NURS 6050 week 1 discussion
Patient Scenario
A 30-year-old, Caucasian female presented to the emergency room complaining of severe epigastric and right upper quadrant (RUQ) pain, nausea, vomiting, and fever. Her medical history is only significant for irritable bowel syndrome and endometriosis. The only medication the patient takes is a birth control pill daily. The patient stated that the pain started about four hours ago, but has steadily increased. She denies any significant changes in her diet or recent abdominal injuries but says she has eaten a lot more over the past week because of the Thanksgiving holiday. The patient says she is very busy between working and taking her kids to after school activities, so they often eat fast food and she requires a lot of caffeine throughout the day, so she doesn’t drink much water. Upon physical examination, bowel sounds present in all four quadrants, RUQ guarding, tenderness noted to entire abdomen upon palpation, no rebound tenderness, but Murphy’s sign was positive.
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Impacting Factors
This patient is suffering from cholelithiasis (gallstones) with an influencing factor of behavior, specifically because of dietary habits. Cholelithiasis is the process of gallstones forming (Pak & Lindseth, 2016). “Gallstones are hardened deposits of digestive fluid that can form in your gallbladder” (Mayo Clinic, 2013). Some impacting factors to this disorder are: being female, eating a high-fat, high cholesterol, low-fiber diet, and taking medications that contain estrogen (Mayo Clinic, 2013). The patient admits to eating fast food frequently which typically means the food she is eating is high in fat, high in cholesterol, and low in fiber. She also said she took a birth control pill daily. A majority of birth control pills contain estrogen and progesterone to prevent pregnancy. NURS 6050 week 1 discussion
Pathophysiology and Associated Alterations
There are two common types of gallstones: cholesterol and pigmented. “Most are composed largely of cholesterol with or without calcium deposits” (Hammer & McPhee, 2014). Cholesterol gallstones form when the cholesterol concentration in the bile is greater than its solubility percentage (Hammer & McPhee, 2014). Having a higher percentage of cholesterol causes cholesterol crystals to form called “microstones” (Huether & McCance, 2012). More crystals collect on the microstones, growing “macrostones” (Huether & McCance, 2012). This process occurs in the gallbladder because of decreased motility. “The stones may lie dormant or become lodged in the cystic or common duct, causing pain when the gallbladder contracts and cholecystitis” (Huether & McCance, 2012). If cholecystitis occurs and is left untreated, it can progress to acute pancreatitis “if a stone travels down the common bile duct but fails to clear the sphincter of Oddi, thereby blocking the pancreatic duct” (Hammer & McPhee, 2014). An infection and necrosis may also occur if the gallbladder is left untreated, putting the patient at risk of becoming septic (Hammer & McPhee, 2014). NURS 6050 week 1 discussion
References
Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of Disease: An Introduction to Clinical Medicine (Seventh ed.). New York, NY: McGraw Hill Education.
Huether, S. E., & McCance, K. L. (2012). Understanding Pathophysiology (Fifth ed.). St. Louis, Missouri: Elsevier.
Mayo Clinic. (2013, July 23). Diseases and Conditions: Gallstones. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/gallstones/basics/definition/con-20020461
Pak, M., & Lindseth, G. (2016). Risk Factors for Cholelithiasis. Gastroenterology Nursing, 39(4), 297-309. NURS 6050 week 1 discussion