Patient demographics and history
Cholecystitis is the inflammation of the gall bladder, one of the most common diseases in the present world. Frequently gall bladder attacks precede the occurrence of cholecystitis in a patient due to which cholecystectomy is to be performed (Wong et al., 2022). The pain during the manifestation of cholecystitis persists longer than that of a normal gall bladder attack. If the case of cholecystitis is not properly treated, the chance of relapsing the condition is observed to be common in the patient. The complications associated with acute cholecystitis are stones in the common bile duct, gall stone pancreatitis, and inflammation of the common bile duct. It has been observed that approximately 90% of acute cholecystitis occurs due to blockage of the cystic duct by the presence of gall stones (Bazzi et al., 2018). The risk factor that causes the development of cholecystitis due to gall stones includes pills for birth control, family history, obesity, high cholesterol, pregnancy and liver disease. The method used for the diagnosis of cholecystitis is abdominal ultrasound, which would help detect gall stones in a patient. It has been observed that about 25 to 30% of adults have developed cholecystitis due to gallstones worldwide (Tarasconi et al., 2021). Women are more prone to such diseases than that man. It usually occurs after 40 years. It has been observed that several ethnic groups possess a higher chance of developing gall stones which might cause cholecystitis in them. Out of the reported cases of cholecystitis, around 10% experience biliary colic. If cholecystitis is left untreated, it might become a life-threatening disease for the older population (Mansour et al., 2021).
The paper’s main purpose is to discuss acute cholecystitis in a patient. The article is sub sectioned with the description of the demographic of the patient and its history, which states about two comorbidities that affect the health of the patient. The paper also contains the presenting problems and its analysis of the problem, health assessment and the clinical manifestations, aetiology and pathophysiology of the primary disease, psychosocial and some other considerations if present in the patient. The paper concludes with a brief description of the main points addressed in the paper.
The patient is a 75 years old lady who presented to ED for the preparation of cholecystectomy in context with the cholecystitis with the recurrent cholelithiasis. The patient complained of gastric pain in the upper quadrant and nausea, chills, vomiting and fever. Other observations recorded for the lady have been within the normal range. She consented to the cholecystectomy procedure. However, she was presented with a history of diabetes, cholesterol and obesity. The secondary health issues affecting her present conditions are obesity and high cholesterol. Her diabetes level is within the normal range and has been considered comorbidity for her present situation. Her workup included computed tomography, and the abdominal US were recorded to be normal. She was admitted due to excessive pain and further workup. Following her admission to the hospital, she underwent a HIDA scan and cholecystokinin (CCK). The reports were recorded to be normal during the previous workup. However, her pain was persistent, so she was suggested to undergo surgery for the clinical cholecystitis.
Health assessment and clinical manifestation
The patient lives with her daughter and is separated from her husband 30 years ago. She is not a social person and usually stays in her home. She does not interact with her daughter since she is a busy lady and works the double shift to afford her family expenses. Her daughter is a single mother, so she must bear her child’s expenses.
The symptoms observed in the lady were gastric pain in the upper quadrant, vomiting, nausea, fever and chills. However, it has been observed that most patient with cholecystitis does not manifest any symptoms. However, if any gall stone is lodged in the cystic duct temporarily, the patient experiences biliary colic. It is the condition in which abdominal pain is in the right upper quadrant or the epigastric regions (Chen et al., 2020). The patient also showed such symptoms when she reported to the hospital for the surgery. The pain is episodic and usually develops after consuming fatty and greasy foods. The patient usually suffers from biliary colic in the initial phase before the development of cholecystitis. It has been recorded that most patients suffering from cholecystitis have presented nausea and vomiting as one of the major symptoms in the initial phase.
In some cases, the pain in the upper quadrant of the abdomen becomes severe, which leads to fever. In this case, the lady was presented with fever and chills during his admission to the hospital. In most cases, it has been observed that obesity is bill recognized in association with cholecystitis. In several types of research, it has been established that obesity is a major risk factor for the formation of gall stones. Gall stones have a major subtype that is formed by the deposition of cholesterol among obese people, and so it can be related that high cholesterol might also lead to the development of gall stones triggering the prevalence of cholecystitis (Wong et al., 2022).
