Table of Contents
Identification and description of the illness.
Signs and symptoms.
Relevant pathophysiology of the illness.
Janet is a 48-year old single mother of two children. With a BMI of 42, she has been hospitalized from the emergency department (ED), possessing a preliminary discovery of Cholecystitis. It has been noticed when Janet informs an increase in abdominal pain and nausea.
Cholecystitis is the phenomenon of the burning of the gallbladder. The gallbladder is a small, pear-shaped organ situated at the abdomen's right, beneath the liver. This gallbladder stores a digestive fluid, which it, later on release to the small intestine. Now, mostly when the gallstones block the path of the tube, Cholecystitis may occur. Other than this, tumors, some problems in the duct and other gallbladder-related illnesses may also be responsible.
In Janet's case, the following things were observed on her arrival: T was 36.7, P was 88, BP was 104/74, RR was 10, SaO2 was 98% on 2L/min Oxygen via nasal cannula. After analgesia, her resting score was 5/10; before that, it was 2/10. She also has been provided with IV Paracetamol, IV Morphine, and IV Normal Saline. Janet will be thoroughly investigated and reviewed by the general surgery consultant. It is decided that when the effect of morphine wears off, the surgical registrar will take her consent to conduct surgery.
As mentioned earlier, Cholecystitis is a phenomenon that occurs when a blockage is formed in the cystic duct by the gallstones that have been produced in the gallbladder (cholelithiasis). Uncomplicated Cholecystitis has very hopeful chances of getting cured. The development of complications such as Perforation or Gangrene worsens the problem and makes it less favorable to cure.
The Cholecystitis cannot be left unattended or uncured fully. If this is left that way, Cholecystitis can lead one to some lethal, life-threatening difficulties such as a gallbladder rupture can be stated as an example for it (Ball et al., 2018). To treat Cholecystitis, the doctors or surgeons often advise removing the gallbladder.
Some of the signs and symptoms that can be noticed in patients bearing Cholecystitis can be jotted down as follows:
These are the clear signs and symptoms directly pointing their fingers at the disease. In Cholecystitis, the signs and symptoms generally appear often after a meal, especially if it is a large and heavy feast.
The chief and foremost cause of Cholecystitis is primarily an obstruction that occurs at the biliary outflow at the cystic tube by the gallstones produced by the gallbladder. Other not so common, or relatively rare cause for the occurrence of the said illness can be stricture, twisting and curving of the cystic duct, which forms a hurdle at the path of the flow, or a thick, concentrated, or congeal bile forming a bar of obstruction itself (Arlati, 2019). Now, this obstruction forces the gallbladder to swell up and bulge out from its standard recommended shape, which compresses the blood vessels in the gallbladder wall. This phenomenon makes possible the occurrence of a patch of gangrene on the fundus. This thing is liable to rupture or slightly be cracked and produce bile peritonitis.
If gallstones can pass through the cystic duct and the mutual bile duct and then get obstructed at the ampulla of the distal portion of the bile duct, the occurrence or emergence of gallstone pancreatitis can also be noticed from storing up all the fluid and with its increase of pressure in the pancreatic ducts and also from the in situ formation and secretion of pancreatic enzyme.
Adding to this series of causes, some mechanical and vascular factors were considered by some investigators and suggested that they can be advantageous for the infections or rather a chemical form of irritation to spread its ground as a cause for the illness.
Graham and Peterman were assumedly the last of all to believe in the role of infections in the disease. They tried their ways through anatomical pathways and medium to eliminate such infection.
Firstly and foremost, an explanation of the case study, including the causes, factors, and necessary steps that ought to be given, is provided to the patient (Here, Janet, 48-year old) of Cholecystitis (Ghadhban, 2019). They have cordially invited and the possible outcome of benefits from it, and the commitments of time required for it is thoroughly discussed with them. The patient can primarily give consent for the invitation of the interview; if not, then by the nurse primarily involved. This consent to participate in the program is definitely an indication of the patient's choice of being interviewed and explained her terms. The patient has every right to stop or withdraw herself from the interview if she doesn't feel the need or comfortable with this. The name of the patient and the institution is representing him, or she remains silent to protect their privacy (Abuhammad et al., 2020). Even to maintain the style of anonymity of the patients or any identifier to recognize the patient, every detail and data regarding the interview is recorded in code language where Patient(Pt.) names are A, B, C, and so on. This form of study is praised and approved by a Human Subject Review Board by University after critically analyzing the protocols and procedures.
