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Acute cholecystitis.

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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)

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