Acute cholecystitis.
It is inflammation of the gallbladder that develops over hours. It is a primary complication of Cholecystolithiasis and the most common cause of acute pain in the right upper quadrant (Jones, Genova & O’Rourke, 2017).
Supporting data
Symptoms of cholecystitis include right upper quadrant pain and tenderness, sometimes accompanied by fever, chills, nausea, and vomiting. The patient presents the following symptoms of the condition: epigastric pain for the last 48 hours (with the pain being constant, sharp in nature, radiates through her back, and is relieved with sitting up), nausea, and non-bloody emesis.
Heart rate 100-high
Respiratory rate 22- high
BP 110/70mmHg- normal
Sodium 140- high
Potassium 3.0- high
Creatinine 1.0- high
BUN 20- high
WBC 12000-high
Hct 54%- high
Hgb 18- normal
Platelets 200,000- normal
AST 70-high
ALK 75- high
Alkaline phosphate 294- high
Total bilirubin 8.0-
GGT 65- high
Lipase 50- high
Etiology
Cholecystolithiasis accounts for 90-95% of all causes of cholecystitis while acalculous cholecystitis accounts for the remaining 5-10% (Chen et al., 2019).
The most likely cause of acute cholecystitis, in this case, is gallstone obstruction.
Pathophysiology
Gallstone obstruction in the gall bladder at the neck of the cystic duct increases pressure in the gallbladder increase. The progression of the disease depends on the degree of obstruction and the duration of the obstruction. When the obstruction is partial and short, a patient only experiences biliary colic (Jones, Genova & O’Rourke, 2017). In the case of complete and long obstruction, a patient develops acute cholecystitis.
Laboratory results show that the patient is in a volume depression state, high hematocrit, and high sodium and potassium values. Low urinary potassium excretion may be the cause of abnormal potassium values. Potassium controls electrolyte balance and the consumption of body fluids. Metabolic alkalosis explains the abnormal value of GGT and Alkaline Phosphate. Elevated lipase indicates inflammation. Phospholipase A, which mediates inflammation, is among the inflammatory enzymes released following triggering by bile stasis. High bilirubin level indicates common bile duct stone (Jones, Genova & O’Rourke, 2017).
Complications
Infection
Intraabdominal abscess
Hepatic injury
Bile duct injury
Retained stones in the bile duct
Biloma
Bleeding
Small bowel injury (Jones, Genova & O’Rourke, 2017)