and
K, rid the body of surpluses and metabolic wastes Cholesterol and Bilirubin.
Bile Function:
1. Aid in the digestion and absorption of lipids and lipid soluble vitamins
2. Eliminate waste products (bilirubin and cholesterol) through secretion into bile and elimination
in feces.
Bile Formation and Composition:
The liver produces bile continuously and excretes it into the bile canaliculi.
Normally liver produce 5001000 mL of bile a day.
Bile is mainly composed of water, electrolytes, bile salts, proteins, lipids, and bile pigments.
The primary bile salts, cholate and chenodeoxycholate, are synthesized in the liver from
cholesterol.
They are conjugated there with taurine and glycine
Bile salts are excreted into the bile by the hepatocyte and aid in the digestion and absorption of
fats in the intestines.
About 95 percent of the bile acid pool is reabsorbed and returned via the portal venous
system to the liver, the so-called enterohepatic circulation.
Five percent is excreted in the stool, leaving the relatively small amount of bile acids to
have maximum effect.