Acalculous Cholecystitis (Nursing)

00:01 Hi! Welcome to our video series on the gallbladder.

00:04 Now I love a good mystery, which is why I labeled this one, the case of a missing stone or a acalculous cholecystitis.

00:13 Come on your this is going to be more fun than you think.

00:16 So, let's talk about a acalculous cholecystitis.

00:19 It's an inflammatory disease of the gallbladder without evidence of a gallstone.

00:24 So take a look at that gallbladder.

00:26 That's what we call angry.

00:28 That's when you see skin that looks Is red and inflamed, you call it angry, same thing with this gall bladder.

00:34 That's a pretty angry looking gallbladder, but there's no stones in there.

00:40 So how can this be? How can a patient have cholecystitis without a stone in the hepatobiliary duct because we've spent big parts of this video series talking about look the liver is up there, the stomach is connected to the small intestine, if you have a stone that comes out of the gallbladder and have blocks up the duct, then we understand why it causes problems.

01:03 But in a calculus, there's no stone a means without calculus is stone.

01:10 So how can we have cholecystitis without a stone in the hepatobiliary duct.

01:16 Well, I'll tell you how, that's why you're watching this video today.

01:19 See the gallstones maybe microscopic and just simply too small for us to see them on a routine ultrasound the patient may have pretty significant inflammation due to some chiral or functional disorders.

01:32 It's also associated with prolonged fasting and immobility.

01:38 Now who does that sound like, who has prolonged fasting and immobility? Usually pretty sick people but can also go along with prolonged parenteral nutrition and even diabetes.

01:52 So patients who are at greater risk to develop cholecystitis, even without a stone people are in prolonged fasting, people who are immobile, people aren't parenteral nutrition instead of eating food and patients with diabetes.

02:07 So this is where those of you who really like ICU are going to become more interested.

02:13 Because critically ill patients are at the highest risk for a acalculous cholecystitis.

02:19 Now, why is that? Well look up there in the things we just talked about that'll give you a beginning idea.

02:25 How often to patients who are critically ill get to eat food.

02:29 Yeah not very long.

02:30 And so the prolonged fasting may not be their idea.

02:34 Immobility, now that makes sense with people who are ill, we turn them every two hours, we prop them but they're not actually doing the normal activities of daily life.

02:44 So whether you're an ICU junkie, or you want to do great medical surgical care, you're both going to run into patients that are immobile and have to do prolonged fasting.

02:57 So why this critically ill patient would It increased risk for a acalculous cholecystitis is what we're talking about next.

03:06 You see the angry gallbladder.

03:07 That's just to give you that visual to picture the inflammation that occurs.

03:13 We've laid the groundwork and I already got you thinking about why critically ill patients are at an increased risk for this inflammation or a acalculous cholecystitis, but see critically ill people don't have the same stimulus for their gallbladder contract like you and I do if I eat lunch, when food hits my mouth, my esophagus, my stomach, and then my duodenum cholecystokinin is released and its job is to stimulate the gallbladder to contract and push more bile into that hepatobiliary system.

03:46 Not so for those that are critically ill.

03:49 Patients may also be on long-term parenteral nutrition, which is not going to give that same type of stimulus as if I ate a breakfast or lunch or dinner.

03:59 So that's one of the Is why the critically ill are at an increased risk for cholecystitis without an actual stone.

04:07 Let's look at increased bile concentration, well, what? Isn't that the gallbladders job to store bile and to concentrate it? Yeah, it is up to a point.

04:19 But if bile gets stuck there for too long, it can become over concentrated and really caustic which is going to cause a lot more inflammation or cholecystitis.

04:30 See bile that remains in the gallbladder for an extended period of time is more concentrated.

04:37 That's the first point I want you to remember.

04:39 Now keep in mind if someone is really ill, they might also have further increase about concentration because they've had a fever or they're dehydrated.

04:49 So the longer gall bladder is full of that bile, It's going to keep concentrating it concentrating it and concentrating it.

04:56 Without the stimulation of food, It's going to hang out there longer than its originally intended.

05:02 So it's going to be there for an extended period of time.

05:05 In addition a critically ill patient may have fever or dehydration that further concentrates that bile.

05:12 The more concentrated that bile is the more caustic it can become to hepatobiliary system.

05:18 So this can be a bit of a difficult diagnosis, but seeing this is the exciting part about studying when you're putting in all that hard work by yourself.

05:28 This is one of the examples of when it will we'll pay off because you see patients in critical care extremely ill and they may not be able to communicate their symptoms to the healthcare team or to you.

05:40 That's where the study payoff is because you studied and you've learned about these diseases, you know, the risks for patients who are immobile and not eating normally, you're on the lookout for this and you're going to recognize it early.

05:54 So make sure you're watching for abdominal distention or maybe an unexplained fever.

05:59 Patient seems to be somewhat uncomfortable.

06:02 This could be developing a acalculous cholecystitis.

06:07 You're going to recognize it early because you've done the work of studying and learning about this possibility.

06:14 Because what if you don't study? What if you don't recognize this difficult diagnosis? Well, if a acalculous cholecystitis isn't recognized and treated the disease can progress fairly rapidly maybe within hours or days, to gallbladder that it's gangrenous and even perforates.

06:35 So you might be saying wait a minute.

06:38 Isn't that the physicians job to diagnose? No, we're a team.

06:42 It's my job as a health care professional and a nurse who's at the bedside to be on the lookout for changes in my patient the way they appear, the way they move, the way they interact.

06:53 So I recognize the early warning signs so I can communicate to the healthcare team that we might need plan of care for a different treatment.

07:02 So if it does perforate what happens? Well perforation can lead to peritonitis, infecting abdominal, which can lead to sepsis and shocked.

07:12 If this happens if, we miss it, and the patient progresses to this, the mortality rate approaches 65 percent.

07:22 Okay, so when it's hard to study when you feel isolated and it's work, I want you to remember you are studying not to pass an exam, but you're studying to keep a patient safe and to make a difference that wouldn't happen unless you were there and you were bringing your A-game.