What is Cholecystitis and the common signs and symptoms associated with it?
Cholecystitis is termed for a disease of the gallbladder which is accompanied by the presence of the inflammation of the gallbladder. Most cases of gallbladder are not accompanied by symptoms and people with gallstones would not necessarily develop Cholecystitis. One of the major reasons for Cholecystitis is the blockage of the cystic duct by gallstones. Abdominal pain is a common sign of Cholecystitis but is often associated with the build-up of bile which increases the pressure within the gallbladder (Nikfarjam, M., et al. 2011).
The inflammation of the gallbladder is mainly caused due to bacterial infection of the gallbladder wall, increased pressure, and concentrated bile. The internal infection would also damage the inner wall of the gallbladder. Cell death is accompanied by inflammation and swelling of the gallbladder due to the reduction of blood blow in certain areas. The inadequate blood flow is also linked with inadequate oxygen supply (Hirota, M., et al. 2007).
Risk factors for cholecystitis include oral contraceptives, rapid weight loss, diabetes, female sex, pregnancy, age, and ethnicity. Cholecystitis diagnosis is based on the symptoms of upper right abdominal such as fever, vomiting, pain, and nausea followed by laboratory evaluation indicative of increased white blood cells. Some healthcare professionals would also utilize abdominal ultrasound for diagnosis of cholecystitis (Kimura, Y., et al. 2007).
Mortality and morbidity is known to increase due to delayed diagnosis of cholecystitis. In more than 25% of cases, complications are observed that may also require surgery. Cholecystitis may occur in successions followed by a single episode. Some of the signs include: (a) Severe pain in upper right abdomen (b) Radiating pain from right shoulder (c) Abdominal tenderness when touched (d) Nausea (e) Vomiting and (f) Fever. Most of the signs and symptoms of cholecystitis are observed after a meal, especially after a larger or fat-rich meal (Schirmer BD, Winters KL, Edlich RF 2005).
Describe nursing education that should accompany a patient with Cholecystitis
Patients with cholecystitis are known to suffer from pain and discomfort in the upper right abdominal area due to inflammation of the gallbladder. Nurses involved the care and treatment of such patients are trained to cater to their needs by educating and providing quality care. Nurse education is a prime factor in preventing and recognizing potential risk factors involved in cholecystitis. Nursing education is also essential to understand the complications of the medical condition. Some of the complications are as follows: (a) Enlarged gallbladder: Untreated cholecystitis can lead to abnormal swelling of the gallbladder that would increase the risk of gallbladder tearing, infection, and tissue death. (b) Infection within gallbladder: Excessive accumulation of bile within the gallbladder can lead to severe infection. The infected bile could be released into other organs including the lining of the abdomen which could lead to severe complications. (c) Death of gallbladder tissue: The last stage of cholecystitis includes gallbladder tear that is associated with limited or no blood flow to the organ that would lead to tissue death and gallbladder burst. Nurses should take preventive action in order to prevent such complications (Kimura, Y., et al. 2007).
The nurse education for nurses would also include certain priorities while treating and caring for patients which include: (a) Promote rest and relieve pain (b) Maintenance of electrolyte and fluid balance within the system (c) Prevent health complications and (d) Provide information on the disease with respect to causes, risk factors, process, diagnosis/prognosis, and treatment. Nurses in the treatment and caregiving of patients with cholecystitis are focused on education, health promotion, and prevention y adopting the following means: (a) Diet: They are involved in educating patients on having healthy foods such as fruits and vegetables and health fats. Some good foods include peanuts, eggs, & soybeans (b) Exercise: Reduce the risk of gallstones and lower levels of cholesterol (Kimura, Y., et al. 2007).
What medications can be used to treat and/or alleviate Cholecystitis?
The main objective of treatment of cholecystitis is to prevent complications and reduce its morbidity. Some of the common medications include antibiotics, antiemetics, and analgesics.
Promethazine: Widely used to treat nausea in the event of vestibular dysfunction. It is also used for treatment of emesis since it acts as an antidopaminergic agent. Prochlorperazine: It is used in cholecystitis by the blockage of postsynaptic mesolimbic dopamine receptors which would prevent and relieve vomiting and nausea. It also acts effectively by depressing the reticular activating system. Meperidine: One of the most recommended medications for pain control. It has multiple actions and is similar to the analgesic morphine. One of the major advantages includes smooth muscle spasm and less complications compared to morphine. Hydrocodone and acetaminophen: Recommended for moderate to severe pain. Oxycodone and acetaminophen: Relief of moderate to severe pain. (Pellegrini, P., et al. 2015 and Hirota, M., et al. 2007).
Antibiotics
Cholecystitis treatment is mainly comprised of antibiotics which provide efficient coverage against a host of organism such as Enterococcus species, Klebsiella, Pseudomonas, Bacteroides fragilis, and Escherichia coli. Based on current evidence, healthcare professionals recommend the use of ampicillin/sulbactam or piperacillin/tazobactam for cholecystitis in the case of moderate conditions. Imipenem/cilastatin or meropenem are used in the case of life-threatening conditions of cholecystitis. Other antibiotics that could be used as alternatives for cholecystitis include aztreonam, ciprofloxacin, and third-generation cephalosporin along with metronidazole. The treatment and management of cholecystitis should be coupled with diet, exercise, and the use of pharmacotherapy in order to get best health outcomes (Pellegrini, P., et al. 2015).
References
Kimura, Y., Takada, T., Kawarada, Y., Nimura, Y., Hirata, K., Sekimoto, M., Gadacz, T.
R. (2007). Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. Journal of Hepato-Biliary-Pancreatic Surgery, 14(1), 15–26. http://doi.org/10.1007/s00534-006-1152-y
Hirota, M., Takada, T., Kawarada, Y., Nimura, Y., Miura, F., Hirata, K., Dervenis, C.
(2007). Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. Journal of Hepato-Biliary-Pancreatic Surgery, 14(1), 78–82. http://doi.org/10.1007/s00534-006-1159-4
Nikfarjam, M., Niumsawatt, V., Sethu, A., Fink, M. A., Muralidharan, V., Starkey, G.,
Christophi, C. (2011). Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB : The Official Journal of the International Hepato Pancreato Biliary Association, 13(8), 551–558. http://doi.org/10.1111/j.1477-2574.2011.00327.x
Pellegrini, P., Campana, J. P., Dietrich, A., Goransky, J., Glinka, J., Giunta, D., de
Santibañes, M. (2015). Protocol for extended antibiotic therapy after laparoscopic cholecystectomy for acute calculous cholecystitis (Cholecystectomy Antibiotic Randomised Trial, CHART). BMJ Open, 5(11), e009502. http://doi.org/10.1136/bmjopen-2015-009502
Schirmer BD, Winters KL, Edlich RF. (2005). Cholelithiasis and cholecystitis. J Long Term
Eff Med Implants. 2005;15(3):329-38.
