I . I N T R O D U C T I O N Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining.

Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects thegallbladder to the hepatic duct. The presence of gallstones in the gallbladder is calledcholelithiasis. Cholelithiasis is the pathologic state of stones or calculi within thegallbladder lumen. A common digestive disorder worldwide, the annual overall cost of cholelithiasis is approximately $5 billion in the United States, where 75 -80% of gallstones are of the cholesterol type, and approximately 10 -25% of gallstones are bilirubinate of either black or brown pigment. In Asia, pigmented stones predominate,although recent studies have shown an increase in cholesterol stones in the Far East.Gallstones are crystalline structures formed by concretion (hardening) or accretion(adherence of particles, accumulation) of normal or abnormal bile constituents.According to various theories, there are four possible explanations for stone formation.First, bile may undergo a change in composition. Second, gallbladder stasis may lead to bile stasis. Third, infection may predispose a person to stone formation. Fourth, geneticsand demography can affect stone formation.Risk factors associated with development of gallstones include heredity, Obesity,rapidweight loss, through diet or surgery, age over 60, Native American or

MexicanAmerican racial makeup, female gendergallbladder disease is more common in womenthan in men. Women with highestrogenlevels, as a result of pregnancy,hormone replacement therapy, or the use of birth control pills, are at particularly high risk for gallstone formation, Diet-Very low calorie diets, prolonged fasting, and low-fiber /high-cholesterol/highstarch diets all may contribute to gallstone formation.Sometimes, persons with gallbladder disease have few or no symptoms. Others,however, will eventually develop one or more of the following symptoms; (1) Frequent bouts of indigestion, especially after eating fatty or greasy foods, or certain vegetablessuch as cabbage, radishes, or pickles, (2) Nausea and bloating (3) Attacks of sharp painsin the upper right part of the abdomen. This pain occurs when a gallstone causes a blockage that prevents the gallbladder from emptying (usually by obstructing the cysticduct). (4) Jaundice (yellowing of the skin) may occur if a gallstone becomes stuck in thecommon bile duct, which leads into the intestine blocking the flow of bile from both thegallbladder and the liver. This is a serious complication and usually requires immediatetreatment.The only treatment that cures gallbladder disease is surgical removal of thegallbladder, called cholecystectomy. Generally, when stones are present and causingsymptoms, or when the gallbladder is infected and inflamed, removal

of the organ isusually necessary. When the gallbladder is removed, the surgeon may examine the bileducts, sometimes with X rays, and remove any stones that may be lodged there. The ductsare not removed so that the liver can continue to secrete bile into the intestine. Most patients experience no further symptoms after cholecystectomy. However, mild residualsymptoms can occur, which can usually be controlled with a special diet and medication.

II.NURSING ASSESSMENT A.Personal History Mr. Aproniano Castro is a 56 year old male, a Filipino citizen who resides at PulongSantol, Porac Pampanga. He was born on January 22, 1950 at Pulong Santol, hisreligious affiliation is Roman Catholic and he is married to Mrs. Brigida M. Castro. Heis a jeepney driver bound in Porac-Angeles route. He is also the president of their jeepneys association. Mr. Castro usually works for 10 to 12 hours a day usually around7am to 7 pm. He always sleeps around 9 in the evening and wakes up at 6 in the morning.His wife was the one who prepares him the breakfast and the snack. He has day-offs butuses this day in working as the president of the jeepney association. He usually eatsinstant food and love eating foods which has condiment like patis, vinegar and soysauce. He also love eating vegetable salads and fatty salty food. He is not also choosy onthe food he eats because he really eat a lots. He seldom drinks alcohol and smoke.Regarding the finances about health he is using his wifes PHILHEALTH

card tocompensate the finances needed. Family Health and Illness History B.Family Health and Illness History According to Mr. Castro that the familial disease he knows that they have in their family was the hypertension that is on his fathers side. His father died because of heartattack and her mother died of natural cause. He also added that cholecystitis is prone totheir family, because of one of his siblings also had acquired this disease. C. History of Past and Present Illness This is the second time Mr. Castro been admitted into this hospital (Porac DistrictHospital). On his first admission into this hospital he had undergone throidectomyoperation, which is almost 3 years ago. He had not experience any accident and injuries,even though his job is prone to accident particularly vehicular accident. He also addedthat he had an ashtma when he was 7 years old that lasts when he is 21 years old, hisashtma just stopped when he start drinking alcohol beverages as he said. As for his present illness, he was admitted into this hospital because of cholecystitis,he was admitted last

February 13, 2006. He was been diagnosed with cholecystitis withmultiple cholelithiasis a month prior to admission due to severe epigastric pain andweight loss and was advised to remove his gallbladder. He just did not have hischolecystectomy done immediately due to financial problem. When the money neededfor his operation was enough he then goes to Porac District Hospital last February 13,2 0 0 5 f o r h i s o p e r a t i o n . H e w a s diagnosed and surgically operated by D r . Serrano.According to Mr. Castro. Upon admission he had undergone some laboratoryexamination such as UTZ, Chest X-ray, U/A, CBC, FBS, BUN,Creatinine and ECG. Hisinitial medication were H2bloc and Cefuroxime.D.Physical ExaminationPhysical Assessment done by the attending physician reveals that patient is; afebrile with pink palpebral conjunctiva (-) cyanosis (+) NABS non tender abdomenVital Signs upon admission (February 13, 2006)BP- 130/90RR-19PR-84Temp-36.5

o C Physical Assessment done by the student reveals that patient is; afebrile with pink palpebral conjunctiva (+) dry lips (+) paleness (+) dryskin decreased skin turgor (-) bowel movement (-) weaknessVital Signs taken and recorded as of February 15, 2006 are as follows;BP- 140/90PR- 85RR21 Temp- 36.4 o C III.ANATOMY AND PHYSIOLOGY

Gallbladder, muscular organ that serves as a reservoir for bile, present in most vertebrates. In humans, it is a pear-shaped membranous sac on the undersurface of theright lobe of the liver just below the lower ribs. It is generally about 7.5 cm (about 3 in)long and 2.5 cm (1 in) in diameter at its thickest part; it has a capacity varying from 1 to1.5 fluid ounces. The bo dy (corpus) and neck (collum) of the gallbladder extend backward, upward, and to the left. The wide end (fundus) points downward and forward,sometimes extending slightly beyond the edge of the liver. Structurally, the gallbladder consists of an outer peritoneal coat (tunica serosa); a middle coat of fibrous tissue andunstriped muscle (tunica muscularis); and an inner mucous membrane coat (tunicamucosa).The function of the gallbladder is to store bile, secreted by the liver and transmittedfrom that organ via the cystic and hepatic ducts, until it is needed in the digestive process.The gallbladder, when functioning normally, empties through the biliary ducts into theduodenum to aid digestion by promoting peristalsis and absorption, preventing putrefaction, and emulsifying fat. Digestion of fatoccurs mainly in the small intestine, by pancreatic enzymes called lipases. The purpose of bile is to; help the Lipases to Work, byemulsifying fat into smaller droplets to increase access for the enzymes, Enable intake of fat, including fat-soluble vitamins: Vitamin A, D, E, and K,

rid the body of surpluses andmetabolic wastesCholesterol and Bilirubin.