Free «Acute Cholecystitis» Essay Sample
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Acute cholecystitis is an inflammatory process with a primary lesion of the gallbladder with the violation of the nervous regulation of the activity of the liver and biliary tracts. In the book Medical-Surgical Nursing, it is affirmed that “cholecystitis is an inflammation of the gallbladder that affects many people, most commonly in affluent countries” (Ignatavicius & Workman, 2013, p. 1316). This dangerous disease belongs to the acute surgery disease that affects the abdominal organs. Acute cholecystitis develops in 13-18% of patients with acute surgical diseases of the abdominal cavity (Ignatavicius & Workman, 2013). Currently, acute cholecystitis occupies the first place in the number of patients admitted with this diagnosis in surgical hospitals, and, consistently, ranks the second place after acute appendicitis in the number of operated patients (Ignatavicius & Workman, 2013). Besides, women get sick three times more often than men (Ignatavicius & Workman, 2013). In such a way, it is a serious disease which deserves thorough study. Therefore, the purpose of the current paper is to study causes, symptoms, and treatment of acute cholecystitis.
Causes of Acute Cholecystitis
The gallbladder is anatomically and physiologically close to the liver. There are different functions of the liver. One of them is the continuous development and release of bile into the duodenum (Feldman, Friedman, & Brandt, 2015). Excess bile accumulates in the gallbladder. Bile dilutes food treated with gastric juice and changes gastric digestion into intestinal. Therefore, it stimulates peristalsis of the small intestine and the production of physiological mucus, playing a protective role in the gut. Bile neutralizes bilirubin, cholesterol, and some other substances. It also activates the digestive enzymes. In such a way, bile performs numerous important functions in the physiology of digestion.
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There are diverse causes of the development of acute cholecystitis. They include hypertension in the biliary tract, cholelithiasis, infection in the biliary tract, disturbance of diet, stomach diseases, reduction of nonspecific resistance of the organism, a change in vessels of the biliary tract associated with atherosclerosis. Violation of closing function of sphincters that are located in the terminal portion of the common bile duct and the large duodenal papilla leads to the development of spasm. Moreover, it delays the output of bile into the duodenum and causes hypertension in the biliary tract. Morphologic changes can be the causes of hypertension – stricture of the terminal part of the common bile duct, which occurs when there is long existing choledocholithiasis. This stricture causes constant cholestasis. Subsequently, the liver increases and hyperbilirubinemia syndrome develops. Hypertension can be caused by the presence of single gallstones larger than 0.3-0.5 centimeters, which are displaced in the distal part of the common bile duct (Eachempati & Reed, 2015). In the book Pathophysiology, it is noted that “the stones may lie ‘silent’ or become lodged in the cystic or common duct causing pain and cholecystitis” (McCance & Huether, 2015, p. 1463). It leads to the development of progressive obstructive jaundice and cholecystitis.
It has been established that in 80-90% of cases, acute cholecystitis is a complication of gallstone disease (Feldman et al., 2015). In this disease, concretions that are in the lumen of the gallbladder for a long time violate the integrity of the mucous membrane and the contractile function of the gallbladder. Frequently, they obturate the mouth of the cystic duct, which, consequently, promotes the development of the inflammatory process.
Generally, the nutritional factor becomes a trigger in almost every patient (Feldman et al., 2015). Spicy and fatty products taken in excessive amounts stimulate intense bile formation. This fact leads to hypertension due to spasm of the sphincter of Oddi. In addition, there is a possibility of the influence of food allergens on the sensitized membrane of the gallbladder. It is also manifested in the development of spasm.
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Among the diseases of the stomach, which can lead to the development of acute cholecystitis, special attention should be paid to chronic hypoacid and gastritis accompanied by significant reduction in gastric acid secretion, especially hydrochloric acid. Local ischemia of the mucous membrane gallbladder and violation of rheological properties of blood contribute to the development of acute cholecystitis (Porth, 2011). Furthermore, local ischemia serves as the background, against which in the presence of pathogenic microorganisms acute destructive cholecystitis easily occurs.
