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Physical Assessment: Computed Tomography Scan

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Question:

Discuss about the Physical Assessment for Computed Tomography Scan.

 

Answer:

Introduction

Kasim, a forty-nine year-old patient, is handed to a nurse who has just walked into the hospital. Kasim is suspected to be suffering from cholecystitis because the patient is complaining of symptoms such as fever, vomiting, and abdominal pain in the right upper abdomen. The previous nurse recorded Kasim’s as HR 126, BP 100/45, temperature 38.8, severe RUQ pain, and the last episode of vomiting 2 hours ago. A twelve-year-old daughter has also accompanied the patient. As a result, the nurse who is currently on duty receives the patient for assessment. The nurse examines the patient’s demographic characteristics with an aim of identifying how the characteristics relate to cholecystitis. The nurse also examines cues and information from the patient, processes the information, and evaluates an appropriate procedure for diagnosing Kasim using ultrasonography and a computed tomography scan. 

 

Demographic Characteristics

The patient in question demonstrates symptoms of cholecystitis that are typical of patients with similar demographic characteristics. As evidenced, a study conducted by Yacoub, Petrosyan, Sehgal, Ma, Chandrasoma, and Mason (2013) reveal that male patients are likely to suffer from cholecystitis than other patients. Specifically, the authors established a significant difference between male and female patients who were diagnosed with the disease in question. Consequently, the study concluded that male patients are at a higher risk of suffering from the disease. Junior, Lemos, Junior, Freire, Garcia, Silva, Rego, and Filho (2016) highlight the same idea by asserting that their study recorded 80 percent of male patients who were suffering from the cholecystitis. Therefore, gender places Kasim in an appropriate demographic category for cholecystitis.

Age is another demographic characteristic that places Kasim in the right demographic category for the condition in question. This owes to the reality that Prystupa, Kurys-Denis, Krupski, and Mosiewicz (2015) argue that age is a major risk factor for cholecystitis. In particular, the authors argue that gallstones occur in an estimated 10 % of Americans who are forty years and older. Critical to the discussion is the fact that Benjelloun, Chbani, Toughrai, Ousadden, Mazaz, and Taleb (2014) reveal that cholecystitis occurs in the presence of gallstones but could still occur in the absence of gallstones. Further, Yacoub, et al., (2013) also reveal that cholecystitis is common in patients who are fifty years and older. Given that Kasim is a 9-year-old male, the patient portrays demographic characteristics for patients with cholecystitis.

 

Cues and Information

Information handed over by the nurse who was on duty before indicates that Kasim recorded a body temperature of 38.80 on admission. Imperative to the debate is the reality that the mentioned body temperature is characteristic of patients with the disease in question. As evidenced, Hayakawa, Oki, Moriya, Mizuma, Ohnuki, Yanag, Fukuda, Ozawa, Takizawa, and Takagi (2012) conducted a case study for a patient with cholecystitis and recorded the patient’s body temperature as 38.50. It follows that the similarities in body temperatures between Kasim and the patient who was studied by the authors in question indicates that Kasim could be suffering from cholecystitis. A similar body temperature was recorded in a patient with cholecystitis from a study conducted by Kaya, Eskazan, Ay, Baysal, Bahadir, Onur, and Duymus (2013).

Kasim recorded a heart rate of 126, which is above the normal heart rate. It is important to note that the same the patient’s blood pressure was recoded as 100/45. This could be an indicator of a cardiac complication, but a study from Habeeb and Ebrahim (2014) provide evidence on the contrary. This owes to the fact that the authors present a case study of an obese patient with a blood pressure and heart rate that is within the same range, but was diagnosed of cholecystitis. In a different study, Rajan, Motoroko, Udayasir, McKenzie, Tan, and Tramontane (2014) discuss a case study where a patient with a blood pressure 108/72 mmHg and a pulse rate of 96/min was diagnosed with cholecystitis. It follows that even though Kasim’s heart rate and blood pressure could raise concern for a cardiac complication, the patient could still be suffering from cholecystitis.

