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.
The lecture Acute Cholecystitis: Worst-Case Scenarios (Nursing) by Prof. Lawes is from the course Gallstones and Cholecystitis: Diagnosis (Nursing).
Which of the following emergency scenarios can occur from acute cholecystitis?
What other ramifications can occur from acute cholecystitis?
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