11.6 Cholecystitis
Cholecystitis is inflammation of the gallbladder due to impaired flow of bile due to blockage by gallstones or a poorly functioning gallbladder. Cholecystitis can be an acute or chronic condition. See Figure 11.25[1] for an image of a gallbladder containing gallstones that was surgically removed.
Cholecystitis can occur in men or women. Certain populations have a higher risk of gallbladder disease such as females or clients who are overweight, pregnant, in their 40s, or have experienced drastic weight loss. A family history of gallstone formation is also a risk factor.[2]
Pathophysiology
The purpose of the gallbladder is to store and concentrate bile, which is needed to break down fats. In normal digestion, the gallbladder releases bile through the cystic duct when fatty foods are eaten. The bile then travels to the duodenum to help break down fatty foods. This process becomes impaired with cholecystitis.
Cholecystitis can be further classified into two types: calculus and acalculous. Calculus cholecystitis means that a stone is present that is blocking the flow of bile. Although there are various potential locations of gallstones, the cystic duct is a common location. See Figure 11.26[3] for an image of the liver, gallbladder, and associated bile ducts. Gallstones can form from excess bilirubin, cholesterol, or calcium. Gallstones can also form when there is biliary stasis (lack of movement of bile), particularly when bile is very concentrated.[4]
In acalculous cholecystitis, there is no stone formation, but the gallbladder does not contract properly to release bile. Whether bile flow is impaired due to a stone or improper gallbladder contraction, the result is the same. Bile starts to build up, and the gallbladder becomes inflamed and edematous. If this is not treated appropriately and it progresses, the gallbladder can become gangrenous and even rupture.[5]
Assessment
Physical Exam
The most common presenting sign of cholecystitis is pain in the right upper quadrant of the abdomen. Murphy’s sign (pain in the right upper quadrant with palpation) is also a common finding. Some clients may also have pain in the back or shoulder. Other symptoms may include bloating, flatulence, nausea/vomiting, and intolerance to fatty and/or spicy foods.
Common Laboratory and Diagnostic Tests
Lab Tests
Lab tests commonly ordered by health care providers to diagnose cholecystitis are a complete blood count (CBC), a metabolic panel, and lipase levels[6]:
- In chronic cholecystitis, a CBC may be normal. However, during acute cases there may be elevated white blood cells.
- A metabolic panel is performed to assess liver function and bilirubin levels. Both liver enzymes and bilirubin levels may be elevated with cholecystitis, particularly when a gallstone is blocking a bile duct.
- A lipase level may also be ordered to rule out pancreatitis. Gallstones can lead to pancreatitis when they become lodged near the pancreatic duct.
Review normal reference