Definition
Cholecystitis refers to acute inflammation of the gallbladder. This usually irritates the gallbladder layer. It can become dense in the cystic duct which causes obstruction and inflammation of the gallbladder wall, triggering infection (Barbara, 1998).
Acute cholecystitis (inflammation of the gallbladder) is an acute inflammatory reaction of the gallbladder wall accompanied by complaints of right upper abdominal pain, tenderness and fever. Until now the pathogenesis of this disease that is quite often encountered is still unclear (Isselbacher, K.J, et al, 2009).
Causes
Cholecystitis occurs when gallbladder becomes inflamed. Gallbladder inflammation can be caused by:
- Gallstones. Most often, cholecystitis is the result of hard particles that develop in gallbladder (gallstones). Gallstones can block the tube (cystic duct) through which bile flows when it leaves the gallbladder. Bile builds up, causing inflammation.
- Tumor. A tumor may prevent bile from draining out of gallbladder properly, causing bile buildup that can lead to cholecystitis.
- Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis.
- Infection. AIDS and certain viral infections can trigger gallbladder inflammation.
- Blood vessel problems. A very severe illness can damage blood vessels and decrease blood flow to the gallbladder, leading to cholecystitis. (mayoclinic.org)
Symptoms
Signs and symptoms of cholecystitis : right upper quadrant pain, fever, and a high white blood cell count. Pain generally occurs around the gallbladder, in the right upper quadrant of the abdomen.
Other symptoms :
- abdominal bloating
- tenderness on the upper-right hand side of the abdomen
- little or no appetite
- nausea
- vomiting
- sweating
Case Examples of Cholecystitis
A 60-year-old female patient admitted to the hospital with complaints of pain in the right upper abdomen, feels more painful when touched, the patient says pain with a scale of 5 from 1-10 and persistent. The patient looks grimace and bends. The Patient said it was uncomfortable when doing activities due to pain. The patient also complained of fever since 3 days ago. 1. The patient looks weak and sweaty. The patient says that she is nausea and vomiting so cannot eat. Eating is only a quarter of a serving. After the history, it is known that the patient has gallstones. The patient said that she likes fried and coconut milk. The patients are anxious about the current condition. Vital signs, Blood pressure: 130/90 mmHg, Pulse: 95 beats / minute, Temperature: 39 0C, Respiration: 24 times / minute. Bad skin turgor. Laboratory results indicate the presence of leukocytosis and increased CRP. Murphy sign (+), USG results: there is pericolastic fluid and thickening of the gallbladder wall.
| No. | Focus Data | Problem | Etiology |
| 1 | Subjective Data : The patient says: 1. abdominal pain in the upper right 2. pain when touched and racing like being stabbed 3. pain with a scale of 5 from 1-10 and persistent 4. uncomfortable when doing activities because of pain Objective Data: 1. The patient looks grimace and bends 2. Assessment of pain: P: during activity, T: like being stabbed, R: upper right abdomen, S: 5, T: persistent 3. Murphys sign: (+) | Acute pain | biological injury agents |
| 2 | Subjective data : 1. The patient complained of fever since 3 days ago Subjective Data: 1. The patient looks weak and sweaty 2. The patient looks limp and nervous 3. Body temperature: 39 0C 4. Laboratory results indicate the presence of leukocytosis and increased CRP. | Hyperthermia | disease |
| 3 | Subjective data : 1. The patient says nausea and vomiting so she can't eat. Objective Data: 1. The patient looks limp 2. The patient looks sweaty | Risk for fluid volume deficit | active fluid loss |
| 4 | Subjective data : 1. The patient says nausea and vomiting, so she can't eat. 2. The patient says eating is only a quarter of a serving Objective Data (DO) 1. The patient looks limp and anxious 2. Bad skin turgor | Imbalanced Nutrition: Less Than Body Requirements | lack of food intake |
Nursing Diagnosis for Acute Cholecystitis
- Acute pain r/t biological injury agents
- Hyperthermia r/t disease
- Risk for fluid volume deficit r/t active fluid loss
- Imbalanced Nutrition: Less Than Body Requirements r/t lack of food intake
- Anthony Fauci, Eugene Braunwald, Dennis Kasper, Stephen Hauser, Dan Longo, J.Jameson, Joseph LoscalzoHarrison's Principles of Internal Medicine, 17th Edition, 17th edn., : Mcgraw-hill, 2008.
- https://www.mayoclinic.org/diseases-conditions/cholecystitis/symptoms-causes/syc-20364867
- https://www.medicalnewstoday.com/articles/172067.php
