Your body needs healthy fats for energy and other
functions. But too much saturated fat can cause
cholesterol to build up in your arteries (blood
vessels).
CHOLECYSTITIS
Overview of the Existing Health Problem
Cholecystitis (is a redness and swelling
(inflammation)of the gallbladder.
It happens when a digestive juice called bile gets
trapped in your gallbladder.
Cholecystitis, or gallbladder inflammation, occurs
when bile can’t circulate out of the gallbladder as it
normally does.
When bile builds up, it causes the gallbladder to
thicken, harden, swell, and become irritated.
When gallstones block this tube, bile builds up in
your gallbladder. This causes irritation and pressure
in the gallbladder. It can cause swelling and
infection.
CHOLELITHIASIS
Cholelithiasis or gallstones are hardened deposits of
digestive fluid that can form in your gallbladder
Gallstones are usually made up of cholesterol or
bilirubin that collect at the bottom of your
gallbladder until they harden into “stones.”
Etiology/Causes CYTS
The gallbladder stores bile. Gallstones are formed in
your gallbladder. They are made from bile.
Cholecystitis happens when a digestive juice called
bile gets trapped in your gallbladder.
In most cases, this happens because lumps of solid
material (gallstones) are blocking a tube that drains
bile from the gallbladder.
When gallstones block this tube, bile builds up in
your gallbladder. This causes irritation and pressure
in the gallbladder. It can cause swelling and
infection.
Bacterial infection in the bile duct system. The bile
duct system is the drainage system that carries bile
from your liver and gallbladder into the first part of
your small intestine (the duodenum).
Cholecystitis most frequently occurs when
gallstones (stones that form within the bile coming
down from the liver) block the tube leading out of
the gallbladder. This results in a build-up of bile,
which causes inflammation.
THIASIS
Occurs when gallbladder doesn't empty correctly. If
your gallbladder doesn't empty completely or often
enough, bile may become very concentrated,
contributing to the formation of gallstones.
Your bile contains too much cholesterol. Normally,
your bile contains enough chemicals to dissolve the
cholesterol excreted by your liver. But if your liver
excretes more cholesterol than your bile can
dissolve, the excess cholesterol may form into
crystals and eventually into stones
Signs & Symptoms
severe and sudden pain in the upper right part of
the abdomen
Pain that spreads to your right shoulder or back
may last for 30 mins to 1 hr
When your gallbladder is inflamed and swollen, it
irritates your phrenic nerve. Your phrenic nerve
stretches from the abdomen, through the chest, and
into your neck. Each time you eat a fatty meal, it
aggravates the nerve and causes referred pain in
your right shoulder blade.
Pain after eating a meal
The gallbladder may hurt after eating because the
body secretes more bile after large or high fat
meals. Bile works to break down fats we eat so the
body can absorb them. When fats are ingested, the
gallbladder contracts significantly in response, and
combined with blocked ducts, this pressure can
cause pain.
An abdomen that’s tender to the touch
Biliary colic is defined as pain in the abdomen,
due to obstruction usually by stones in the cystic
duct or common bile duct of the biliary tree. It
typically occurs after eating a large, fatty meal that
causes contraction of the gallbladder.
Nausea
Vomiting
Fever
Due to inflammation
4 f’s
The incidence of gallstones had been thought to be
more common in Females over Forty as they were
reaching perimenopause. Women who were
Fertile, meaning that they had one or more
children, were thought to be at higher risk due to
higher estrogen levels and the association of
gallstones with pregnancy. Fat was included
because being “overweight” or “obese” was linked
to increased levels of cholesterol that could cause
gallstones.
Anatomy and Physiology
gallbladder is a pear-shaped, hollow structure
located under the liver and on the right side of the
abdomen
The gallbladder is a small, pear-shaped hollow
organ. It is approximately an inch wide and 3 inches
long,1 and is tapered at one end where it connects to
the cystic duct. It can store approximately 30 to 50
cubic centimeters (cc) of bile.q
The gallbladder's main function is to store bile, a
fluid that helps with digestion
The gallbladder is a small organ that holds bile from
the liver and releases it into the small intestine to
help with digestion.
Pathophysiology
Predisposing factors:
40y/o and older
Female
Diabetes meilltus
Precipitating factors”
Diet:
Increased cholesterol intake
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, the cystic duct, gets
blocked by a gallstone or 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
cholesterol and salt crystals.
The blockage in the cystic duct causes bile to build
up in the gallbladder, increasing the pressure inside
it and causing it to become inflamed. An inflamed
gallbladder can sometimes become infected by
bacteria.
Acalculous cholecystitis
Acalculous cholecystitis is gallbladder
inflammation without gallstones. It's less common,
but usually more serious, than calculous
cholecystitis.
The exact cause of acalculous cholecystitis is not
known, but it's usually a complication of a serious
illness, infection or injury that damages the
gallbladder.
A combination of risk factors may lead to
acalculous cholecystitis, including accidental
damage to the gallbladder during major surgery,
serious injuries
or burns, sepsis,severe malnutrition or dehydration.
Cholesterol gallstones: This most common type of
gallstone often appears yellow in color and is
composed mainly of undissolved cholesterol.
Pigment gallstones: These dark brown or black
stones form when bile contains too much bilirubin
(a brownish yellow substance produced when the
liver breaks down red blood cells).