The assessment approach for the patient to diagnose her condition would include a physical examination with the inclusive history as the chief method for diagnosing cholecystitis. In addition to these examinations, laboratory testing and ultrasonography would help diagnose gall bladder diseases (Nguyen et al., 2020). A suspected patient of cholecystitis should undergo a blood test to identify the inflammation markers that are present in the blood. The laboratory test for these markers includes complete blood count and C reactive protein, along with which bilirubin level is also assessed for identifying the blockage in the bile duct. The complete blood count would help identify the level of white blood cells, and an elevated level of it might indicate the presence of inflammation in the body (Fang, Yerkovich & Chandrasegaram, 2021). The C reactive protein has been elevated in patients suffering from cholecystitis. If the bilirubin level is higher, an alternative diagnosis is to be considered for identifying blockage in the common bile duct. Ultrasound of the right upper quadrant of the abdominal area is widely used for diagnosing cholecystitis. The ultrasound findings suggest acute cholecystitis, which includes thickening gall bladder walls, dilation of the bile duct, gall stones, pericholecystic fluid and sonographic Murphy’s signs. Another method for diagnosing cholecystitis is the hepatic iminodiacetic acid if the ultrasound results are negative (Mansour et al., 2021). CT scan can also help diagnose the condition if certain complications are suspected, including gangrene or perforation. The histopathological result can be used to diagnose if the preoperative image and the cross examination are observed to suspect cancer in the gallbladder (Fang, Yerkovich & Chandrasegaram, 2021).
In most cases, it has been observed that patients suffering from cholecystitis manifest the symptoms of nausea and vomiting, which might indicate health issues related to the gallbladder. In the case of chronic cholecystitis, the complete blood count results could be normal, which becomes difficult to evaluate the condition. However, in the case of acute cholecystitis, the level of white blood cells increases, indicating the presence of inflammation in the body (Nguyen et al., 2020). The range of liver enzymes is also increased, and the level of bilirubin above the range of 2 can be considered a possible result of stone in the common bile duct. In severe cases of cholecystitis, the laboratory result is observed to be normal and therefore test for identifying the level of amylase and lipase is to be checked to rule out the possibility of pancreatitis. In this case, the complaint of abdominal pain in the right upper quadrant associated with nausea and vomiting has been the integrative sign of suspecting cholecystitis. She also has a history of high cholesterol and obesity, which acted as a comorbidity for such a condition. This indicated that she might have gall stones which triggered the manifestation of the disease in the patient (Choi et al., 2021).
In this case, the patient was presented with gastric pain in the upper quadrant along with nausea, vomiting, chills and fever. She had comorbidity of high cholesterol and obesity, which might have triggered the development of cholecystitis due to cholesterol stones in the gall bladder.
Cholecystitis refers to the inflammation of the gall bladder due to blockage of the cystic duct. Cholecystitis is a condition that can be treated by performing surgery, although it can also be treated by conservative method if required, which is determined by the health condition of the patient. However, cholecystitis can be present with or without gallstones. Cholecystitis can be confused with other illnesses like peptic ulcer disease, cardiac disease and irritable bowel disease (Tan, Friesen & Friesen, 2018).
The etiology of cholecystitis can be defined by the blockage of the cystic duct that causes inflammation. Usually, the liver produces by which travels through the build which gets stored in the gall bladder. After consuming greasy food, the gallbladder releases bile through the cystic duct into the duodenum. When the presence of a stone blocks the cystic duct, the gallbladder is unable to release the bile and therefore, the concentration of the bile in the gallbladder is increased (Utsumi et al., 2022). With the buildup of bile in the gallbladder, excessive pressure is exerted on the gallbladder walls, causing edema that eventually results in wall ischemia which over time is transformed into gangrenous. Two factors determine the progression of the cholecystitis, including the degree of the obstruction and the duration. If the obstruction is observed to be partial and for a short duration, the patient might experience biliary colic. If the obstruction is observed to be complete and for a long duration, the patient might develop cholecystitis. Such gangrenous gall bladder could be infected by organisms that produce gas which might cause acute emphysematous cholecystitis in the patient (Tarasconi et al., 2021). Cholecystitis might occur due to several other clinical manifestations, including acute calculous cholecystitis, acalculous cholecystitis, and chronic cholecystitis.
