Question

A 36 year old caucasian, obese, female presents to the ED with a complaint of epigastric pain for the last 2 days. THe pain radiates through to her back, is consistant, sharp in nature and relieved with sitting up. Associated symptoms includes nausea and non-bloody emesis. Eating make the pain worse and therefore she has not eaten for the last 24 hrs. He is married and has two children. She denies any alcohol and drug use. One assessment she is afebrile, heart rate 100, respirations 22, and BP 110/70mmhg. SHe is restless from the pain, diaphorietic and has a icteric sclera. Heart and lung assessment are unremarkable. abdomen is soft with hypoactive bowel sound and tender in the epigastric area and RUQ.

LAB;

Sodium- 140

Potassium- 3.0

Creatnine- 1.0

BUN- 20

WBC 12000

Hct- 54%

Hgb-18

platetes 200,000

AST- 70

ALT 75

Alkaline phosphatase 294

Total bilirubin- 8.0

GGT- 65

Lipase- 1050

Questions

1. The clinical scenario is most consistent with which diagnosis? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.

2. What data in the clinical scenario supports your diagnosis? Make sure to interpret the lab values that you list. You may simply list your answers below using a bullet point format. This does not have to be in a complete sentence. Interpret the labs that you list as part of your answer by indicating normal, high or low.

3. What are the two most common causes of the diagnoses in question 1? Which etiology is most likely causing the diagnosis in question 1? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.

4. Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.

a. Why is the potassium value abnormal?

b. What do the abnormal GGT and Alkaline Phosphate indicate?

c. Why are the lipase and bilirubin elevated?

5. For what actual or potential complications related to the diagnosis in question 1 does she need to be monitored? You may simply list your answer(s) below using a bullet point format. This does not have to be in a complete sentence.

Answer 1

ANSWER 1. Clinical scenario most consistent with diagnosis of ACUTE CHOLECYSTITIS

• pain in right upper quadrant
• epigatric pain,that radiates to back and relieve on sitting
• nausea
• bloody emesis
• right hypochondrial tenderness
• pain,
• diaphorietic
• icteric sclera

ANSWER 2 lab report suggesting ACUTE CHOLECYSTITIS

• WBC 12000 LEucocytosis
• AST- 70 increase in aspartate transferase
• ALT 75 increase in alanine amino trasferase
• low potassium level
• high ggt
• high alkaline phosphatase
• high lipase
• high billirubin

ANSWER 3 coomon causes of the diagnoses in question 1

1. GALL stone
2. cystic duct obstruction by gall stone
3. other inlcuude  bile duct problems, tumors, serious illness and certain infection

ANSWER 4

answer a,low potassium level

answer b increase in alkalonephosphatase and ggt ,due to obstruction in gall bladder and inflammmation of Inflammation or damage to the biliary tract

answer c

When a stone becomes impacted in the cystic duct and persistently obstructs it, acute inflammation results. Bile stasis triggers release of liver enzymes e.g., serum 5 NT, ALP, AST, ALT along with serum bilirubin level.

ANSWER 5

• Torn gallbladder. A tear (perforation) in your gallbladder may result from gallbladder swelling, infection or death of tissue.
• gall bladder empyema
• gangrene