Gallbladder Disease: Biliary Colic And Cholecystitis - Adult
Gallbladder Disease: Biliary Colic And Cholecystitis
Definition
The spectrum of gallbladder disease ranges from
asymptomatic gallstones to biliary colic,
cholecystitis, choledocholithiasis and cholangitis.
Cholecystitis is inflammation of the gallbladder
caused by obstruction of the cystic duct, usually
by a gallstone (calculous cholecystitis). The
inflammation may be sterile or bacterial. The
obstruction may be acalculous or caused by
sludge.
Choledocholithiasis occurs when the stones
become lodged in the common bile duct; from
this, cholangitis and ascending infections can
occur.
Causes
Biliary Colic
Gallstones temporarily obstruct the cystic duct or
pass into the common bile duct.
Cholecystitis
The cystic duct or common bile duct becomes
obstructed for hours, or gallstones irritate the
gallbladder. Bacterial infection is thought to be a
consequence, not a cause, of cholecystitis.
The most common organisms are E. coli,
Klebsiella spp. and enterococci. Stones of the
common bile duct (occurring in 10% of patients
with gallbladder disease) are secondary (from the
gallbladder) or primary (formed in the bile ducts).
Risk Factors
The phrase "fair, fat and fertile female"
summarizes the major risk factors for gallstones.
Although gallstones and cholecystitis are more
common in women, men with gallstones are more
likely to experience cholecystitis than women with
gallstones. It is unknown if women who are
pregnant or have multiple pregnancies are more
likely to have gallstones or if they simply have
more symptoms of the stones.
Some oral contraceptives and estrogen
replacement therapy may increase the risk of
gallstones.
Rates of gallstones, cholecystitis and stones of the
common bile duct increase with age. Elderly
clients are more likely to have asymptomatic
gallstones that result in serious complications
without gallbladder colic.
The causes of gallstones in teenagers are the same
as for adults, and there is a higher prevalence
among girls and during pregnancy.
History
Most gallstones (60% to 80%) are asymptomatic.
Small stones are more likely to be symptomatic
than large ones. Almost all patients experience
symptoms before complications occur.
Indigestion, belching, bloating and intolerance of
fatty food are thought to be typical symptoms of
gallstones; however, these symptoms are just as
common in people without gallstones and
frequently are not cured by cholecystectomy.
Biliary Colic
•1-5 hours of constant pain, commonly in the
epigastrium or right upper quadrant
•Pain may radiate to the right scapular region or
back
•Client tends to move around to seek relief from
pain
•Onset of pain occurs hours after a meal,
frequently at night, waking the client from sleep
•Peritoneal irritation by direct contact with the
gallbladder localizes the pain to the right upper
quadrant
•Pain is severe, dull, or boring and constant (not
colicky)
•Associated symptoms include nausea, vomiting,
pleuritic pain and fever
Cholecystitis
•Persistence of the biliary obstruction leads to
cholecystitis
•Persistent right upper quadrant pain
•The character of the pain is similar to the pain
associated with gallbladder colic, except that it
is prolonged and lasts for hours or days
•Nausea, vomiting and low-grade fever are more
commonly associated with cholecystitis
NWT Clinical Practice Guidelines for Primary Community Care Nursing - Gastrointestinal System
September 2004 1
