Digestion Case Study
Abdominal ultrasound revealed two small stones in the gallbladder, one in the common bile duct CM above ampoule. Assessment: Patient has gallstones in the gall bladder and common duct stones. Stones in the common bile duct are an emergency since this can lead to further problems for the liver or pancreas. Patient also suffers from obstructive Jaundice as a result of the gallstones. Plan: Start patient on an anti-biotic to help fight infection. Recommend removal of stones antiseptically.
Diagnosis: Patient’s symptoms included a fever, which led me to have complete blood count (CB) blood test administered. The results showed a high white blood cell count indicating an infection present. I chose to the abdominal ultrasound for imaging. The ultra sound involves exposing part of the body to high-frequency sound waves to produce pictures of the Inside of the body. Because ultrasound images are captured in real-time, they can show the structure and movement of the body Internal present in gallbladder and common bile duct.
Possible treatments can include medicine to dissolve stones, in which they will likely come back. Endoscope, where an endoscope is used to remove the stones in an out patient procedure. Surgery can be used to remove the gallbladder. In this case, the gallbladder does not show severe inflammation, so I don’t feel the stones in the gallbladder are problematic. The stone in the common bile duct is the most likely cause of the pain. This stone is blocking the bile from being released by the gall bladder and causing the bile to be released into the blood stream, which is the cause of Jaundice.
Treatment: Endoscopies retrograde cholangiopancreatography (ERIC). Procedure involves local anesthetic and medicine through the vein to help relax the patient. Generally, patients are awake but so sedated that there is no discomfort or memory of ERIC. With ERIC, the endoscope is passed through the mouth, esophagi, and stomach onto the duodenum (first part of the small intestine). A small plastic tube, called a catheter, is passed through the endoscope and manipulated by the gastroenteritis’s into the bile ducts and pancreatic ducts.
Dye is injected and x-ray pictures are obtained. Upon further confirmation of stones, instruments are put through the endoscope in order to remove gallstones. ERIC often can avoid the need for surgery. Antibiotics will be given intravenously prior to ERIC. After the test, patient will be monitored for 30-60 minutes until most of the effects of the medication have worn off. Patients will be allowed to resume normal diet. May be kept overnight in the hospital for observation and administration of further antibiotics.
Anatomy & Physiology: The gallbladder is a sac attached to the bottom of the liver and is storage for bile. Bile is made in the liver and passes down through a duct and up into the gallbladder. After a person eats, the bile is released into the small intestine to mix with the food for better digestion and absorption of fat. Gallstones develop in the gallbladder when the amount of cholesterol secreted into the gallbladder by the liver is too high, r the amount of other substances in the bile is too low to prevent the cholesterol from remaining in solution.
The cholesterol or other substances turn into small sharp crystals which eventually form larger stones. When the gallbladder or its ducts contract, the sharp crystals cause agonizing pain which radiates throughout the right thoracic region. Many people have gallstones for years without any symptoms whatsoever. Symptoms from gallbladder disease usually consist of upper right quadrant abdominal pain especially after eating meals. Sometimes nausea and vomiting occur.