Symptoms of Gallbladder Disease Essay

Symptoms of Gallbladder Disease Essay

Symptoms of Gallbladder Disease Essay

Jordan is a 14-year-old middle school student who weighs 275 pounds and is 5’6” tall. Over the past 2 years, he has gained 60 pounds, has begun to withdraw from social activities, and has avoided other students due to bullying from others his age about his weight/appearance. Lately, Jordan has been missing a great deal of school too, particularly on the days he has gym. Jordan’s parents are both average in height and weight. Jordan’s mother says that he just takes after his grandfather William, who “was a husky man, and died of a sudden heart attack at the age of 44.” She says, “We just have fat genes in the family; you can’t do anything about that!” Symptoms of Gallbladder Disease Essay

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He has been told he has “…no willpower, or is weak, and that he needs to change his lifestyle, eat less, and exercise more.” Jordan says “I go for a couple days without eating, but then I get so hungry that I could eat the couch!”
Jordan has recently been diagnosed with gallbladder disease and has symptoms that typically occur after eating that include mild pain in the midepigastric region, radiating to the right upper quadrant of the abdomen and right subscapular area of the body.
You are the nurse assigned to Jordan.
1. What would you include in your initial assessment data based on the scenario provided?
2. What would you teach Jordan based on the Recommended Daily Allowance from choosemyplate.gov (Links to an external site.) discussed in Week 1 and the information provided about gallbladder disease provided in Week 6?
3. Based on your assessment data and the information from the scenario, what might be two high-priority nursing diagnoses to guide Jordan’s plan of care?Symptoms of Gallbladder Disease Essay

The most common form of gallbladder disease is cholelithiasis (gallstones).1 Cholelithiasis affects more than 20 million Americans annually, resulting in a direct cost of more than $6.3 billion.2 Gallstones generally are asymptomatic and typically are discovered during a surgical procedure for an unrelated condition or during autopsy.1,2 In the United States, cholelithiasis is the most common inpatient diagnosis among gastrointestinal and liver diseases.3,4 Although gallstones are usually asymptomatic, some patients progress to symptomatic disease. The primary clinical manifestation and complication of cholelithiasis is cholecystitis (inflammation of the gallbladder).1,2 Less commonly, patients with severe cases may develop gallstone pancreatitis, gallbladder perforation, or other gallbladder diseases  Symptoms of Gallbladder Disease Essay

Pathophysiology
Gallstones are hard, pebble-like structures that obstruct the cystic duct. The formation of gallstones is often preceded by the presence of biliary sludge, a viscous mixture of glycoproteins, calcium deposits, and cholesterol crystals in the gallbladder or biliary ducts.5 In the U.S., most gallstones consist largely of bile supersaturated with cholesterol.1,2 This hypersaturation, which results from the cholesterol concentration being greater than its solubility percentage, is caused primarily by hypersecretion of cholesterol due to altered hepatic cholesterol metabolism.1,3 A distorted balance between pronucleating (crystallization-promoting) and antinucleating (crystallization-inhibiting) proteins in the bile also can accelerate crystallization of cholesterol in the bile.1-3,5 Mucin, a glycoprotein mixture secreted by biliary epithelial cells, has been documented as a pronucleating protein. It is the decreased degradation of mucin by lysosomal enzymes that is believed to promote the formation of cholesterol crystals.3

Loss of gallbladder muscular-wall motility and excessive sphincteric contraction also are involved in gallstone formation.1 This hypomotility leads to prolonged bile stasis (delayed gallbladder emptying), along with decreased reservoir function.3,5 The lack of bile flow causes an accumulation of bile and an increased predisposition for stone formation. Ineffective filling and a higher proportion of hepatic bile diverted from the gallbladder to the small bile duct can occur as a result of hypomotility.Symptoms of Gallbladder Disease Essay

Occasionally, gallstones are composed of bilirubin, a chemical that is produced as a result of the standard breakdown of RBCs. Infection of the biliary tract and increased enterohepatic cycling of bilirubin are the suggested causes of bilirubin stone formation. Bilirubin stones, often referred to as pigment stones, are seen primarily in patients with infections of the biliary tract or chronic hemolytic diseases (or damaged RBCs).1,3,6 Pigment stones are more frequent in Asia and Africa.3,6

The pathogenesis of cholecystitis most commonly involves the impaction of gallstones in the bladder neck, Hartmann’s pouch, or the cystic duct; gallstones are not always present in cholecystitis, however.5 Pressure on the gallbladder increases, the organ becomes enlarged, the walls thicken, the blood supply decreases, and an exudate may form.2,5 Cholecystitis can be either acute or chronic, with repeated episodes of acute inflammation potentially leading to chronic cholecystitis. The gallbladder can become infected by various microorganisms, including those that are gas forming. An inflamed gallbladder can undergo necrosis and gangrene and, if left untreated, may progress to symptomatic sepsis.1,2,5 Failure to properly treat cholecystitis may result in perforation of the gallbladder, a rare but life-threatening phenomenon.2,5,7 Cholecystitis also can lead to gallstone pancreatitis if stones dislodge down to the sphincter of Oddi and are not cleared, thus blocking the pancreatic duct.Symptoms of Gallbladder Disease Essay

