[Alterations in Metabolic and Endocrine Functions]

CHOLECYSTITIS
Precipitating factors:

Predisposing factor:

- Pregnancy
- Diabetes
- Tumor surrounding the Gallbladder
- Hyperlipidemia
- Losing weight rapidly and diet
- Obesity
- Gallstones
- Oral contraceptives

- Female (estrogen levels)

- Pregnancy
- Hormone therapy
- Family History
- Ethnicity

Decreased contractility of Bile Flow

Bile stasis

Contraction of substances present in bile

Precipitation of bile substances

Bile substances will increase in size

Stones migrate to gallbladder

Kinking/compression of common bile duct/pancreatic duct

Obstruction to gallbladder

Obstruction of flow of bile

Increase intraluminal pressure

Gallbladder distention

Stimulates smooth
muscle contraction

RUQ abdominal
pain

Increase tension
to duodenum
Pain radiates to
lower back

Presence of bile in the

circulation
Wall edema
Impaired Hepatic
uptake of bilirubin

Collection of soluble
bilirubin in the urine

No bile reaches the

GIT

Vascular compromise

Ischemia to Gallbladder
Cholesterol salts in
the skin

Jaundice

No bile in small intestine

for fat digestion
Escape of
bilirubin to GUT

Decreased
sterobilin

Presence of bile in
the urine

Emulsification
of fats

Dark yellow
urine

Nausea and
Vomiting

SOURCES:

Decrease bile in
the duodenum

Necrosis to Gallbladder

Invasion of bacteria
Realease of toxic metabolites into

Clay-colored
stool

Shock
Pulmonary Insufficiency
Acute renal failure
Dissemenated Intravascular
Coagulation

Intuit and Docstoc. (2014). Cholecystitis Pathophysiology. Retrieved March 2015, from
http://img.docstoccdn.com/thumb/orig/113462569.png.
Mayo Foundation for Medical Educationand Research. (2015). Cholecystitis. Retrieved March 2015, from
http://www.mayoclinic.org/diseases-conditions/cholecystitis/basics/symptoms/con-20034277.
Nursing Crib. (2015). Pathophysiology of Cholelithiasis/Cholecystitis. Retrieved March 2015, from http://nursing
crib.com/pathophysiology/pathophysiology-of-cholelithiasischoleccsytitis/.
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[Alterations in Metabolic and Endocrine Functions]

CHOLECYSTITIS
Cholecystitis is inflammation of the gallbladder, a small organ near the liver that plays a
part in digesting food. It is usually associated with cholelithiasis. Normally, fluid called bile
passes out of the gallbladder on its way to the small intestine. If the flow of bile is blocked, it
builds up inside the gallbladder, causing swelling, pain, and possible infection. Cholecystitis
may be acute or chronic. These conditions usually occur together.[1]
ETIOLOGY
Cholecystitis occurs when gallbladder becomes inflamed. Gallbladder inflammation can
be caused by gallstones, the result of hard particles that develop in gallbladder from imbalances
in the substances in bile such as cholesterol and bile salts. Gallstones can block the cystic duct,
the tube through which bile flows when it leaves the gallbladder, causing the bile to build up and
resulting in inflammation. Also, it is caused by tumor that may prevent bile from draining out of
the gallbladder properly, causing the buildup that can lead to cholecystitis. Kinking or scarring of
the bile ducts can cause also blockages that lead to cholecystitis.[2]
Risk factors in developing cholecystitis include increasing age, female gender, obesity
and rapid weight loss, using hormonal therapies, pregnancy, having diabetes and being Native
American or Hispanic.[3]
Sometimes the bile duct becomes blocked temporarily. When this occurs repeatedly, it
can lead to chronic cholecystitis. This is swelling and irritation that continues over time.
Eventually, the gallbladder becomes thick and hard. It also does not store and release bile as
well.[4]
PATHOPHYSIOLOGY
The initial event in acute cholecystitis (ACC) is believed to be obstruction to
gallbladder drainage. This causes an increase in intraluminal pressure, gallbladder distention, and
wall edema that may progress to venous and lymphatic obstruction, ischemia, and necrosis. A
number of potential mediators have been identified including cholesterol-supersaturated bile,
lysolecithin,phospholipase A, and prostaglandins. Enhanced production of prostaglandins is
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_
1

Mayo Clinic Health Letter-Online Edition. (2014, August 28). Disease and Conditions: Cholecsytitis. Retrieved March 2015,
from http://www.mayoclinic.org/diseases-conditions/cholecystitis/basics/symptoms/con-20034277.

Mayo Foundation for Medical Educationand Research. (2015). Cholecystitis. Retrieved March 2015, from
http://www.mayoclinic.org/diseases-conditions/cholecystitis/basics/symptoms/con-20034277.

Udan, J. Medical Surgical: Concepts and Clinical Application (First Edition). Philippines: Guiani Prints House. (2002).

Black, J.M., & Hawks, J.H. Medical-Surgical Nursing Clinical Management for Positive Outcomes. Philippines: Elsevier.
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[Alterations in Metabolic and Endocrine Functions]

(2005).

believed to play a key role in mediating inflammation, and agents that reduce prostaglandin
production have been shown to block the inflammatory response and reduce the pain of
cholecystitis. Bile is sterile in the early stages of acute cholecystitis and infection is believed to
be a secondary event. Indeed, although ACC is often considered an infection. The organisms
most commonly cultured are enteric bacteria including Escherichia coli, Klebsiella, and
Enterococcus.[1]
Cholelithiasis develops when the balance that keeps cholesterol, bile salts, and calcium
in solution is altered so that precipitation of these substances occurs. Conditions that upset this
balance include infection and disturbances in the metabolism of cholesterol. It is known that in
patients with cholethiasis, the bile secreted by the liver is supersaturated with cholesterol. The
bile in the gallbladder also becomes supersaturated with cholesterol. When bile is supersaturated
with cholesterol, precipitation of cholesterol will occur.
CLINICAL MANIFESTATIONS
The main symptom is pain in the upper right side or upper middle of your belly that
usually lasts at least 30 minutes. You may feel:

Sharp, cramping, or dull pain

Steady pain

Pain that spreads to your back or below your right shoulder blade
Other symptoms that may occur include:

Clay-colored stools, steatorrhea

Fever

Nausea and vomiting

Yellowing of skin and whites of the eyes (jaundice)

Chronic diarrhea (4 - 10 bowel movements every day for at least 3 months) may be a
common symptom of gallbladder dysfunction.[3]

Jaclyn Mae T. Alviola, RN

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_
1

Mayo Clinic Health Letter-Online Edition. (2014, August 28). Disease and Conditions: Cholecsytitis. Retrieved March 2015,
from http://www.mayoclinic.org/diseases-conditions/cholecystitis/basics/symptoms/con-20034277.

Black, J.M., & Hawks, J.H. Medical-Surgical Nursing Clinical Management for Positive Outcomes. Philippines: Elsevier.
(2005).
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[Alterations in Metabolic and Endocrine Functions]

3

Lewis, S. and et.al. Medical Surgical Nursing: Assessment and Management of Clinical Problems. Singapore: Mosby Elsevier
Inc. . (2008).