Acute Cholecystitis: Worst-Case Scenarios (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 There's a gallstone, now what? Well we know we have this acute cholecystitis because we have a gallstone that's blocking the outflow of bile from the gallbladder into the hepatobiliary system.

    00:13 We've seen that on the ERCP and it's stopping the hepatobiliary system from draining.

    00:19 It's also caused inflammation may be some infection in the gallbladder.

    00:23 Now keep in mind the risk of developing acute cholecystitis from a symptomatic gallstone it's pretty low about one to three percent, but you know how I roll.

    00:32 I'm going to show you the worst case scenario, which is a gangrenous gallbladder or even a ruptured gallbladder.

    00:40 So this is when it becomes a medical emergency that may not resolved unless you have treatment.

    00:48 So acute cholecystitis we've got a gallstone in there.

    00:51 It may resolve without treatment or it could progress to a medical emergency.

    00:57 What's the name of the medical emergency? Well, that's when the gallbladder is gangrenous or possibly rupturing.

    01:07 I don't even need to explain to you why this is a bad deal.

    01:11 So worst case scenarios for acute cholecystitis is a gangrenous gallbladder.

    01:17 That means there's a bacterial infection and this could lead to sepsis.

    01:21 Sepsis has to be treated or it will end up in the patient's death.

    01:26 So worst case scenario for acute cholecystitis is a gangrenous gallbladder.

    01:31 This does not happen very often.

    01:34 But I always want you to be thinking about what are the risks for your patient.

    01:38 Now if this gallbladder ruptures and start spreading all whatever was in that gallbladder throughout the abdominal cavity, now the patients at risk for peritonitis and or sepsis.

    01:52 So two worst-case scenarios for cholecystitis, if it's not resolved, gangrenous gallbladder really bad infection and sepsis or rupture of the gallbladder diffuse peritonitis, and likely sepsis.

    02:06 So keep those in mind when you're evaluating and assessing your patients.

    02:11 We've just talked about two of the worst case scenarios with a bad gallbladder, but want to give you a few more to have in your back pack of knowledge.

    02:20 Look at subphrenic abscess.

    02:23 I know that's a word you may not be familiar with but take a look at how we can break it down.

    02:28 Well, you already know that sub means below and phrenic refers to the diaphragm.

    02:34 So a subphrenic abscess is the accumulation of infected fluid between the diaphragm liver and spleen.

    02:42 Pancreatitis makes sense because you can end up with that gallstone backing everything up and the pancreas becomes inflamed.

    02:50 Cholangitis is an inflammation of the bile duct.

    02:54 Biliary cirrhosis develops due to long-term partial or total obstruction of the large bile ducts outside of the liver.

    03:02 So when these ducts are damaged, bile, which is a substance that helps digest fat, remember, builds up in the liver and damages the liver.

    03:11 So cirrhosis is damage to the liver and that's because you have things backing up and kind of chewing up that liver.

    03:20 They can also develop fistulas.

    03:22 Bile drains into adjacent organs and things back up and can go really really bad.

    03:28 So this is a list, you know, how I feel about list.

    03:32 What I want you to recognize is to pause the video for just a moment, think through each one of these bullet points and see if you can come up with, why a patient with cholecystitis might have a subphrenic abscess.

    03:46 Pancreatitis or cholangitis, then restart the video and join us again.

    About the Lecture

    The lecture Acute Cholecystitis: Worst-Case Scenarios (Nursing) by Rhonda Lawes, PhD, RN is from the course Gallstones and Cholecystitis: Diagnosis (Nursing).

    Included Quiz Questions

    1. Gangrenous gallbladder
    2. Bacterial infection
    3. Rupture
    4. Urinary tract infection
    5. Inflammation of the bile duct
    1. Pancreatitis
    2. Fistulas
    3. Cholangitis
    4. Cerebral access
    5. Bursitis

    Author of lecture Acute Cholecystitis: Worst-Case Scenarios (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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