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Diagnostic Evaluation

- The diagnosis of cholecystitis is based on clinical history, physical examination and laboratory and imaging tests.

i. Laboratory tests include:

  • Complete blood count (CBC) - may show leukocytosis (increased white blood cells) due to infection or inflammation
  • Liver function tests (LFTs) - may show elevated serum bilirubin, alkaline phosphatase, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) due to impaired bile flow or liver damage
  • Serum amylase and lipase - may show elevated levels due to pancreatitis
  • Blood cultures - may show bacterial growth in cases of sepsis
  • Urinalysis - may show bilirubinuria (bilirubin in urine) due to increased serum bilirubin

ii. Imaging tests include:

  • Abdominal ultrasound - the first-line imaging test that can show gallstones, gallbladder wall thickening, pericholecystic fluid, gallbladder distension or sludge
  • Abdominal computed tomography (CT) scan - can provide more detailed images of the gallbladder and surrounding structures, and can detect complications such as abscess, perforation or fistula
  • Hepatobiliary iminodiacetic acid (HIDA) scan - a nuclear medicine test that can assess the function and patency of the biliary system by injecting a radioactive tracer that is taken up by the liver and excreted into the bile; a positive HIDA scan shows non-visualization of the gallbladder within 4 hours, indicating obstruction of the cystic duct
  • Magnetic resonance cholangiopancreatography (MRCP) - a non-invasive test that can provide high-resolution images of the biliary and pancreatic ducts using magnetic resonance imaging (MRI)
  • Endoscopic retrograde cholangiopancreatography (ERCP) - an invasive test that can visualize and treat the biliary and pancreatic ducts by inserting an endoscope through the mouth, esophagus, stomach and duodenum, and injecting contrast dye into the ampulla of Vater; ERCP can also be used

Questions on Diagnostic Evaluation

Correct Answer is C

Explanation

This statement is correct and does not indicate a need for further teaching. Applying a warm compress to the abdomen can help relieve pain associated with cholecystitis and promote comfort.

Correct Answer is A

Explanation

This statement is incorrect and is not an appropriate preoperative intervention. Anticoagulants are not typically administered preoperatively for cholecystectomy. Their use may increase bleeding risk during surgery and is generally avoided unless medically indicated.

Correct Answer is C

Explanation

This statement is incorrect. Pain radiating to the left shoulder is more indicative of conditions such as splenic disorders, not cholecystitis.

Correct Answer is D

Explanation

This statement is incorrect and indicates a need for further teaching. The client should not resume their regular exercise routine immediately after the surgery. After cholecystectomy, clients should avoid strenuous physical activities for a period specified by the healthcare provider to promote proper healing and prevent complications. The nurse should educate the client on gradually increasing their activity level and resuming exercise after receiving clearance from their healthcare provider.

Correct Answer is C

Explanation

Left lower quadrant abdominal pain with rebound tenderness is not a classic manifestation of cholecystitis. Cholecystitis typically presents with pain in the right upper quadrant of the abdomen.

Correct Answer is A

Explanation

This statement is incorrect. Both acute and chronic cholecystitis may require surgical intervention, depending on the severity and complications of the condition. Lifestyle modifications are often recommended to prevent gallstone formation and manage symptoms, but they are not the sole treatment for acute cholecystitis.

Correct Answer is C

Explanation

Epigastric pain worsened by fatty meals is not typically associated with acute cholecystitis. This symptom is more commonly seen in gastroesophageal reflux disease (GERD) or peptic ulcer disease.

Correct Answer is B

Explanation

Complications of chronic cholecystitis do not typically include lung infections. The primary complications are related to the gallbladder, pancreas, and bile ducts.

Correct Answer is C

Explanation

Increasing the intake of carbonated beverages is not recommended to improve digestion or manage chronic cholecystitis. Carbonated beverages can potentially worsen symptoms in some individuals with gallbladder conditions.

