Acute Cholecystitis: Worst-Case Scenarios (Nursing)

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.