Typically, the disease occurs in conjunction with cholangitis – inflammation of the ducts. Cholecystitis is especially common pathology among middle-aged and older women (Eachempati & Reed, 2015). There are several main reasons for the gender predisposition. Chronic compression of the gallbladder during pregnancy triggers long-term effects – violation of balance of cholesterol and bile acids. As a result, it leads to stagnation of bile. The next reason is a peculiarity of hormonal metabolism in women. It has been proved that progesterone and other sexual hormones produced in large quantities during pregnancy and menopause have a negative effect on the operation of the gallbladder. One more reason is associated with the fact that women tend to have numerous diets. In turn, they violate the motility of the gallbladder, especially by limiting food intake. Regardless of gender and age, the risk group includes individuals that previously have been ill with intestinal or hepatic infections, parasitic diseases, gallstone disease with obstruction and formation of pressure sores on the mucous membranes of the gallbladder, and diseases that violate the blood supply of the walls of the gallbladder.
Clinic of Acute Cholecystitis
Clinic of acute cholecystitis depends on the pathological changes in the gallbladder, duration of disease, presence of complications, and reactivity of the organism. The disease usually begins with twinge in the right hypochondrium (Eachempati & Reed, 2015). Pain may jolt to the right shoulder and the shoulder blade. It is accompanied by nausea and repeated vomiting. The characteristic signs include the appearance of feeling of bitterness in the mouth and the presence of impurities of bile in the vomit. In the initial stage of the disease, pain is dull in nature. However, as the process progresses, it becomes more intense. There is increase in body temperature (Porth, 2011). Pulse quickens in accordance with the increase in body temperature. Severe jaundice occurs in violation of patency of the common bile duct. A tongue is dry and coated. An abdomen is painful in the right upper quadrant. There is also protective tension of abdominal muscles and symptoms of irritation of the peritoneum, which are most pronounced at a destructive cholecystitis.
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Specific symptoms of acute cholecystitis include pain during effleurage with the edge of the hand on the right costal arch, pain during deep palpation in the right upper quadrant, increased pain on palpation on inspiration among others. In the book Essentials of Pathophysiology, it is affirmed that “persons with acute cholecystitis usually experience an acute onset of upper right quadrant or epigastric pain, frequently associated with mild fever, anorexia, nausea, vomiting” (Porth, 2011, p. 754). A patient cannot produce breath on deep palpation in right hypochondrium. In peripheral blood, there is leukocytosis, neutrophilia, and lymphopenia.
In acute cholecystitis, symptoms occur only once, develop, and with adequate treatment disappear without leaving pronounced effects. Repetition of acute attacks of inflammation of the gallbladder leads to chronic cholecystitis. The treatment of patients with acute cholecystitis should be performed at the pre-hospital stage (Ignatavicius & Workman, 2013). The antispasmodic mixture is introduced intravenously. It relieves spasm of the sphincter of Oddi and decreases the intraductal pressure as a result of improving the outflow of bile into the duodenum (Ignatavicius & Workman, 2013). All patients with acute cholecystitis are subject to immediate hospitalization in a surgical hospital for further treatment, either conservative or surgical.
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As it was already mentioned, during adequate treatment, acute cholecystitis can become chronic. In case of complications, likelihood of death is rather high. Mortality from complications of acute cholecystitis constitutes almost half of the cases. In the absence of timely medical care, the development of gangrene, perforation, and empyema of the gallbladder happens extremely fast and is fraught with fatal consequences. Removal of the gallbladder does not lead to a significant deterioration in the quality of life of patients. The liver continues to produce the required amount of bile, which goes directly into the duodenum. However, the postcholecystectomy syndrome can develop after removal of the gallbladder.
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All in all, cholecystitis is a process caused by irritation and inflammation of the gallbladder, which is located next to the liver and is involved in digestion. The output of bile occurs predominantly through the small intestine. However, sometimes, there are problems with bile excretion. Thus, it is collected in the gallbladder resulting in pain and the risk of infection. Acute cholecystitis is a common surgical disease, especially among women. It is manifested by such symptoms as vomiting, nausea, pain, and increased body temperatures. Proper treatment can decrease symptoms. However, inadequate treatment can even lead to death of a patient.