[cholecysto- + -itis]
Inflammation of the gallbladder wall, usually caused by obstruction of the bile ducts by gallstones. Cholecystitis caused by gallstones occurs commonly, esp. in women, the obese, and those who have been dieting, and it can occur after pregnancy. The acute form is more common during middle age; the chronic form occurring more frequently in the older population. The disease is marked by colicky pain developing shortly after a meal in the right upper quadrant of the abdomen.
Acalculous cholecystitis (biliary inflammation not caused by gallstones) is a disease of the critically ill. It is associated with a high likelihood of abscess formation, gallbladder perforation, gangrene, and death.
Acute cholecystitis is usually caused by obstruction of the bile ducts, with chemical irritation and often infection of the gallbladder.
SYMPTOMS AND SIGNS
Cholecystitis caused by gallstones results in right upper quadrant pain that occurs after a fatty meal, as well as fever, chills, nausea, and vomiting. The pain of cholecystitis often radiates into the right shoulder or right side of the back. Jaundice is present in about 20% of patients, usually related to obstruction of the common bile duct by a gallstone. In patients in intensive care units, acalculous cholecystitis may present with fever and some other easily identified symptoms.
Ultrasonography of the right upper quadrant, the diagnostic procedure of choice, reveals cholecystitis in about 90% of patients. Oral cholecystograms, computed tomography of the abdomen, and other diagnostic tests are sometimes used when the disease is suspected clinically but ultrasonography is not diagnostic.
Gallbladder drainage (cholecystectomy) is the usual treatment; it is sometimes used as a temporizing procedure in unstable patients. Gallstones lodged in the ampulla of Vater can sometimes be removed with endoscopic retrograde cholangiopancreatography.
During an acute attack, the patient's vital signs and fluid balance are monitored, oral intake is withheld, prescribed antiemetics are administered as necessary, and intravenous fluid and electrolyte therapy are maintained as prescribed. A nasogastric tube may be employed. The patient's comfort is ensured, and narcotic analgesics and anticholinergics are administered to relieve pain.
Diagnostic tests, including pretest instructions and aftercare, are explained to the patient; the surgeon's explanation of any prescribed surgical interventions, including possible complications, is reinforced; and the patient is prepared physically and emotionally for such procedures.
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