Digestive System Case Study
The physician would suspect that she is suffering from cholecystitis. The differential diagnoses would include cholelithiasis from cholecystitis. Fever and abdominal pains are signs of cholelithiasis. These two diseases have the same clinical manifestation because of the blockage in the gallbladder.
Cholelithiasis entails the presence of gallstones in the gallbladder caused by an imbalance in substances like bile salts and cholesterol. Gallstones result in the blockage of the cystic duct leading to a build-up of bile leading to inflammation (Mayo Clinic, 2016). The major characteristics of gallbladder attack include boring pain that usually radiates to the right scapula with bloating and nausea. The key cause of cholecystitis is biliary obstruction by the gallbladder. As the gallbladder distends, the flow of blood and lymphatic drainage become compromised, resulting in necrosis and mucosal ischemia (Mayo Clinic, 2016).
Cholecystitis is also caused by a tumor that hinders bile from draining from the gallbladder appropriately, resulting in bile build-up that causes cholecystitis.
The pathological procedure for the diagnosis will entail gallbladder evaluation. Evaluation of structural changes in the gallbladder may be attained by using a number of imaging techniques (Mayo Clinic, 2016). Blockage of bile ducts from tumors, stones, or inflammation hinders the flow of bile from the gallbladder and liver from reaching the gastrointestinal tract. This result in the elevation of the conjugated and total serum bilirubin values, the level of urine urobilinogen rises, jaundice develops, and stools become clay colored. The doctor would recommend a number of tests to confirm the disease and give a diagnosis. An ultrasound would enable a doctor to detect the shape and size of the gallbladder of the patient. Additionally, a nuclear scanning test would enable a physician to check how well the gallbladder is functioning (Mayo Clinic, 2016).
One of the tests that would be done to confirm the diagnosis is blood tests. A doctor may request blood tests to confirm signs of gallbladder problems (Lal, 2016). A doctor can also recommend a test that indicates the movement of bile through a patient’s body. A HIDA scan can be done to determine how bile is produced and flows from the liver to the intestines and shows blockage. This enables a physician to identify any blockage in the gallbladder. Other tests also include imaging tests that show one’s gall bladder. For instance, a computerized tomography scan or abdominal ultrasound could be applicable in creating pictures of the patient’s gallbladder that may reveal any signs of cholecystitis (Lal, 2016). This scan can also be used to detect blockage in the bile ducts.
The treatments that would be the first line of protocol for diagnosis are; for acute cholecystitis, medical treatments entail IV antibiotics, IV hydration, and bowel rest. For minor circumstances of acute cholecystitis, antibiotic therapy with one broad-spectrum antibiotic is enough. Bacteria popularly related with acute cholecystitis are Klebsiella, Pseudomonas species, B. Fragilis, and E. Coli (Mayo Clinic, 2016). Another recommended care for a surgical treatment of this diagnosis is Laparoscopic cholecystectomy. Surgery is usually done after symptoms have lessened, but when one is hospitalized for an acute illness. The surgery is aimed at removing the gallbladder. Another valid approach in the removal of the gallbladder is open cholecystectomy.
In conclusion, physicians must carry out a number of tests to confirm the presence of gallstones in the gallbladder prior to providing a diagnosis.
References
Mayo Clinic. (2016). Cholecystitis Causes – Mayo Clinic. Mayoclinic.org. Retrieved 18 December 2016, from http://www.mayoclinic.org/diseases-conditions/cholecystitis/basics/causes/con-20034277
Lal, S. (2016). Acute cholecystitis: MedlinePlus Medical Encyclopedia. Medlineplus.gov. Retrieved 18 December 2016, from https://medlineplus.gov/ency/article/000264.htm