4068_Ch35_779-808 15/11/14 1:46 PM Page 802
802 UNIT EIGHT Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems
Etiology and Incidence vomiting, and a low-grade fever with the pain. Heartburn, in-
digestion, and flatulence are more common with chronic
CHOLELITHIASIS. Gallstones occur most in w omen, from
cholecystitis. Patients often report repeated attacks of acute
aging, obesity, pregnancy, stasis of bile, f asting, medica-
cholecystitis symptoms (Table 35.6).
tions, and heredity. Stasis may be caused by a decreased
gallbladder-emptying rate, a partial obstruction in the
common duct, or pregnancy. Excessive cholesterol intake
combined with a sedentary lifestyle is link ed to an CRITICAL THINKING
increased incidence of cholelithiasis, as are hemolytic
blood disorders such as sickle cell disease and bo wel Donna Stewart
disorders such as Crohn’s disease. After age 50, the rate of ■ Donna Stewart, a 23-year-old woman, is diagnosed
gallstones is about the same for men and women (“Cultural with possible acute cholecystitis. She is 5 feet, 6 inches
Considerations”). tall and weighs 138 pounds. She is 4 months pre gnant.
CHOLECYSTITIS. Cholelithiasis is responsible for most cases Her HCP wishes to delay surgery until her inflammation
of cholecystitis, or inflammation of the gallbladder. has subsided.
Signs and Symptoms 1. What risk factors does Donna have for
cholecystitis?
Signs and symptoms of cholecystitis and cholelithiasis are 2. What diagnostic tests might be ordered to confirm
similar. Subjective symptoms include epigastric pain, Donna’s diagnosis of cholecystitis?
RUQ tenderness, nausea, and indigestion, especially after 3. What considerations should be weighed when
eating foods high in f at. Objective symptoms include scheduling diagnostic tests?
evidence of inflammation, such as an elevated temperature, 4. What medications can you anticipate that the
pulse, and respirations; vomiting; and jaundice. The patient physician will order for Donna?
may have a positive Murphy’s sign, which is the inability 5. What type of diet will Donna need to eat after
to take a deep breath when an examiner’s fingers are pressed discharge?
below the liver margin. Family history of either cholecystitis 6. If the diagnosis of cholecystitis is confirmed, what
or cholelithiasis, dietary habits such as high f at intake type of surgical treatment might be ordered?
or a recent lo w-fat diet, and reports of flatulence (gas), Suggested answers are at the end of the chapter.
eructation (belching), nausea, v omiting, or abdominal
discomfort after a high-f at meal are common e vidence of
a gallbladder disorder.
Complications
CHOLELITHIASIS. The epigastric pain caused by cholelithiasis Complications of cholecystitis include cholangitis (inflam-
may also be called biliary colic. The pain is a steady, aching, mation of the bile ducts), necrosis or perforation of the
severe pain in the epigastrium and RUQ that may radiate back gallbladder, empyema (a collection of purulent drainage in
to behind the right scapula or to the right shoulder. The pain the gallbladder), fistulas, and adenocarcinoma of the gall-
usually begins suddenly after a f atty meal and lasts for 1 to bladder. A major complication of choledocholithiasis is
3 hours. If the pain is caused by a stone in the common bile acute pancreatitis if the pancreatic duct is obstructed.
duct (choledocholithiasis), the pain may last until the stone
has passed into the duodenum. Jaundice is more commonly Diagnostic Tests
present with acute choledocholithiasis because the common An ultrasound of the gallbladder is the classic test done to
bile duct is blocked or inflamed. detect stones, inflamed walls of the gallbladder, and dilated
CHOLECYSTITIS. The biliary colic caused by cholecystitis typ-
ically lasts 4 to 6 hours. The pain is made worse with move- • WORD • BUILDING •
ment such as breathing. The patient usually has nausea, colic: colic—spasm
Cultural Considerations
Gallbladder disease is more common among Mexican Americans. Risk factors include working in occupations such as
mining, factories using chemicals, and farming with pesticides. The disease has a lower incidence in blacks in Africa
and in blacks living in the Western world. Native Americans have an increased incidence of pancreatic and gallbladder
disease. It is unknown how much increased dietary risk factors may contribute to gallbladder disease. The nurse can
positively affect the nutritional status of at-risk patients by teaching food preparation practices that use less fat.
