1. PATHOPHYSIOLOGY: Inflammation of the gallbladder and develops in association with cholelithiasis or with biliary stasis caused by any condition that affects the regular filling or emptying of the gallbladder. Gallstones obstruct the cystic duct causing an inflammatory response and bile is reabsorbed and acts as a chemical irritant to the gallbladder wall leading to ischemia, tissue sloughing, necrosis and gangrene. Perforation of the gallbladder may occur causing an abscess or peritonitis.
2. TREATMENT
   1. Nonsurgical: Most have no symptoms unless ducts are partially or totally obstructed. Extracorporeal shock wave lithotripsy (ESWL) may be used for gallstones. Insertion of percutaneous transhepatic biliary catheter to allow bile flow. Anticholinergics to decrease spasms, antiemetics for nausea and vomiting and antibiotics.
   2. Surgical: Cholecsytectomy
      1. Laprascopic or "lap chole" is minimally invasive, has less complications, death rate is low, bile duct injuries rare, quicker recovery and post-op less severe.
      2. Traditional or open surgical approach is performed on patients with chronic lung disease, heart failure or those who cannot tolerate CO2.
3. Imbalanced Nutrition: Less than body requirements
   1. S/SX
      1. Dyspepsia
      2. Feeling of abdominal fullness
      3. Nausea/Vomiting
   2. NIC
      1. Topic
         1. Topic
      2. Maintain NPO status with IV hydration
      3. Advance diet as tolerated
      4. Monitor weight
      5. Obtain nutritional history
      6. Monitor dietary intake
      7. Administer antiemetics prn
      8. Teach to avoid high fat foods especially fried food, butter and fast food
4. Abdominal Pain
   1. S/Sx
      1. Topic
      2. Abdominal Pain (may radiate to right shoulder or after high fat meal)
      3. Rebound Tenderness (Blumberg's sign)
      4. Fever
      5. Chronic Cholecystitis
         1. Jaundice
         2. Clay colored stools
         3. Dark Urine
         4. Steatorrhea
   2. NIC
      1. Topic
      2. Assess pain level at regular intervals
      3. Utilize a reliable, valid pain assessment tool
      4. Assess GI system
      5. Analgesics and Anticholinergics
      6. Assess for adverse effects of pain medications: oversedation, resp depression
      7. Instruct patient in non-drug pain relief strategies: imagery, distraction relaxation, heat, cold