Kasim also complained of two days of right upper quadrant (RUQ) abdominal pain, which is a clear indicator of cholecystitis. As evidenced, Prystupa, et al., (2015) reveals that the most common symptom in patients with cholecystitis is abdominal pain in the right upper quadrant. Rajan, et al., (2014) and Benjelloun et al., (2014), put the same argument forward. Kasim also complained of fever with the last case of vomiting being recorded in the last two hours. Like abdominal pain, Rajan, et al., (2014) and Benjelloun et al., (2014) indicate that fever and vomiting is common among patients with the disease under discussion. In fact, evidence from case studies conducted by Habeeb and Ebrahim (2014) indicates that fever and vomiting is a common symptom among patients with cholecystitis. In short, reviewing records from the nurse who was on duty before indicates that Kasim could be suffering from cholecystitis.  

 

Process Information

Patients with the diseases in question often portray symptoms discussed in the cues and information section. This owes to the fact that Sartelli and Trana (2013) argue that gallbladder stones is a common disorder that causes deceptive infections and could be easily misdiagnosed. Regardless, cholecystitis is a bacterial disease that arises when the cystic duct is obstructed with gallstones. The obstruction leads to ischemia, wall edema, gall bladder distention and a bacterial infection. According to Li, Song, Liu, Xie, Jiang, Wei, Ma, Wang, and Jin (2017), the wall of the gall bladder may undergo gangrene and necrosis, which would result to perforation. In other cases, it may result in the development of generalized peritonitis or an abscess. The obstruction is rarely caused by sludge and mostly caused by gallstones (90% of the time).  

Evidence from published studies indicates that clinicians must be keen when diagnosing cholecystitis to avoid misdiagnosis. For instance, Li, et al., (2017) reveals that there have been instances where clinicians have misdiagnosed cholecystitis for gastrointestinal stromal tumor. In a different study, Rammohan, Cherukuri, Sathyanesan, Palaniappan, and Govindan (2014) reveal that the same disease could be misdiagnosed for gallbladder cancer. This owes to the fact that the authors conclude one such finding in 68.7% of the observations in the study. Evidently, cholecystitis could be misdiagnosed for gallbladder cancer. Regardless, the misdiagnosis could be avoided using histopathological examination.

 

Problems and Issues

An ultrasonography or a laboratory criterion could be used to diagnose the disease in question. Clérigo, Rocha, Rodrigues, Fernandes, Sargento, Silva (2014) reveal that the two techniques are effective, but the laboratory criterion could easily result in a misdiagnosis. It follows that it is advisable to use the ultrasonography technique for diagnosing the disease. Imperative to the debate is the fact that an ultrasonography will portray gall bladder distension, a superior wall thickening in the patient. On the contrary, a healthy person would portray a normal wall, and the absence of gall bladder distension. Further, Kasim would portray the presence of a lumen gas, the absence of mural-enhancement, irregular wall, periholecystic fluid, and intra-luminal membranes (Clérigo et al., 2014). An ultrasonography test is not enough implying the test should be complemented by a computed tomography scan. Such a scan would display pericholecystic fat, intrahepatic periportal tissues, and inflammatory changes in the GB wall for a patient who is suffering from cholecystitis.

Detail Assessment

Kasim will be separated from the daughter before taking the tests because this is a standard practice in nursing. To begin with, a 4D ultrasound machine will be prepared for the test and Kasim will be asked to fast for 12 hours. Water and medications will not be refrained from the patient for an efficient test to be performed. The patient will be dressed in an appropriate gown, a lubricating jelly will be applied on the skin, and the machine will be used to record an image of the gall bladder (Clérigo et al., 2014). The machine will then be connected to a computer, which will print out the recorded image. The patient will then be subjected to a computed tomography scan. Kasim will be prepared and driven into a CT scanning machine. A remote control will be used to take pictures of the patient’s gall bladder and the results printed out using a computer.

Conclusion

In conclusion, this paper discusses cholecystitis using a case study of a 49-year-old patient called Kasim. Evidence from reputable resources indicates that symptoms such as fever, vomiting, and abdominal pain in the right upper abdomen point towards cholecystitis. The patient’s body temperature, blood pressure, and heart rate also point to the same disease. As evidenced, case studies from authors such as Rajan, et al., (2014) and Benjelloun et al., (2014) indicate that patients suffering from cholecystitis can portray abnormal rates of blood pressure and heart rate. Regardless, patients with similar symptoms could be suffering from cancer in the gall bladder implying the nurse should be keen when assessing the patient. It is why the paper recommends using an ultrasonography together with computed tomography scan before reaching a final diagnosis. 

