Laguna State Polytechnic University Bachelor of Science in Nursing

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OVERVIEW OF DISEASE
Cholecystitis is the inflammation of the gallbladder. It may be calculous or acalculous.
Calculous cholecystitis occurs when there is blockage of bile outflow due to gall stones.
Study shows that more than 90% of patient with cholecystitis has gallstones. Acalculous
cholecystitis occurs after surgical procedure, trauma or burn. Other factors associated
includes torsion, cystic duct obstruction, bacterial infection and multiple blood
transfusions. Acute cholecystitis secondary to infection of bile with E. Coli and klebsiella
Sp. and other enteric organisms, occurs in 60% of patients. It could be calculous or
acalculous.
Calculous cholecystitis
Calculous cholecystitis is the most common, and usually less serious, type of acute
cholecystitis. It accounts for around 95% of all cases.Calculous cholecystitis develops
when the main opening to the gallbladder, called the cystic duct, gets blocked by

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a gallstone or by a substance known as biliary sludge.Biliary sludge is a mixture of bile (a
liquid produced by the liver that helps digest fats) and small crystals of cholesterol and
salt.The blockage in the cystic duct results in a build-up of bile in the gallbladder,
increasing the pressure inside it and causing it to become inflamed. In around one in every
five cases, the inflamed gallbladder also becomes infected by bacteria.
Acalculous cholecystitis
Acalculous cholecystitis is a less common, but usually more serious, type of acute
cholecystitis. It usually develops as a complication of a serious illness, infection or injury
that damages the gallbladder or is associated with bacterial infection.Acalculous
cholecystitis is often associated with problems such as accidental damage to the gallbladder
during major surgery, serious injuries or burns, blood poisoning (sepsis),
severe malnutrition or AIDS.
ASSESSMENT
Symptoms include indigestion, fever, pain, tenderness and rigidity of right upper abdomen
that may radiate to midsternal area or right shoulder and is associated with nausea and
vomiting, restlessness and diaphoresis. Jaundice may occur. Empyema develops if
gallbladder becomes filled with purulent fluid. Symptoms of chronic cholecystitis includes
a history of fat intolerance, dyspepsia, heartburn and flatulence.
DIAGNOSTIC TEST
• Cholescyntigraphy
• Ultrasonography
• Liver function tests

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• WBC and serum bilirubin
MEDICAL MANAGEMENT
Focus of treatment is on control of pain, control of infections with antibiotics, maintenance
of fluid and electrolyte imbalance. If nausea and vomiting is severe, gastric decompression
may be used to prevent further gallbladder stimulation. Anticholinergics and analgesics
are given as well.
NURSING DIAGNOSIS
 Pain related to surgical procedure
 Ineffective management of therapeutic regimen related to lack of knowledge of
diet and post operative management
NURSING MANAGEMENT
• assess pain
• Assess color , amount and consistency of urine
• Assess for signs of dehydration
• Monitor I and O
• Monitor for fluids and electrolyte imbalance
• Provide comfort and emotional support
• Emphasize low fat diet

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• Assess effectiveness of treatment
• Monitor for complications such as fistula, rupture of gallbladder,cholangitis and
subphrenic abscess and pancreatitis.
• Administer analgesics as ordered
• Promote oral hygiene
• Prepare suction equipment
• Administer antiemetics as ordered
• Encourage use of lotions containing calamine to relieve itching
• Teach the patient use of knuckles instead of nails to avoid scratching
• Assess color and appearance of stool
• Assess for jaundice
• Initiate TSB if fever occurs
• Assess for signs of bleeding
• Monitor vital signs
• Promote bed rest
• Emphasize NPO prior to surgery
• Encourage deep breathing exercise
• Place in sim’s position if dyspnea occurs