Cholecystitis/Cholelithiasis


  1. General information
    1. Cholecystitis: acute or chronic inflammation of the gallbladder, most commonly associated with gallstones. Inflammation occurs within the walls of the gallbladder and creates a thickening accompanied by edema. Consequently, there is impaired circulation, ischemia, and eventual necrosis.
    2. Cholelithiasis: formation of gallstones, cholesterol stones most common variety
    3. Most often occurs in women after age 40, in postmenopausal women on estrogen therapy, in women taking oral contraceptives, and in the obese; Caucasians and Native Americans are also more commonly affected.
    4. Stone formation may be caused by genetic defect of bile composition, gallbladder/bile stasis, infection.
    5. Acute cholecystitis usually follows stone impaction, adhesions; neoplasms may also be implicated.
  2. Medical management
    1. Supportive treatment: NPO with NG intubation and IV fluids
    2. Diet modification with administration of fat-soluble vitamins
    3. Drug therapy
      1. Narcotic analgesics (Demerol is drug of choice) for pain. Morphine sulfate is contraindicated because it causes spasms of the sphincter of Oddi.
      2. Anticholinergics (atropine) for pain. (Anticholinergics relax smooth muscle and open bile ducts.)
      3. Antiemetics
    4. Surgery: cholecystectomy / choledochostomy
  3. Assessment findings
    1. Epigastric or right upper quadrant pain, precipitated by a heavy meal or occurring at night
    2. Intolerance for fatty foods (nausea, vomiting, sensation of fullness)
    3. Pruritus, easy bruising, jaundice, dark amber urine, steatorrhea
    4. Diagnostic tests
      1. Direct bilirubin transaminase, alkaline phosphatase, WBC, amylase, lipase: all increased
      2. Oral cholecystogram (gallbladder series): positive for gallstone
  4. Nursing interventions
    1. Administer pain medications as ordered and monitor for effects.
    2. Administer IV fluids as ordered.
    3. Provide small, frequent meals of modified diet (if oral intake allowed).
    4. Provide care to relieve pruritus.
    5. Provide care for the client with a cholecystectomy or choledochostomy.

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