- QUESTION
DC comes to the emergency room complaining of acute abdominal pain. She states the pain came after dinner at an all-you-can-eat buffet and has been increasing steadily. The pain is located in her right upper quadrant and is “boring†into her back. She says she feels “gassy†and bloated.
What are your differential diagnoses? Include the pathological process involved with your diagnosis. What tests would you order to confirm your diagnosis?
What treatments or interventions would be the first line of protocol for your diagnosis?
DC is having a gallbladder attack.
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| Subject | Nursing | Pages | 4 | Style | APA |
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Answer
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DC Case Study: Gallbladder Attack
The right upper quadrant abdominal pain is usually experienced in pancreatitis, gallbladder attacks, and stomach ulcers (Feldman, Friedman, & Brandt, 2015). The symptoms and DC’S medical history are indispensable in the differential diagnosis. DC experienced the pain after a buffet. Only pain due to gallbladder attacks and pancreatitis is aggravated after meals (Feldman, Friedman, & Brandt, 2015). Both gallbladder attack and pancreatitis pain radiate to the back or the right shoulder (Feldman, Friedman, & Brandt, 2015). However, pain due to pancreatitis is usually constant while pain due to gallbladder attacks usually increases (Feldman, Friedman, & Brandt, 2015). Furthermore, gallbladder attack is the only right upper quadrant abdominal pain associated with gastro-enteric bloating. Therefore, DC suffered from a gallbladder attack.
The pathophysiology of the gallbladder attack starts with the formation of gallstones following inflammation of the bile duct or more concentration of cholesterol than the saturation limit (Feldman, Friedman, & Brandt, 2015). The gas formation and bloating suggest the infection of the bile duct and sphincter of Oddi by the gas forming H. pylori (Allen, 2013). This infection causes inflammation of the bile duct. Gallstones, precipitating from bile also block the flow of bile. After taking meals especially containing fats, the gallbladder contracts to discharge bile into the duodenum. However, the gallstones block the bile, and the bile irritates the bile duct epithelium that has undergone inflammation (Allen, 2013).
The nurse would need to order for the abdominal X-ray that would detect gallstones or alterations in the bile duct. Blood tests would reveal complications of gallstones such as infection and jaundice while liver function tests would detect elevated liver enzymes alkaline phosphatase and 5' nucleotidase (Allen, 2013). The first line of protocol would be to control the acute pain DC was experiencing because medical treatment for gallstones, beyond pain control, is not initiated in the emergency department (Allen, 2013). DC had reached the symptomatic stage of gallbladder disease and therefore, cholecystectomy would be the best alternative to alleviate pain and remove the gallstones (Allen, 2013). Therefore, DC would have his pain mitigated.
References
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Allen, S. N. (2013). Gallbladder disease: Pathophysiology, diagnosis, and treatment. US Pharm, 38(3), 33-41.
Friedman, L. S., Feldman, M., & Brandt, L. J. (Eds.). (2015). Sleisenger and Fordtran's Gastrointestinal and liver disease: pathophysiology, diagnosis, management. Elsevier Health Sciences.
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