Cholesterol stones are usually yellow-green in color
and are made of mostly hardened cholesterol. In
some countries, cholesterol stones make up about
75 percent of gallstones.
Pigment stones are dark in color and are made of
bilirubin. Some people have a mix of both kinds of
stones. Made of a yellowish pigment called
bilirubin
Laboratory Study or Confirmatory tests
Complete blood count: A high white blood cell
count may indicate an infection. High levels of
bilirubin, alkaline phosphatase, and serum
aminotransferase may also help the doctor make a
diagnosis
CT scans or ultrasound: Images of the gallbladder
may reveal signs of cholecystitis.
Surgical Management
A cholecystectomy is surgery to remove your
gallbladder.
There are 2 types of surgery to remove the
gallbladder:
Open (traditional) method. In this method, 1 cut
(incision) about 4 to 6 inches long is made in the
upper right-hand side of your belly. The surgeon
finds the gallbladder and takes it out through the
incision.
Laparoscopic method. This method uses 3 to 4 very
small incisions. It uses a long, thin tube called a
laparoscope. The tube has a tiny video camera and
surgical tools. The tube, camera and tools are put in
through the incisions. The surgeon does the surgery
while looking at a TV monitor. The gallbladder is
removed through 1 of the incisions.
Nursing Management
- Assess vital signs
-Provide adequate nutrition by Assessing nutritional
status. Encourage a low salt low fat diet
-Observe and document location, severity (0-10
scale), and character of pain.
- Relieve pain and promote rest.
- Activity. Promote bedrest, allowing the patient to
assume a position of comfort.
- Administer IV fluids, monitor intake and output
Drug Study
CHOLELITHIASIS
Cholelithiasis or gallstones are hardened deposits of
digestive fluid that can form in your gallbladder
Gallstones are usually made up of cholesterol or
bilirubin that collect at the bottom of your
gallbladder until they harden into “stones.”
Cholesterol gallstones: This most common type of
gallstone often appears yellow in color and is
composed mainly of undissolved cholesterol.
Pigment gallstones: These dark brown or black
stones form when bile contains too much bilirubin
(a brownish yellow substance produced when the
liver breaks down red blood cells).
Cholesterol stones are usually yellow-green in color
and are made of mostly hardened cholesterol. In
some countries, cholesterol stones make up about
75 percent of gallstones.
Pigment stones are dark in color and are made of
bilirubin. Some people have a mix of both kinds of
stones. Made of a yellowish pigment called
bilirubin
Etiology/Causes
Occurs when gallbladder doesn't empty correctly. If
your gallbladder doesn't empty completely or often
enough, bile may become very concentrated,
contributing to the formation of gallstones.
Your bile contains too much cholesterol. Normally,
your bile contains enough chemicals to dissolve the
cholesterol excreted by your liver. But if your liver
excretes more cholesterol than your bile can
dissolve, the excess cholesterol may form into
crystals and eventually into stones
Types of gallstones Types of gallstones that can
form in the gallbladder include: Cholesterol
gallstones. The most common type of gallstone,
called a cholesterol gallstone, often appears yellow
in color. These gallstones are composed mainly of
undissolved cholesterol, but may contain other
components. Pigment gallstones. These dark brown
or black stones form when your bile contains too
much bilirubin
Signs & Symptoms
Sudden and rapidly intensifying pain in the upper
right portion of your abdomen
Sudden and rapidly intensifying pain in the center
of your abdomen, just below your breastbone
Back pain between your shoulder blades
Pain in your right shoulder
Nausea or vomiting
yellowing of the skin and whites of the eyes
(jaundice)
Anatomy and Physiology
gallbladder is a pear-shaped, hollow structure
located under the liver and on the right side of the
abdomen
The gallbladder is a small, pear-shaped hollow
organ. It is approximately an inch wide and 3 inches
long,1 and is tapered at one end where it connects to
the cystic duct.
It can store approximately 30 to 50 cubic
centimeters (cc) of bile.
The gallbladder's main function is to store bile, a
fluid that helps with digestion
Pathophysiology
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, the cystic duct, gets
blocked by a gallstone or 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
cholesterol and salt crystals.
The blockage in the cystic duct causes bile to build
up in the gallbladder, increasing the pressure inside
it and causing it to become inflamed. An inflamed
gallbladder can sometimes become infected by
bacteria.
Acalculous cholecystitis
Acalculous cholecystitis is gallbladder
inflammation without gallstones. It's less common,
but usually more serious, than calculous
cholecystitis.
The exact cause of acalculous cholecystitis is not
known, but it's usually a complication of a serious
illness, infection or injury that damages the
gallbladder.
A combination of risk factors may lead to
acalculous cholecystitis, including accidental
damage to the gallbladder during major surgery,
serious injuries
or burns, sepsis,severe malnutrition or dehydration.
Laboratory Study or Confirmatory tests
Complete blood count: A high white blood cell
count may indicate an infection. High levels of
bilirubin, alkaline phosphatase, and serum
aminotransferase may also help the doctor make a
diagnosis. However, these markers may notTrusted
Source be present in the chronic version.
CT scans or ultrasound: Images of the gallbladder
may reveal signs of cholecystitis.
Surgical Management
A cholecystectomy is surgery to remove your
gallbladder.
 age; female--sex; fertile--fertility; fat--obesity) still
There are 2 types of surgery to remove the remains the basic canon among risk factors that
gallbladder: determine the development of cholecystolithiasis.