Correct Answer is D

Explanation

This statement is correct. Instructing the client to remain NPO after midnight before the surgery is essential to prevent aspiration during anesthesia. Clients should not eat or drink anything after the specified time to ensure their stomach is empty during the surgery.

Correct Answer is C

Explanation

Consuming a low-fat diet is not a risk factor for cholecystitis. On the contrary, a high-fat diet is associated with an increased risk of gallstone formation and subsequent cholecystitis.

Correct Answer is C

Explanation

Allergic reactions to certain foods are not a common cause of gallbladder inflammation or cholecystitis. Cholecystitis is primarily related to gallstones, bile flow abnormalities, or infections.

Correct Answer is C

Explanation

Obesity does not slow down the emptying of the gallbladder. On the contrary, obesity may lead to reduced gallbladder motility, which can contribute to gallstone formation due to stasis of bile.

Correct Answer is C

Explanation

Diabetes does not increase the motility of the gallbladder. Instead, it may lead to reduced gallbladder motility, which can contribute to gallstone formation due to stasis of bile.

Correct Answer is C

Explanation

Family history of gallstones can affect the risk of gallstones in both men and women. It is not limited to a specific gender.

Correct Answer is C

Explanation

Pancreatitis may cause upper abdominal pain, but it typically radiates to the back rather than the right shoulder.

Correct Answer is B

Explanation

Left lower quadrant abdominal pain is not associated with acute cholecystitis. This type of pain is more commonly seen in conditions such as diverticulitis or colitis.

Cholecystitis does not typically cause elevated blood sugar levels. However, certain conditions like diabetes mellitus may increase the risk of cholecystitis.

Dehydration may occur in some cases of cholecystitis, but it is not the primary cause of changes in urine and stool color.

GERD is a condition characterized by acid reflux and heartburn. It does not cause severe right upper quadrant abdominal pain or jaundice.

This statement is correct. To have a full bladder for the ultrasound, the client should drink 16 ounces of water about one hour before the procedure. A full bladder helps lift the intestines and improves the visualization of the gallbladder and surrounding structures.

This statement is incorrect. The HIDA scan does not involve the use of an endoscope. It is a non-invasive imaging test that is performed externally, not internally.

C-reactive protein (CRP) is a marker of inflammation and can be elevated in various conditions, including cholecystitis. However, it is not specific to cholecystitis and may also be elevated in other inflammatory processes.

This statement is incorrect. ERCP is not a non-invasive test that uses sound waves. It is an invasive procedure that requires the insertion of an endoscope into the body to view the biliary system.

Laparoscopic surgery is not associated with a higher risk of postoperative infection. In fact, it is known for having lower rates of surgical site infections compared to open surgery.

Requesting additional opioids to manage pain may worsen the nausea and vomiting. It is essential to balance pain management with measures to minimize side effects like nausea.

While over-the-counter NSAIDs can be effective for mild pain relief, they should be used with caution in clients with cholecystitis, especially if there is any concern about gallstone-related inflammation. It is best to consult with a healthcare provider before using NSAIDs in this case.

Changing the dressing and cleaning the insertion site is important for maintaining cleanliness, but the nurse should first notify the healthcare provider about the client's symptoms for further evaluation.

Avoiding physical activities for four weeks is unnecessary and may lead to physical deconditioning. Gradual reengagement in physical activities is encouraged to support the healing process.

Avoiding all solid foods for 24 hours after the surgery is unnecessary and may lead to nutritional deficits. The client can gradually resume a low-fat, solid diet after the surgery.

Offering herbal tea for relaxation is a non-pharmacological intervention that can be helpful, but it is not the first action the nurse should take when the client is experiencing severe abdominal pain.

While sharing personal experiences can sometimes be helpful, it is essential to focus on the client's feelings and needs rather than diverting attention to the nurse's experience.

Deep breathing exercises are not directly related to reducing the risk of gallstone formation. Gallstone formation is primarily influenced by factors such as diet, bile composition, and gallbladder function.

Taking prescribed pain medication as needed is essential for managing postoperative discomfort and promoting recovery.
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