Clinical meaning
Cholecystitis results from gallstone impaction in the cystic duct causing bile stasis, gallbladder distension, and inflammation. Persistent obstruction leads to mucosal ischemia, secondary bacterial infection (E. coli, Klebsiella), and risk of empyema, gangrene, or perforation with bile peritonitis. Acalculous cholecystitis occurs in critically ill patients from bile stasis without stones. The nurse must perform comprehensive pain assessment, manage fluid resuscitation, administer antibiotics and analgesics, monitor for surgical complications, and coordinate perioperative care.
Exam relevance
Risk factors: - Cholelithiasis (90% of cases) - Female sex, age >40, obesity - Rapid weight loss or prolonged fasting - TPN administration - Critical illness (acalculous cholecystitis) - Pregnancy - Oral contraceptives - Sickle cell disease
Diagnostics: - Interpret RUQ ultrasound findings: gallstones, wall thickening >3mm, pericholecystic fluid, sonographic Murphy's sign - Evaluate WBC count for leukocytosis (>11,000) - Monitor liver function tests: elevated ALP and GGT suggest biliary involvement - Assess lipase and amylase to rule out pancreatitis - Evaluate bilirubin levels: elevated direct bilirubin suggests common bile duct obstruction - Order HIDA scan if ultrasound is equivocal