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Ú GENERAL OBJECTIVE:
At the end of 1hour case
presentation, Students will be able to
understand the pathologic process of
calculi cholecystitis and the clinical
manifestation of the disease.
6

 

6
Ú At the end of Case presentation, students will be
able to:
1.Understand the pathologic process of calculous
cholecystitis and differentiate the disease to the
other types of biliary disorder.
2.Use the nursing process as a frame work for care of
patient with calculous cholecystitis.
3.Know and identify what are the clinical
management of a patient having calculous
cholecystitis disease.
m
m
Ú Cholecystitis results from obstruction of the
cystic duct, usually by a gallstone, followed by
distension and subsequent chemical or
bacterial inflammation of the gallbladder.
People with acute cholecystitis usually have
unremitting right upper quadrant pain,
anorexia, nausea, vomiting, and fever. About
95% of people with acute cholecystitis have
gallstones (calculous cholecystitis) and 5%
lack gallstones (acalculous cholecystitis).
Ú Severe acute cholecystitis may lead to necrosis
of the gallbladder wall, known as gangrenous
cholecystitis. This review does not include
people with acute cholangitis, which is a
severe complication of gallstone disease and
generally a result of bacterial infection. The
incidence of acute cholecystitis among people
with gallstones is unknown. Of people
admitted to hospital for biliary tract disease,
20% have acute cholecystitis.
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Ú 6


Cholecystitis usually presents as a pain in the
right upper quadrant. This is usually a
constant, severe pain. The pain may be felt to
'refer' to the right flank or right scapular
region at first. This may also present with the
above mentioned pain after eating greasy or
fatty foods such as pastries, pies and fried
foods. This is usually accompanied by a low
grade fever, vomiting and nausea.
Ú ^ore severe symptoms such as high fever,
shock and jaundice indicate the development
of complications such as abscess formation,
perforation or ascending cholangitis. Another
complication, gallstone ileus, occurs if the
gallbladder perforates and forms a fistula with
the nearby small bowel, leading to symptoms
of intestinal obstruction.
Ú Chronic cholecystitis manifests with non-
specific symptoms such as nausea, vague
abdominal pain, belching, and diarrhea.
Ú Etiology / Risk factors
Acute calculous cholecystitis seems to be caused
by obstruction of the cystic duct by a gallstone,
or local mucosal erosion and inflammation
caused by a stone, but cystic duct ligation alone
does not produce acute cholecystitis in animal
studies. The role of bacteria in the pathogenesis
of acute cholecystitis is not clear; positive
cultures of bile or gallbladder wall are found in
50Ȃ75% of cases. The cause of acute acalculous
cholecystitis is uncertain and may be
multifactorial, including increased
susceptibility to bacterial colonisation of static
gallbladder bile.
   
  6
Ú The gallbladder is a small (10 cm long) pear-
shaped organ that is located near the duodenum
and the liver. The gallbladder is connected to the
liver and the duodenum through small tubes.
The gallbladder's main function is to store bile, a
dark green digestive liquid produced by the liver.
Bile is a substance that helps to break down fats.
When stored in the gallbladder, bile becomes
more concentrated and therefore more powerful
in its ability to do its work.
When foods containing fats arrive in the small
intestine, the gallbladder releases the stored bile
into the duodenum. Here the bile helps to break
down fats and also neutralize acids in the food
that has arrived from the stomach.
 66
66

Ú Patient Vital Information
Patient X is 33 years old male. He was born on
February 1, 1980 at Salay ^isamis Oriental and
presently residing at Looc, Salay ^isamis
Oriental. His religion is Roman Catholic. He was
admitted on 4:35 P^ of August 31, 2010 at CU^C.
His height is 5ǯ6ǯǯ, weight is 68 kilogram,
temperature is 36.7, pulse is 64, respiratory rate is
22 and BP is 120/80. His chief complaint is pain @
RUQ. According to patient, 1 month PTA, sudden
onset of severe RUQ pain radiating to the back
and precipitated by eating meals.
Ú Health History
Patient X has no previous hospitalization. No
food allergies but have allergy on diarrheal
medication.

