INTRODUCTION

The gallbladder is a small pear-shaped organ which aids in the digestive process.
Its function is to store and concentrate bile - a digestive liquid continually secreted by the
liver. The bile in turn emulsifies fats and neutralizes acids in partly digested food. Despite
its importance in the digestion of fat, many people are unaware of their gallbladder.
Fortunately enough, the gallbladder is an organ that people can live without. Perhaps, this
fact contributes to the laxity of the majority. The gallbladder tends to be taken for granted
– ignored of the proper care and conditioning. Lifestyle together with heredity, sex, race
and age are just some factors that leave a room for gallbladder complications to occur.
This study is about cholecystitis. The most common cause of cholecystitis is
gallstones (90% of the cases). The bile becomes concentrated in the gallbladder. This
later causes irritation and is probably the leading cause of inflammation. Cholecystitis
affects women more often than men and is more likely to occur after age 40. People who
have a history of gallstones are at increased risk for cholecystitis. In the international
level, cholecystitis has an increased prevalence among people of Scandinavian descent,
Pima Indians, and Hispanic populations, whereas cholelithiasis is less common among
individuals from sub-Saharan Africa and Asia. It affected 20.5 million people (1988-
1994) with a mortality record of 1,077 deaths in 2002. Hospitalizations total up to
636,000 in the same year and over 500,000 have undergone cholecystectomies.
Cholelithiasis is the presence of one or more calculi (gallstones) in the
gallbladder. In developed countries, about 10% of adults and 20% of people > 65 yr have
gallstones. Gallstones tend to be asymptomatic. The most common symptom is biliary
colic; gallstones do not cause dyspepsia or fatty food intolerance. More serious
complications include cholecystitis; biliary tract obstruction (from stones in the bile ducts
or choledocholithiasis), sometimes with infection (cholangitis); and gallstone
pancreatitis. Diagnosis is usually by ultrasonography. If cholelithiasis causes symptoms
or complications, cholecystectomy is necessary. About 80% of people with gallstones are
asymptomatic. The remainder have symptoms ranging from biliary-type pain (biliary
colic) to cholecystitis to life-threatening cholangitis. Biliary colic is the most common
symptom (http://www.merck.com/mmpe/sec03/ch030/ch030b.html ).
 Risk factors for gallstones include female sex, obesity, increased age, American
Indian ethnicity, a Western diet, and a family history. Most disorders of the biliary tract
result from gallstones. Those with asymptomatic gallstones become symptomatic at a rate
of about 2%/yr. The symptom that develops most commonly is biliary colic rather than a
major biliary complication. Once biliary symptoms begin, they are likely to recur; pain
returns in 20 to 40% of patients/yr, while about 1 to 2% of patients/yr develop
complications such as cholecystitis, choledocholithiasis, cholangitis, and gallstone
pancreatitis. Gallstone disease remains one of the most common medical problems
leading to surgical intervention. Every year, approximately 500,000 cholecystectomies
are performed in the US. Cholelithiasis affects approximately 10% of the adult
population in the United States. It has been well demonstrated that the presence of
gallstones increases with age. An estimated 20% of adults over 40 years of age and 30%
of those over age 70 have biliary calculi. During the reproductive years, the female-to-
male ratio is about 4:1, with the sex discrepancy narrowing in the older population to near
equality. The risk factors predisposing to gallstone formation include obesity, diabetes
mellitus, estrogen and pregnancy, hemolytic diseases, and cirrhosis. A study of the
natural history of cholelithiasis demonstrates that approximately 35% of patients initially
diagnosed with having, but not treated for, gallstones later developed complications or
recurrent symptoms leading to cholecystectomy (Schirmer BD, Winters KL, & Edlich
RF., 2005).
In the Philippines, some patients with gallstones choose to have their gallbladders
removed for peace of mind. Some even choose to have their gallbladders removed for
overseas employment purposes. Agencies would tend to hire someone who will not be a
potential patient abroad (as the cost of surgery is higher in other countries). This is
acceptable as long as the patient understands and can weigh the benefits and risks of
undergoing surgery (http://www.pinoyexchange.com/forums/showthread .php?t=281799
&page=5). In the Philippines alone, an extrapolated prevalence of 5,073,040 people are
affected by the disease last 2007 (http://digestive.niddk.nih.gov/statistics).
The student nurses (mini-CP group 2) have chosen this case as they see it fit for
the peri-operative concept as the patient has had undergone open cholecystectomy. Much
often gallbladder is not given importance. Furthermore, this case is quite interesting since
it does not always affect only females and elderly. It can affect everyone. It can be
alarming since many people are confused and unaware of the symptoms presented.

Reference:

[1] Schirmer B.D., Winters K.L., & Edlich R.F., (2005). Cholelithiasis and
cholecystitis. Department of Surgery, University of Virginia Health System.
Charlottesville VA 22908: USA. J Long Term Eff Med Implants. 2005;15(3):329-38.
bs@virginia.edu.

[2] http://www.merck.com/mmpe/sec03/ch030/ch030b.html

[3] http://www.pinoyexchange.com/forums/showthread.php?t=281799&page=5

[4] http://digestive.niddk.nih.gov/statistics)