For surgical treatment of a cholecystectomy patient, Laparoscopic cholecystectomy is preferable to open cholecystectomy. Laparoscopic cholecystectomy has been adopted for over ten years as an advanced procedure for the treatment (Utsumi et al., 2017). It is also essential for the surgeon to master the skill of surgery by laparoscopic cholecystectomy since the procedure and training of skills for open cholecystectomy is widely different. The surgeon should also be thoroughly studying the various complications present like abdominal pain, nauseating tendency, and heart rates, blood pressures, respiratory rate, etc., before going into action. Some of the complications may present with the procedure, so as much possible care should be taken for the prevention of bile duct injury since it is the most sensitive region for the operation.
The surgeon should also be a little adept at the open cholecystectomy because if required, he must have to convert to open cholecystectomy to minimize the risk of complications, for example, if the anatomy of Calot's triangle remains unclear in spite of providing accurate dissection in the area.
Cholecystectomy, or to be more specific laparoscopic cholecystectomy, is yet considered to be the most effective and advanced procedure for curing the disease through surgery. To perform this surgery, a clear indication or green signal is given by tremendous and constant pain caused to the patient. The results of this method main present too much question and doubt concerning the patient and surgeon with uncertainty, suggesting uncomplicated symptomatic gallstone might have some benign course than prior assumed one. The treatment really demands the patience of the patient since it's a long, strenuous, and painful process that requires lots of energy and hope for the people involved.
Of late, basing on some information regarding its treatments, it is found that the UK provides cholecystectomy as a default option for all people who bear the pain of symptomatic gallstone disease without trying to look out for those patients who are actually going to benefit from it or not (Janssen et al., 2020). Around 65000-70000 surgical treatments are performed every year in the country, and many hospitals also have to publish a waiting list of patients or have to operate them electively.
Again, conservative institutions can also be considered a valid and reasonable option for people having uncomplicated symptoms like biliary pain or Cholecystitis on the basis of their age and sex, as well as it can be based on the clinical presentation of the disease or how it is evolving over time. Again, these uncomplicated symptoms are not that much urgent like a complicated one, so non-surgical options would be just fine.
Abuhammad, S., Mufleh, S., Alzoubi, K.H., Almasri, R. and Khraisat, O., 2020. Pediatrics Palliative Care and Ethical Consideration From Nursing and PharmD Perspectives: A Study in Jordan.
Arlati, S., 2019. Pathophysiology of Acute Illness and Injury. In Operative Techniques and Recent Advances in Acute Care and Emergency Surgery (pp. 11-42). Springer, Cham.
Ball, C.G., Sutherland, F.R. and Hameed, S.M., 2018. Managing the Difficult Gallbladder in Acute Cholecystitis. In Minimally Invasive Acute Care Surgery (pp. 45-52). Springer, Cham.
Ghadhban, B.R., 2019. Assessment of the difficulties in laparoscopic cholecystectomy among patients at Baghdad province. Annals of Medicine and Surgery, 41, pp.16-19.
Janssen, E.R., Hendriks, T., Natroshvili, T. and Bremers, A.J., 2020. Retrospective Analysis of Non-Surgical Treatment of Acute Cholecystitis. Surgical infections, 21(5), pp.428-432.
Kumar, N., Kumar, P., Dubey, P.K., Kumar, A. and Kumar, A., 2020. Cope's sign and complete heart block secondary to acute Cholecystitis: A case report. Journal of Acute Disease, 9(4), p.176.
Utsumi, M., Aoki, H., Kunitomo, T., Mushiake, Y., Yasuhara, I., Arata, T., Katsuda, K., Tanakaya, K. and Takeuchi, H., 2017. Evaluation of surgical treatment for incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy: single center results. BMC research notes, 10(1), pp.1-5.
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