Cholecystitis

Definition

Cholecystitis is inflammation of the gallbladder, most commonly caused by cystic duct obstruction from a gallstone (cholelithiasis). It may be acute or chronic and is associated with the 'Five Fs': female, fat, forty, fertile, fair.

Signs and Symptoms

• Right upper quadrant pain radiating to the right shoulder (referred pain)
• Pain worse after fatty meals
• Positive Murphy's sign (RUQ pain on inspiration during palpation)
• Nausea, vomiting
• Fever, leukocytosis
• Jaundice if common bile duct obstructed (choledocholithiasis)

Diagnostics

RUQ ultrasound (gold standard), HIDA scan if equivocal, elevated WBC, bilirubin, alkaline phosphatase, AST/ALT, amylase.

Nursing Interventions

Keep NPO, provide IV hydration, administer pain medication and antibiotics as ordered, prepare for laparoscopic cholecystectomy. Post-op: early ambulation, deep breathing, pain control, progress diet from clear liquids. Teach low-fat diet initially.

NCLEX Relevance

Classic cue: RUQ pain after a fatty meal with positive Murphy's sign.