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Physical Assessment Of Cholecystitis

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Question:

Discuss about the Physical Assessment of  Cholecystitis.
 
 

Answer:

Cholecystitis is a disease that affects the urinary system. The condition occurs as a result of inflammation of the bladder. The inflammation of the gall bladder is as a result of blockage of the cystic duct through which the bile is usually released from the gallbladder (Huffman & Schenker, 2010). The piling up of bile in that tube is what leads to inflammation of the gall bladder. The major sign of the disease is severe right upper quadrant pain that lasts for more than 48 hours.

In 90% of the cases, Cholecystitis results from the presence and buildup of gallstones in the gallbladder (Huffman & Schenker, 2010).  Other causes of Cholecystitis include severe illness, alcohol abuse and tumors of the gallbladder on rare occasions (Everhart & Ruhl, 2009). The piling up of the gallstones in the bladder lead to irritation and pressure in the gallbladder. Gallstones commonly occur in women as compared to men. Additional estrogen from pregnancy, birth control pills and hormonal replacement therapy are what makes women twice as likely to suffer from Cholecystitis as compared to men. The Cholecystitis occurs more frequently in older adults due to the increased excretion of cholesterol into the bile. Individuals who are above 40 years are at high risk of suffering from gallstones (Sebbane et al., 2011). The gallstones are common in Pima Indians, Hispanic populations, and Scandinavian descent. This is due to genetic predisposition.

The gallbladder can become inflamed due to different factors. In some cases, the gallbladder becomes sensitive to particular foods such as whole milk produce, red meat, and adipose or fried foods. To accurately diagnose Mr. Kasim, the daughter is asked what kinds of food her father took before suffering from Cholecystitis. Neoplasm of the gallbladder can also lead to Cholecystitis. The growth pushes against the gallbladder or blocks the cystic duct, leading to accumulation of the gallstones in the gallbladder. Critical injury on the gallbladder can also result to Cholecystitis. Acute injury of the gallbladder can be caused by car accidents or abdominal trauma (Ahmad & Keeffe, 2003).

The weight of Mr.Kasim can also be taken into consideration as the Cholecystitis is associated with obesity. It is caused by excessive caloric intake and not fat or cholesterol, which is usually the cause of Cholecystitis (Ahmad & Keeffe, 2003). Individuals who lose weight at a rapid rate are at high risk of suffering from the gallstones accumulating in the gallbladder. When people use the reserved cholesterol and fat at a faster rate than normal, cholesterol increment is witnessed in the bile of the gallbladder.

 


The primary symptom of Cholecystitis is the abdominal pain on the upper right side of the body as presented by Mr. Kasim. This is mostly standard after taking a fatty meal. Physical examination by a doctor will reveal tenderness in the right upper quarter accompanied by guarding or rebound (Everhart & Ruhl, 2009). Jaundice, fever and palpable gallbladder can also be detected through physical examination. This explains why Mr. Kasim presented increases in temperature of 38.8, high blood pressure of 100/45 and HR of 126.

Sick people also complain about experiencing deferred aches between the shoulders or at the right shoulder pain, as in the case with Mr. Kasim. He presented shoulder tip pain scoring 7/10. Some also experience yellowing of the skin, better known as the Jaundice. Some patients become dehydrated as a result of Cholecystitis making them frequently drink water.

Cholecystitis can either be calculous (presence of gallstones) or acalculous(without gallstones). Acalculous Cholecystitis only accounts for 10% of the Cholecystitis cases (Csenar, 2015). It usually occurs in severely ill patients and is associated with high mortality and morbidity.

Complications associated with Cholecystitis is the bacterial (. E. coli, Enterococcus, Klebsiella, and Enterobacter) proliferation within the obstructed gallbladder. These are gas producing bacteria that will subsequently lead to Emphysematous cholecystitis.

Acute Cholelithiasis also called biliary colic display similar symptoms as acute Cholecystitis. However, in biliary colic, the pain subsides after a while. In acute Cholecystitis, the pain is consistent and severe without showing any signs of improvement (Lameris et al., 2007). It can be deduced that Mr. Kasim is suffering from the acute Cholecystitis as the pain has been consistent in the past two days.

 According to Murphy's sign, when the patient inspires, the gallbladder descends inferiorly towards the examiner's hand. If the maneuverability of the gallbladder is associated with discomfort, Mr. Kasim can be confirmed that he is suffering from acute Cholecystitis.

Acute Cholecystitis and Cholelithiasis are common conditions that nurses, clinicians, and surgeons encounter on a daily basis. The Cholecystitis can either be calculus or acalculous. Calculous cases are more common and account for 90%. The susceptibility to gallbladder diseases is determined by gender, ethnicity, medical history, and diet. The condition can be quickly assessed physically by clinicians and appropriate measure taken to treat it.

 

References

Ahmad, A., & Keeffe, B. (2003). Gallstones and biliary tract disease. WebMD Scientific American® Medicine.

Csenar, M. L. (2015). Assessment of Acute Abdomen in the Emergency Department (Doctoral dissertation, University of Zagreb. School of Medicine. Chair of Internal Medicine.)

Everhart, J. E., & Ruhl, C. E. (2009). Burden of digestive diseases in the United States Part III: Liver, biliary tract, and pancreas. Gastroenterology, 136(4), 1134-1144.

Huffman, J. L., & Schenker, S. (2010). Acute acalculous cholecystitis: a review. Clinical Gastroenterology and Hepatology, 8(1), 15-22.

Laméris, W., van Randen, A., Dijkgraaf, M. G., Bossuyt, P. M., Stoker, J., & Boermeester, M. A. (2007). Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): design and rationale. BMC emergency medicine, 7(1), 9.

Orient, J. M., & Sapira, J. D. (2010). Sapira's art & science of bedside diagnosis. Lippincott Williams & Wilkins.

Sebbane, M., Dumont, R., Jreige, R., & Eledjam, J. J. (2011). Epidemiology of acute abdominal pain in adults in the emergency department setting. In CT of the Acute Abdomen (pp. 3-13). Springer Berlin Heidelberg.

Silen, W. (2006). Cope's Early Diagnosis of the Acute Abdomen (21st edn). Annals of the Royal College of Surgeons of England, 88(2), 248.

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