Open (traditional) method. In this method, 1 cut

(incision) about 4 to 6 inches long is made in the
upper right-hand side of your belly. The surgeon
finds the gallbladder and takes it out through the
incision.

Laparoscopic method. This method uses 3 to 4 very

small incisions. It uses a long, thin tube called a
laparoscope. The tube has a tiny video camera and
surgical tools. The tube, camera and tools are put in
through the incisions. The surgeon does the surgery
while looking at a TV monitor. The gallbladder is
removed through 1 of the incisions.

Which is better laparoscopy or open surgery for

gallbladder?

According to reports, a laparoscopic approach

generally causes less blood loss, less trauma, and
provides a faster recovery with reduced
hospitalization as compared to open surgery.
However, laparoscopic does require general
anesthesia, and it costs more than open surgery.

Nursing Management
Low salt low fat diet

Avoid fatty foods

Assess general condition of the patient

Closely monitor vital signgs

Provide a comfortable and restful environment.

Keep the patient on bed rest and assist in a position

of comfort such as low-Fowler’s, knee-to-chest, or
side-lying position.

Administer prescribed medications

Assess vital signs

-Provide adequate nutrition by Assessing nutritional
status. Encourage a low salt low fat diet
-Observe and document location, severity (0-10
scale), and character of pain.
- Relieve pain and promote rest.
- Activity. Promote bedrest, allowing the patient to
assume a position of comfort.
- Administer IV fluids, monitor intake and output

Your liver produces bile, which is mostly made of

cholesterol, bile salts, and bilirubin. Your
gallbladder stores the bile until it’s needed. When
you eat, your body signals your gallbladder to
empty bile into your duodenum to mix with food.
The bile ducts carry the bile from your gallbladder
to the duodenum.

What are the 4fs in cholecystitis?

It seemed appropriate to answer the question
whether 4 x F canon (forty--the age over 40 years of