CHOLECYSTITIS Flashcards
Pertinent Anatomy of a patient with Cholecystitis.
(1) Gallbladder
(2) Liver
(3) Pancreas
(4) Small Intestine
Pertinent Physiology of a patient with Cholecystitis.
Gallbladder serves as a reservoir for bile and stores excess bile for use in the digestive
tract.
Pertinent Pathophysiology of a patient with Cholecystitis.
(1) Gallstones form because certain substances in bile are so concentrated it approaches the limits of their solubility.
(2) When bile is concentrated in the gallbladder, it becomes supersaturated with these substances, which then precipitate from the solution as microscopic crystals.
(3) The crystals are trapped in gallbladder mucus, producing gallbladder sludge. Over time, the crystals grow, aggregate, and fuse to form macroscopic stones.
(4) Occlusion of the ducts by sludge and/or stones produces the complications of gallstone disease.
Symptoms
(1) The acute attack is often precipitated by a large or fatty meal - sudden steady pain in the epigastrium or right hypochondrium, may gradually subside over 12-18 hours.
(2) Vomiting
(3) palpable
(4) Jaundice, when persistent or severe, suggests choledocholithiasis.
(5) Continuation or progression of right upper quadrant abdominal pain, tenderness, muscle guarding (often with Murphy sign), fever, and leukocytosis after 24-48 hours suggests severe inflammation and possible gangrene of the gallbladder (may lead to perforation)
(6) Necrosis may occasionally develop without definite signs in the obese, diabetic, elderly, or immunosuppressed patient.
(7) Other serious acute complications include emphysematous cholecystitis (secondary infection with a gas-forming organism) and empyema.
Differential Diagnosis
(1) Peptic ulcer
(2) Acute pancreatitis
(3) Hepatitis
(4) Appendicitis
(5) Pneumonia
Treatment
(1) Antibiotic options include:
(a) Ceftriaxone (Rocephin) - is a 3rd generation Cephalosporin antibiotic
1) Dose: 1-2 grams IV every 12 hours
(b) In severe cases, Piperacillin-Tazobactam (Zosyn - a PCN antibiotic) PLUS Metronidazole (Flagyl) may be given.
(2) Morphine may be administered for pain.
(a) Morphine- opioid analgesic
1) The initial dosage is 2-8 mg intravenously and may be repeated after 2-4 hours.
(b) Because of the high risk of recurrence, cholecystectomy should be
performed within 2-4 days after hospitalization.
(c) If nonsurgical treatment, the patient (especially if diabetic or elderly) should be watched carefully for recurrent symptoms, evidence of gangrene of the gallbladder, or cholangitis.
(d) Immediate cholecystectomy is mandatory when there is evidence of gangrene or perforation.
Disposition
MEDEVAC
Initial Care
Upon diagnosis, stabilize and prep for surgery. Perforation could lead to peritonitis
(5) The two main substances involved in gallstone formation are
cholesterol and calcium bilirubinate.
Most gallstones in the United States contain _____ as their major component.
cholesterol
the presence of gallstones within the gallbladder.
Cholelithiasis
the presence of the gallstones in the common bile duct.
Choledocholithiasis
the inflammation of the gallbladder. The gallbladder holds bile, which is released into your small intestine.
Cholecystitis
Treatment for cholecystitis
gallbladder removal
_________should be considered when unexplained fever or right upper quadrant pain occurs within 2- 4 weeks of major surgery or in a critically ill patient who has had no oral intake for a prolonged period; multiorgan failure is often present.
Acalculous cholecystitis
