Disorders of the Gastrointestinal System, 2nd Edition
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Most patients suffering from cholecys - titis will report epigastric pain that may initially be intermittent but typically pro- gresses to constant pain with or without nausea, vomiting, and fever (Kapoor, 2022). | NURSING CONSIDERATION Pain from cholecystitis may become localized to the right upper quadrant or radiate to the shoulder or scapula (Kapoor, 2022). Some patients with gallstones have no pain or other rec- ognized symptoms. The gold standard for diagnosing gall- stones is ultrasonography. Still, additional testing, such as MRI or endoscopic ul - trasonography (EUS), may be required if stones are small or within the bile ducts (Kapoor, 2022). CT scans can help identify complications or provide further informa- tion if a clear diagnosis has been difficult to establish. A cholescintigraphy, or he- patic iminodiacetic acid (HIDA) scan, is another helpful tool if a diagnosis cannot be determined via ultrasound. A HIDA scan entails injecting a tracer that assists with visualizing the gallbladder and deter- mining the patency of the common bile duct and ampulla (Zakko & Afdhal, 2022).
Although the prognosis is usually good, with a generally low mortality rate, com- plications can be severe and fatal. Perfo- ration, necrosis, and gangrene can occur, which in turn can cause sepsis, shock, and—ultimately—death (Zakko & Afdhal, 2022). Treatment and nursing care are fo- cused on supportive measures and symp- tom management if the cholecystitis is not complicated by infection or necrosis. These measures include managing pain and symptoms such as nausea and vom- iting, hydration, and using antibiotics to prevent infections. If surgery is anticipat- ed, nutritional support and the introduc- tion of a liquid or low-fat diet are needed. Education should be provided to patients and families on causative factors and po- tential lifestyle changes (Kapoor, 2022). For cholecystitis with complications such as sepsis, shock, bleeding, or perfora- tion, emergent surgery may be necessary, and intensive medical management and monitoring may be required to maintain hemodynamic stability (Zakko & Afdhal, 2022).
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