 

References

Benjelloun, B. E., Chbani, L., Toughrai, I., Ousadden, A., Mazaz, K., and Taleb, A, K. (2014).

A Case Report of Acute Acalculous Cholecystitis Due To Salmonella Paratyphi B Complicated By Biliary Peritonitis. Pan African Medical Journal, Retrieved from  https://www.panafrican-med-journal.com/content/article/16/127/pdf/127.pdf

Clérigo, V., Rocha, C., Rodrigues, A., Fernandes, L., Sargento, D., and Silva, G. (2014). 

Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman. Case Reports in Clinical Medicine, 3: 503-507. Retrieved from https://file.scirp.org/pdf/CRCM_2014090210573795.pdf  

Habeeb, O., and Ebrahim, E. T. (2014). Acute Cholecystitis Mimics Ischemic Cardiac

Disease: A Case Report and Review of the Literature. Case Reports in Clinical Medicine, 3:  609-615. Retrieved from https://file.scirp.org/pdf/CRCM_2014112515292565.pdf

Hayakawa K, Oki M, Moriya Y, Mizuma A, Ohnuki Y, Yanagi H, Fukuda R, Ozawa H,

Takizawa S, Takagi A. (2012). A Case of Scrub Typhus with Acalculous Cholecystitis, Aseptic Meningitis, and Mononeuritis Multiplex. Journal of Medical Microbiology, 61(2): 291–294. Retrieved from https://jmm.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.034678-0#tab2

Junior, S., Lemos, T., Junior, A., Freire, A., Garcia, C., Silva, R., Rego, A., and Filho, I. (2016).

Acute Acalculous Cholecystitis in Critically ill Patients: Risk Factors, Diagnosis, and Treatment Strategies. Journal of the Pancreas, 17(6): 580-586. Retrieved from https://pancreas.imedpub.com/acute-acalculous-cholecystitis-in-critically-ill-patients-risk-factors-diagnosis-and-treatment-strategies.pdf

Kaya, S., Eskazan, E. A., Ay, N., Baysal, B., Bahadir, V. M., Onur, A., and Duymus, R. (2013).

Case Report Acute Acalculous Cholecystitis due to Viral Hepatitis A. Case Reports in Infectious Diseases,  Article ID 407182, 1-4 https://dx.doi.org/10.1155/2013/407182

Li, Y., Song, J., Liu, Z., Xie, D., Jiang, T., Wei, G., Ma, H., Wang, J., and Jin, M. (2017).

Xanthogranulomatous Cholecystitis and Misdiagnosis Analysis. Chinese Medical Journal, 128(12): Retrieved from https://www.cmj.org/temp/ChinMedJ128121700-1588759_042447.pdf

Prystupa, A., Kurys-Denis, E., Krupski, W., and Mosiewicz, J. (2015). Diagnostics of Acute Pain

in Abdominal Right Upper Quadrant. Journal of Pre-Clinical and Clinical Research, 5(2): 56-59. Retrieved from jpccr.eu/fulltxt.php?ICID= 978533

Rajan, N., Motoroko, I., Udayasir, D., McKenzie, J., Tan, S. C. J., and Tramontane, R. A.

(2014). A Case Report of Typhoidal Acute Acalculous Cholecystitis. Case Reports in Infectious Diseases, Volume 2014 (2014), Article ID 171496, 5 pages https://dx.doi.org/10.1155/2014/171496

Rammohan, A., Cherukuri, D. S., Sathyanesan, J., Palaniappan, R., and Govindan, M. (2014).

Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Can It Be Diagnosed Preoperatively? Gastroenterology Research and Practice, Gastroenterology Research and Practice, 5(2): 1-5. doi:10.1155/2010/901739

Sartelli, M., and Trana C. (2013). A Focus on Acute Cholecystitis and acute Cholangitis. Journal

of Acute Medicine, 77-81. Retrieved from https://www.sciencedirect.com/science/article/pii/S2221618913600190

Yacoub, N, W., Mikael, P., Sehga, I., Ma, Y., Chandrasoma, P., and Mason, J. R. (2013).

Prediction of Patients with Acute Cholecystitis Requiring Emergent Cholecystectomy: A Simple Score. Gastroenterology Research and Practice, 4(5): 1-5. doi:10.1155/2010/901739 

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