Cholecystitis is inflammation of the gallbladder, usually resulting from a gallstone blocking the cystic duct.

Acute Cholecystitis : Acute cholecystitis begins suddenly, resulting in severe, steady pain in the upper abdomen. At least 95% of people with acute cholecystitis have gallstones. The inflammation almost always begins without infectionor another infection.

Chronic Cholecystitis : Chronic cholecystitis is gallbladder inflammation that has lasted a long time. It almost always results from gallstones. It is characterized by repeated attacks of pain (biliary colic). In chronic cholecystitis, the gallbladder is damaged by repeated attacks of acute inflammation

Anatomy and physiology of liver

Largest organ in the body produces and conveys bile synthesizes coagulation factors VII, IX, X and prothrombin storing copper, iron and Vitamins ADEK and B12 detoxify chemicals, excretes bilirubin and produce and store glycogen

Acute cholecystitis is caused by obstruction of the cystic duct, leading to distention of the gallbladder. As the gallbladder becomes distended, blood flow and lymphatic drainage are compromised, leading to mucosal ischemia and necrosis.

Signs and symptoms of cholecystitis may include: Severe, steady pain in the upper right part of your abdomen Pain that radiates from your abdomen to your right shoulder or back Tenderness over your abdomen when it's touched Sweating Nausea Vomiting Fever.

Chills ,jundice ,dyspepsia Abdominal bloating Cholecystitis signs and symptoms usually occur after a meal, particularly a large meal or a meal high in fat

Cholecystitis 4Fs = female, forty, fat, fertile; flatulence, fat intolerance, fatigue

Tests and procedures used to diagnose cholecystitis include: Blood tests. Your doctor may order blood tests to look for signs of an infection or signs of gallbladder problems.
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Imaging tests that show your gallbladder. Imaging tests, such as abdominal ultrasound or a computerized tomography (CT) scan, can be used to create pictures of your gallbladder that may reveal signs of cholecystitis

Treatment for cholecystitis usually involves a stay in the hospital to stabilize the inflammation in your gallbladder. Once your cholecystitis is under control, your doctor may recommend surgery to remove your gallbladder, since cholecystitis frequently recurs. In emergency situations, such as a ruptured gallbladder, surgery may be required right away.

If the patient admmited in the hospital they will start intervention such as : Fasting. patient may not be allowed to eat or drink at first in order to take stress off
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Antibiotics to fight infection. If your cholecystitis is caused by an infection or has caused an infection in your gallbladder, your doctor may recommend antibiotics to treat the infection. Pain medications. You may receive pain medications to help control pain until the inflammation in your gallbladder is relieved. Your symptoms may begin to go away in a day or two after being hospitalized.

Surgery to remove the gallbladder Because cholecystitis frequently recurs, most people diagnosed with cholecystitis eventually require gallbladder removal surgery (cholecystectomy).

NURSING CARE PLAN FOR ACUTE CHOLECYSTITIS

Assessment Assessing (Pre-operative): Head-to-toe subjective and objective

assessments including smoking history, OTC drugs, anticoagulant drugs, herbal remedies, past respiratory problems, and nutritional status. Focused assessment of the heart, lungs and abdomen. Completion of an ECG because of the patients previous myocardial infarction history, and chest X-ray to exclude right lower lobe pneumonia. Full pain assessment (COLDSPAA), and assessment for nausea. Assess for skin integrity: wound

 Diagnosis
Potential for acute pain and discomfort related to the

inflammation and obstruction of the gall bladder and its associated ducts. Potential for nutritional deficiency related to nausea and vomiting and anorexia. Potential for anxiety and frustration related to pain, frequent hospital changes and upcoming cholecystectomy procedure.

Planning and Goals Pain management Goal: Pain free or at least tolerable pain. Maintain fluid and electrolyte balance Goal: Homeostasis. Educate patient regarding dietary restrictions. Goal: Decrease acute pain attack related to fatty foods. Maintain Respiratory Status. Goal: Optimum pulmonary function and prevention of post-op complications. Encourage walking, when pain is under control. Goal: Prevention of DVT, Prevention of pressure sores/ulcers. Encourage deep breathing exercises and relaxing techniques. Goal: Decrease anxiety. Regain strength.

 Explore and encourage patients prior means of coping

with pain. Goal: Facilitates self-care management Explain and make care plan with the patient. Goal: Build trust, decrease anxiety and fear, Increase confidence and comfort. Respect and consider cultural sensitivity. Goal: Establish trust and comfort. Notify primary nurse/physician immediately if complications arise. Goal: Best patient outcome

Nursing intervention
pain relief. Soft talking, music and touch therapy as alternative interventions. Fluid and electrolyte balance: Continuous IV therapy. Nutritional status: Encouragement to avoid fatty foods and fluids. Patient education: Patient teaching about the process of cholecystectomy. Answer questions the patient has to reduce anxiety. Circulatory: Encourage walking, and turning while in bed. Ensure the patient is taking pills for his pre-existing cardiac conditions in timely manner.
Pain management: PRN morphine administration for

 Gastrointestinal: Encourage fluid intake. Modified diet

provision. IV administration. Encouragement of mouth care. Monitor fluid balance, and bowel routine. Musculoskeletal: Encourage ROM and ambulation. Integument: Maintain overall skin integrity. Neurological: Monitor for orientation, alertness, and confusion/delirium. Respiratory status: Encouraged deep breathing. Maintained Adequate Ventilation. Monitor Respiratory rate and rhythm, and SPO2. Psychological: Monitor affect, anxiety, and depression

Expected patient outcome Relief from pain Vital signs stable Hydration and adequate nutrition achieved Respiratory status normal Motivated to do self-care Ambulation Support system in place No anxiety or fear

Patient teaching
Prepare and educate patient about anaesthesia and postoperative care. Explain to the patient why pre-surgical NPO is important to maintain. Discuss with the patient his care network once discharged from the

hospital. Talk to the patient about predicted post-surgical pain, and associated interventions. Explain to that patient that it is important to walk, cough and deep breathing after surgery to avoid post-operative pneumonia. Discuss the importance of healthy diet with the patient i.e. eating fresh fruits, vegetables, and whole grains, and avoiding fatty or deep fried foods.