Acute Acalculous Cholecystitis Case Study

HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around

ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen.

Cholecystitis is inflammation of the gallbladder. Inflammation usually forms when a gallstone blocks the cystic duct that transports bile. Cholecystitis is the most common problem resulting from gallbladder stones (90% of the cases).

Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys, pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the abdomen appeared unremarkable. No free air was seen.

Acute Pancreatitis: Acute inflammation of the pancreas.The most common pathogenic mechanism is autodigestion of the pancreas. The etiological factor injures pancreatic cells or activates the pancreatic enzymes in the pancreas rather than in the intestine which may be due to reflux of bile acids into the pancreatic duct through an open or distended sphincter of Oddi. The result may also be caused by blockage created by a gallstone. Obstruction of pancreatic ducts results in pancreatic ischemia.The pathophysiology involvement of acute pancreatitis is

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

The patient complained of right lower quadrant pain and of feeling faint. Dr. O'Donnel documented a chief complaint, a brief history of present illness, and a systemic review of the gastrointestinal system and respiratory system. Dr. O'Donnel also documented a complete examination of all body systems, which included all required elements. Medical decision making was of moderate complexity.

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

Obstetric Cholestasis (OC) or Intraheptic Cholestasis of pregnancy is a disorder that is unique to pregnancy (Kelly and Nelson-Piercy, 2000).OC classically presents in the third trimester (Royal College of Obstetricians and Gynaecologists [RCOG], 2006), With maternal pruritus and raised bile acids (Geenes and Williamson, 2009).It is one of the few disorders of pregnancy that can affect both maternal well being and fetal outcome. OC usually resolves forty eight hours after delivery (Mays, 2010).

Other symptoms of gall stone formation in your body are decreased appetite, severe pain by your left side, vomiting, low grade fever, abdominal distention, flatulence, elevated cholesterol level and taking deep breaths causes you pain.

Obesity is one of the major risk factors for gallstones, especially in women. A large clinical study showed that being even moderately overweight increases one’s risk for developing gallstones.

Although many adults may present with any of these abdominal symptoms, acute (sudden severe inflammation of the gallbladder), lactose intolerance, and hepatitis there are differences in presentation and predominance of disease process between 20 year old and fifty year old middle age adult (Lange, 2012). Symptoms are difficult to indicate for many young adults they present with vague symptoms. Often it may be

The patient was asked to lie flat on the examination table and take a deep breath; during the inspiration, the PT palpated the edge of the liver which was firm and smooth but not painful. Next, the PT tried palpating below the liver margin and felt abnormally enlarged gall bladder. The gallbladder sits under the liver, therefore normally it is difficult to palpate unless it is grossly distended (Goodman & Snyder, 2013). On palpating the gallbladder, the tenderness was present and the patient also complained of pain. The suspected differential diagnosis of gallbladder diseases includes cholecystitis, cholelithiasis, cholangitis, and gallbladder cancer. However, the presence of tenderness on palpation of gall bladder indicates positive Murphy's sign which is a sign of acute cholecystitis (Goodman & Snyder,

Gallstone diseases are one of the most common biliary diseases, demanding a great progress in understanding the gallstones. The historical background of Cholelithiasis helps the researchers for easy classification of Gallstones. According to Japanese, there are two types of Gallstones are widely discussed: the Cholesterol stone, which is further of three types, the Pure Cholesterol stone, the Combination stone and the Mixed stone. Second is the Pigment stone, which is further classified as the Black stone and the Calcium Bilirubinate stone. The division line between Cholesterol and the pigment stones depends upon the proportion of Cholesterol. If the proportion of cholesterol is equal to or more than 70% then the stone is a Cholesterol stone; otherwise the stone is a pigment stone with calcium bilirubinate as its principal constituent. The purpose of this

Diagnosing cholecystitis involves a thorough physical exam and blood tests. White blood count is usually high, which indicates infection. High bilirubin levels, alkaline phosphatase and liver enzymes will also increase. Computerized tomography (CT) can be used to reveal signs of cholecystitis but “ultrasound is considered the primary imaging method for most gallbladder and ductal disease” (Baldwin 2008).