Several cases reported that occlusion of cystic duct and malfunction of the mechanism of the gall bladder while emptying is thought to be the main pathophysiology of the disease. Blockage of the cystic duct by gall stones results in a buildup of the bile salt in the gall bladder, which causes elevation of the pressure within the gall bladder (Yildirim, 2022). The concentrated bile in the gall bladder exerts extreme pressure, which sometimes manifests in several bacterial infections, causing irritation and damage to the bladder’s walls (Iqbal & Wiadii, 2021). This causes inflammation and swelling, increasing the white blood cell count. The gall bladder’s inflammation and swelling might reduce the normal flow of blood to the areas linked and connected to the gall bladder, which might result in the cell death of that particular area due to a lack of sufficient oxygen in the cells. In severe cases of cholecystitis, perforation and sepsis of the gall bladder might occur, which could lead to cell death. The gallstones might develop from different materials, including cholesterol and bilirubinate (Taghavi et al., 2021). These materials elevate the likelihood of cholecystitis and cholelithiasis in conditions like sickle cell diseases in which the red blood cells are being broken down, which causes excessive production of bilirubin and the formation of pigmented stones. Patients who possess an excessive amount of calcium, like in the condition of hyperparathyroidism, might also produce calcium stones in the gall bladder. Patients with excessive cholesterol levels in the blood can also possess the chance of developing cholesterol stones (Kim et al., 2019). Occlusion of common bile duct-like in the neoplasms or the strictures leads to the stasis of bile flow, which might also result in gall stones. Since gallstone can be formed by cholesterol end, the patient’s clinical manifestation indicated high cholesterol; therefore, the analysis of clinical manifestations fits the assessment findings of the patient (Iqbal & Wiadii, 2021).
Age is one of the major factors for cholecystitis in a patient. Cholecystitis might occur at a young and old age, or although maximum incidence off the disease is observed in the 4th decade. The food intolerance of an individual is frequently marked as initiating factor for nausea, bloating and vomiting. However, the progress of this condition might be associated with persistent symptoms even if the patient did not consume any food (Richardson, 2019). The cultural aspect is related to the type of food consumed by the community. Therefore, a patient consuming an excessive amount of greasy and oily food might have a higher chance of developing such a health condition.
Moreover, food habit also determines cholesterol and obesity, the most common comorbidity of cholecystitis. A proper communication issue between the patient and the health care professional is required for patient education which would help name and identify the risk factors that might trigger cholecystitis. Patients with more comorbidities might face several challenges during the treatment procedure. Therefore, the health care professionals would also face challenges in maintaining high standards of the ethical contract despite the pressure of comorbidity on the primary health issue (Thompson, Hamilton & Porter, 2021). In a few cases, it has been observed that patients with limited education about the disease do not agree to undergo the surgical procedure, although it is the only method for improving their condition. A legal issue arises in such a situation in which no procedure can be performed without the patient’s consent, which might hinder the treatment procedure and health outcome of the patient. In most cases, especially for older people, the family members and their friends do not support the surgical procedure for cholecystitis, and therefore, a social conflict arises due to a lack of support from other people who were considered to be closer ones to the patient (Toma et al., 2022).
Conclusion
From the above discussion, it can be concluded that cholecystitis is regarded as inflammation of the gall bladder, one of the most frequently reported diseases among the young and older populations. Cholecystitis is associated with several signs and symptoms that help health care professionals suspect the prevalence of the patient’s disease. In this paper, a 75-year-old lady is present with a decision to undergo cholecystectomy to improve her condition of cholecystitis. She was presented with gastric pain in the upper quadrant, nausea and vomiting, all of which are the guarded as the major data analyzed to detect the prevalence of cholecystitis in the patient. Cholecystitis could result from a blockage in the common bile duct due to gall stones usually formed by deposition of several materials, including cholesterol. Therefore, it can be interpreted that high levels of cholesterol and obesity linked to each other act as comorbidity and trigger factors for the development of cholecystitis in a patient. Health assessment could be performed by physical examination with inclusive history, and some laboratory testing includes total blood count and ultrasonography. The complete blood count helps identify markers associated with inflammation and the level of white blood cells, indicating some bacterial infection in the body. The progression of the disease can be determined by the degree and duration of obstruction present in the cystic duct.
References
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