Chronic Acalculous Cholecystitis

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

When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam or CT Scan, the most sensitive and specific test for gallstones. Other exams that may be performed are a Cholescintigraphy a.k.a. HIDA (hepatobiliary iminodiactec acid) Scan, ERCP (endoscopic retrograde cholangiopancreatography), and blood tests.

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 3 days of abdominal pain. It initially started 3 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 6am, but he now

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

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

Pain can be categorized as acute or chronic pain. Chronic pain is described as pain that is both long-term and continuous, or is pain that persists after the expected healing time following an injury (British Pain Society, n.d.) Acute pain can provide a warning signal that an illness or injury has occurred. It is defined as pain that lasts less than three months and lessens with healing (Briggs, 2010). Acute pain can then be described in more detail by the following categories; somatic, visceral and neuropathic pain. Somatic pain is a localized pain described as sharp, burning, dull, aching or cramping. It is seen with incisional pain and orthopedic injuries or procedures. Visceral pain refers to an injury to the organs and linings of the body cavities. It produces diffuse pain and can be described as splitting, sharp or stabbing. This is pain that be described from patients with appendicitis, pancreatitis or intestinal injuries and illnesses. Injuries to the nerve fibers, spinal cord and central nervous system cause neuropathic pain. This pain can be described as shooting, burning, fiery, sharp, and as a painful numbness. This can be seen after an

I knew the severe symptoms that I had were not characteristic of gallbladder disease. Particularly not in the beginning, when there was only a very small amount of gallbladder sludge. The very elevated liver enzymes I had were also a mystery because they also do not occur when there is gallbladder sludge alone. They can occur when there is sludge blocking a duct, but there never appeared to be any obstructed ducts in either of the ultrasounds I had during that

Diagnosis of Obstetric Cholestasis is made by excluding all other liver diseases. Blood test to assess OC should generally include Liver Function tests as well as screening for Hepatitis B and C and Serum bile acids. (Bryne, 2000). Kenyon et al 2001 suggest that bile acid levels will often rise before liver function tests become abnormal so continual investigation is vital. Jacinta presented with intense pruritus however her liver function tests and serum bile levels were initially normal. Many women will have pruritus for days or weeks before the development of any abnormal liver function (Kenyon et al 2001). Midwives need to be extremely vigilant and not ignore persistent pruritus even in the presence of normal blood results. Diagnosis is suggested if a woman in the third trimester of pregnancy develops pruritus without a rash and at least one biochemical liver abnormality (See appendix) (Walker, Nelson –Piercy and Williamson, 2002). However OC has been diagnosed in women at only eight weeks gestation, (Mays 2010) and Jacinta presented to her General Practitioner with pruritus at twenty four weeks. Diagnosis can be extremely

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.

I was happy that I managed to rule out any distinct causes of the abdominal pain by performing the examination to collect data, analyse it, and use the results to make an appropriate decision (Schon, 1984). However, had I performed the examination without assistance I may not have gained all the information required to confirm diagnosis, as I did forget some aspects.

Diagnosis: creating pictures of the Gallbladder- recommend an abdominal ultrasound and/or a (CT) computerized tomography scan to produce pictures of your gallbladder. These images are then analyzed for the signs of gallstones.

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.

Initial use of ultrasonography in diagnosis of intra-abdominal collections was found to have several advantages and disadvantages. The accuracy of ultrasonography in diagnosis of intra-abdominal collection was found to be 97% with sensitivity of 93% and a specificity of 99% 14.