Ú Neurologic
His mental status is normal only his
movements is weak. His speech is clear and able
to understand. Pain present during my
assessment @ RUQ pain noted @ intensity of 7/10.

Ú Senses
No vision or hearing impairment. His cranial
nerves are well functioned.
Ú Activity/Rest
Decrease RO^ and body weakness noted and
observed.
Ú Integumentary
Skin is warmth to touch and skin color is
normal pale. His texture is smooth and normal
skin turgor. No edema noted. Dressing noted and
seen because of postoperative cholecystectomy.
Ú Oxygenation
Lung expansion is regular and breath sound
is clear, no cough present. Used to smoke and
drink everyday. Heart sound is audible.
 FUNCTIONAL ASSESS^ENT
Ú Health perception
Patient X was hospitalized for health
management. He understands the need why he
was hospitalized in order for his to cure and live
well. He expects that upon his hospitalization he
would be totally cured.

Ú Nutritional/ ^etabolic Pattern

His apetite is good. His likes to eat Dzhumba,
kinilaw and sinugbadz. But he was restricted to eat
fatty foods because of the removal of the bladder.
He take vitamin C. His daily typical fluid intake is
3-4 glasses.
Ú Elimination Pattern
His regular bowel movement pattern is one
times a day. He had experienced constipation. He
urinates 3-4 times a day and had experienced
Noctria.

Ú Sleep and Rest Pattern

He usually sleeps @ 11-12pm and wake up @ 5-
6am but he doesnǯt take a nap. He doesnǯt take
aids to sleep. He had experienced insomnia.
 U 6U


Ú The liver, pancreas and spleen are normal in
dimension with homogeneous parenchymal
echopattern and regular external outline. No
definite mass or calcification seen.
The biliary ducts are dilated. The gallbladder is
not adequately distended with irregularly
thickened echogenic walls. There is an ovoid
intense echo with posterior sonic shadowing in its
lumen measuring 1.9 cm.
Abdominal aorta is unremarkable with no
definite dilatation. No enlarged para-aortic lymph
nodes or masses noted. No definite
intraabdominal mass or face intra peritoneal
fluid seen.
Ú The kidneys show no significant disparity in size
and location, exhibiting hypo echoic
parenchymal echopattern relatives to the liver
and spleen. The corticomedullary demarcation is
preserved. The pelvocalyreal systems and ureters
are not dilated. No definite mass or lithiasis
noted.
The urinary bladder is adequately distended
exhibiting smooth mucosal contour. No definite
intraluminal lithiasis noted.
Ú The prostate is normal in size measuring
2.6x3.2x3.5cm with homogeneous parenchymal
echopattern and regular contour. No definite
mass calcifications seen.
ACalculous cholecystitis
ASonologically normal liver, biliary ducts,
pancreas, spleen, kidneys, urinary bladder and
prostate.

6
 
Ú ^EDICATION:
o Advice pt. to take medication on time @ right
dose and right interval:
1.Atenolol 50mg 1 tab P.O. daily
2.Esomeprazole magnesium(Nexium) 40mg
1 tab P.O. Daily

Ú EXERCISES:
o Advice patient for early ambulation to prevent
DVT.
o Encourage patient on deep breathing exercises.
Ú TREAT^ENT:
o Advise to clean the incision site/ wound.
o Encourage frequent intake of fluids.
o Encourage the family for intensive monitoring and
follow-up for the compliance treatment.
o Advise family to attend his needs.

Ú HEALTH TEACHING:
o Advice pt. to avoid eating foods rich in Cholesterol
and fats.
o Advice to healthy lifestyle.
o Advice to avoid use smoking and alcoholic drinking.
Ú OPD:
o Keep regular appointment with the physician
after 2 weeks.

Ú DIET:
o Encourage frequent intake of fluid at least 8
glasses/day.

Ú SPIRITUAL:
o Advice the family to always communicate with
god, be faithful enough and not lose hope.