NUR4271 GI Cholecysitis, Diverticulitis,
Cirrhosis, NAFLD, PUD Exam
-Are you taking any medications?
-Has this pain occurred before? What have you taken for it?
-If so, what triggers this pain?
-When do you get pain?
-Do you have a feeling of gas? Bloating in the abdomen?
-Have you had a fever?
-What color are your stools?
-Color of urine?
-Skin color? - ANSWER Patient has abdominal pain that began as indegestion but now
has constant pain in upper right quadrant. Pt. is 5'3" and 255lbs, rebound tenderness on
palpation.
What questions would you ask the patient based on these S&S?
Cholecystitis (gallbladder inflammation)/possible gallstones - ANSWER Pt. states they
ate a big mac and double french fries an hour ago and the pain started after that.
ESR=40mm/h (Normal range: 0-15 M, 0-20 F) & WBC=18,000/mcL (Normal range: 5-10k).
What is most likely the problem?
Located underneath the liver
Collects, concentrates and stores bile
Bile comes from the liver
Bile essential for fat breakdown
GB releases bile into duodenum - ANSWER What is the function of the gallbaldder:
,Bilirubin, biliary - ANSWER ____ is the primary pigment in bile. Normally conjugated and
excreted by the liver and ____ system.
bilirubin - ANSWER Higher than usual levels of ____ can indicate liver or bile duct
problems as well as other conditions
-Acute/chronic
-Inflammatory condition of the gall bladder - ANSWER What is cholecystitis?
Calculous cholecystitis (cholelithiasis) - ANSWER Irritation and inflammation result in
gall stones that obstruct cystic duct, gall bladder neck, or common bile duct
Acalculous cholecystitis - ANSWER irritation of gallbladder without gall stones
-Trapped bile reabsorbed and irritates gall bladder wall
-Reabsorbed bile, edema, impaired circulation and distention of gall bladder cause
ischemia and infection
-Tissue sloughing with necrosis and gangrene within gall bladder itself
-Gall bladder can rupture
-If perforation is large can get peritonitis
-Hyperlipidemia, rapid weight loss (causes) - ANSWER Acute cholecystitis with
Cholelithiasis:
-Chronic inflammation due to repeated episodes of duct obstruction
-Many patients are managed with these episodes in the community with emphasis on
weight loss and avoidance of fatty foods (What are fatty foods?)- anything fried, full fat
dairy (cheese, milk, cream)
-Gall bladder becomes fibrotic and atrophied
-Jaundice/icterus (these symptoms can also occur with an acute condition)
-Itching/burning of skin (Excessive build up of bile salts in the skin)
, -Bile flow blockage prevents bilirubin from going to large intestine, converting there to
urobilinogen which makes stools brown - ANSWER Chronic cholecystitis:
-Episodic or vague pain in the URQ that can radiate to right shoulder
-Pain triggered by a high fat or high volume meal
-Anorexia, nausea or vomiting
-Dyspepsia (stomach pain), eructation (burp), flatulence
-Rebound tenderness (Blumberg sign: when there is pain upon removal of pressure,
rather than application of pressure to the abdomen)
-Fever
-Jaundice
-Steatorrhea (most common with chronic disease/oily smelly stools)
-Clay colored stools - ANSWER Cholecystitis symptoms:
-Women of all ages (calculi increase with aging)
-Native American, Caucasian, Mexican American
-Obesity
-Low fat diet (rapid wt. loss/fasting)
-High fat diet
-Increased cholesterol/lipids
-Women on hormone replacement
-On cholesterol lowering drugs
-Family history/genetic factors - ANSWER Risk factors for cholecystitis:
-Pain
-Nutrition - ANSWER concepts w/ cholecystitis
-Xray/CT scan
Cirrhosis, NAFLD, PUD Exam
-Are you taking any medications?
-Has this pain occurred before? What have you taken for it?
-If so, what triggers this pain?
-When do you get pain?
-Do you have a feeling of gas? Bloating in the abdomen?
-Have you had a fever?
-What color are your stools?
-Color of urine?
-Skin color? - ANSWER Patient has abdominal pain that began as indegestion but now
has constant pain in upper right quadrant. Pt. is 5'3" and 255lbs, rebound tenderness on
palpation.
What questions would you ask the patient based on these S&S?
Cholecystitis (gallbladder inflammation)/possible gallstones - ANSWER Pt. states they
ate a big mac and double french fries an hour ago and the pain started after that.
ESR=40mm/h (Normal range: 0-15 M, 0-20 F) & WBC=18,000/mcL (Normal range: 5-10k).
What is most likely the problem?
Located underneath the liver
Collects, concentrates and stores bile
Bile comes from the liver
Bile essential for fat breakdown
GB releases bile into duodenum - ANSWER What is the function of the gallbaldder:
,Bilirubin, biliary - ANSWER ____ is the primary pigment in bile. Normally conjugated and
excreted by the liver and ____ system.
bilirubin - ANSWER Higher than usual levels of ____ can indicate liver or bile duct
problems as well as other conditions
-Acute/chronic
-Inflammatory condition of the gall bladder - ANSWER What is cholecystitis?
Calculous cholecystitis (cholelithiasis) - ANSWER Irritation and inflammation result in
gall stones that obstruct cystic duct, gall bladder neck, or common bile duct
Acalculous cholecystitis - ANSWER irritation of gallbladder without gall stones
-Trapped bile reabsorbed and irritates gall bladder wall
-Reabsorbed bile, edema, impaired circulation and distention of gall bladder cause
ischemia and infection
-Tissue sloughing with necrosis and gangrene within gall bladder itself
-Gall bladder can rupture
-If perforation is large can get peritonitis
-Hyperlipidemia, rapid weight loss (causes) - ANSWER Acute cholecystitis with
Cholelithiasis:
-Chronic inflammation due to repeated episodes of duct obstruction
-Many patients are managed with these episodes in the community with emphasis on
weight loss and avoidance of fatty foods (What are fatty foods?)- anything fried, full fat
dairy (cheese, milk, cream)
-Gall bladder becomes fibrotic and atrophied
-Jaundice/icterus (these symptoms can also occur with an acute condition)
-Itching/burning of skin (Excessive build up of bile salts in the skin)
, -Bile flow blockage prevents bilirubin from going to large intestine, converting there to
urobilinogen which makes stools brown - ANSWER Chronic cholecystitis:
-Episodic or vague pain in the URQ that can radiate to right shoulder
-Pain triggered by a high fat or high volume meal
-Anorexia, nausea or vomiting
-Dyspepsia (stomach pain), eructation (burp), flatulence
-Rebound tenderness (Blumberg sign: when there is pain upon removal of pressure,
rather than application of pressure to the abdomen)
-Fever
-Jaundice
-Steatorrhea (most common with chronic disease/oily smelly stools)
-Clay colored stools - ANSWER Cholecystitis symptoms:
-Women of all ages (calculi increase with aging)
-Native American, Caucasian, Mexican American
-Obesity
-Low fat diet (rapid wt. loss/fasting)
-High fat diet
-Increased cholesterol/lipids
-Women on hormone replacement
-On cholesterol lowering drugs
-Family history/genetic factors - ANSWER Risk factors for cholecystitis:
-Pain
-Nutrition - ANSWER concepts w/ cholecystitis
-Xray/CT scan
