(^288) Medical-Surgical Nursing Demystified
Cholecystitis
WHAT WENT WRONG?
An inflammation of the gallbladder, often accompanied by the formation of gall-
stones (cholelithiasis), is cholecystitis. The inflammation may be either acute or
chronic in nature. In an acute cholecystitis, the blood flow to the gallbladder may
become compromised which in turn will cause problems with the normal filling and
emptying of the gallbladder. A stone may block the cystic duct which will result in
bile becoming trapped within the gallbladder due to inflammation around the stone
within the duct. Blood flow to the inflamed area will be minimized, localized
edema develops, the gallbladder distends due to retained bile, and ischemic changes
will occur within the wall of the gallbladder. Chronic cholecystitis occurs when
there have been recurrent episodes of blockage of the cystic duct, usually due to
stones. There is chronic inflammation. The gallbladder is often contracted, which
leads to problems with storing and moving the bile. Patients may develop jaundice
due to back-up of bile or obstructive jaundice. They will exhibit a yellowish tone to
skin and mucous membranes. If patients have a naturally dark pigmentation to their
skin, check palms and soles. Icterus is the yellow color change seen in the sclera
(white) of the eye.
There is increased risk for gallbladder inflammation and development of gall-
stones with increasing age, being female or overweight, having a family history of
gallbladder disease, people on rapid weight loss diets, and during pregnancy.PROGNOSIS
The ischemic changes of the gallbladder wall increase the risk of perforation of the
organ or development of gangrene. Peritonitis is a potential risk in patients if a sig-
nificant area of gallbladder perforates or there is associated infection or abscess
that spreads. A small percentage of patients will develop cancer of the gallbladder.
There is increased surgical risk for older patients or patients with comorbidities.HALLMARK SIGNS AND SYMPTOMS
- Upper abdominal, epigastric, or right upper quadrant abdominal pain which
may radiate to right shoulder - Right upper quadrant (RUQ) pain increases with palpation of right upper
abdomen during inspiration (Murphy’s sign) causing the patient to stop tak-
ing deep breaths
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