Risk Factors
Genetic and environmental factors contribute to gallbladder disease. Female gender, previous pregnancies, and family history of gallstone disease are highly correlated with cholelithiasis.1,3 Approximately 60% of patients with acute cholecystitis are women; however, the disease tends to be more severe in men.2 Estrogen increases cholesterol and its saturation in bile and promotes gallbladder hypomotility.1 Diminished gallbladder motility is commonly seen during pregnancy.9

Other risk factors include a high dietary intake of fats and carbohydrates, a sedentary lifestyle, type 2 diabetes mellitus, and dyslipidemia (increased triglycerides and low HDL).3,9 A diet high in fats and carbohydrates predisposes a patient to obesity, which increases cholesterol synthesis, biliary secretion of cholesterol, and cholesterol hypersaturation. However, a direct correlation between high dietary intake of fats and cholelithiasis risk has not been established because previous studies have yielded controversial results.9 Acute cholecystitis develops more frequently in symptomatic cholelithiasis patients with type 2 diabetes mellitus than in symptomatic patients without it.2 These patients also are more likely to have complications.Symptoms of Gallbladder Disease Essay

American Indians have the highest prevalence of cholelithiasis, with the disease reaching epidemic proportions in this population. Gallstone disease is also prevalent in Chilean and Mexican Hispanics.3,9 In addition to ethnicity, age plays a role in gallstone disease. Patients who develop complicated symptomatic cholelithiasis tend to be older, and the typical patient with gallstones is in her 40s.Symptoms of Gallbladder Disease Essay

Clinical Presentation
Gallstones are generally asymptomatic. In the uncommon event that a patient develops symptomatic cholelithiasis, presentation can range from mild nausea or abdominal discomfort to biliary colic and jaundice.1,5,10 Biliary colic, usually sharp in nature, is postprandial epigastric or right-quadrant pain that lasts for several minutes to several hours. The pain often radiates to the back or the right shoulder, and in more intense cases it may be accompanied by nausea and vomiting. Upper-right-quadrant tenderness and palpable infiltrate in the region of the gallbladder are revealed upon physical examination.5,10 Cholecystitis presents in the same manner; however, the obstruction of the cystic duct is persistent (rather than transient), and fever is common.10 A patient with cholecystitis also may exhibit Murphy’s sign (discomfort so severe that the patient stops inspiring during palpation of the gallbladder) or jaundice. Jaundice, a yellow discoloration of the skin and the sclera of the eyes, occurs when the common bile duct is obstructed because of an impacted stone in Hartmann’s pouch (Mirizzi’s syndrome). Other nonspecific symptoms, such as indigestion, intolerance to fatty or fried foods, belching, and flatulence, may also be present.Symptoms of Gallbladder Disease Essay

Diagnosis
Current techniques for diagnosing gallbladder disease are less invasive and allow patients to recover more quickly than was the case with earlier diagnostic procedures.10 Although the incidence of cholelithiasis is quite high in the U.S., few patients present with symptoms.4 This can complicate and prolong the diagnosis. CBC, liver-function testing, and serum amylase and lipase should be included in the laboratory tests to help discriminate between the various types of gallbladder disease and/or identify complications caused by gallbladder disease (TABLE 2).5,10

The diagnosis of cholelithiasis, cholecystitis, and other gallbladder diseases can be confirmed via a number of different imaging techniques. Ultrasonography and cholescintigraphy are the imaging studies most commonly used to diagnose cholelithiasis and cholecystitis.10 Positive findings upon ultrasonography include stones, thickening of the gallbladder wall, pericholecystic fluid, and Murphy’s sign (i.e., pain) upon contact with the ultrasonographic probe.10 Ultrasonography performed in the fasting state reveals the correct diagnosis in more than 90% of cases, but bile-duct stones may be missed in 50% of cases.Symptoms of Gallbladder Disease Essay

Cholescintigraphy, also called hepatobiliary iminodiacetic acid (HIDA) scan, is used to assess the function of the gallbladder and to diagnose acute cholecystitis. HIDA scans are not helpful in identifying cholelithiasis or chronic cholecystitis.11 In ambulatory patients, cholescintigraphy provides a correct diagnosis more than 95% of the time. However, cholescintigraphy may produce false-positive results in 30% to 40% of hospitalized patients, particularly those receiving parenteral nutrition. Ultrasonography is the preferred diagnostic method in these patients.10 Cholescintigraphy results are considered abnormal when the radioactive tracer or dye does not visualize the gallbladder, moves slowly through the bile ducts, or is detected outside the biliary system.12

If choledocholithiasis is suspected, endoscopic retrograde cholangiopancreatography (ERCP) may be beneficial. ERCP is used to identify common bile-duct stones and also may be used to remove them. ERCP is associated with complications such as pancreatitis. Noninvasive techniques, such as endoscopic ultrasonography, may be used to detect cholelithiasis, but not to remove the stones.4,11 CT may be used, but it is considered less accurate than other imaging methods, as it detects approximately 75% of gallstones.4,10 Magnetic resonance cholangiopancreatography (MRCP) is an imaging method used to detect choledocholithiasis and other abnormalities of the biliary tract. MRCP has a sensitivity of approximately 98%.Symptoms of Gallbladder Disease Essa

Treatment
Patients experiencing asymptomatic cholelithiasis do not require treatment.5 The treatment of choice for symptomatic cholelithiasis currently is laparoscopic cholecystectomy, whereas previously it was open cholecystectomy.3,10 Laparoscopic cholecystectomy is associated with a shorter hospital stay and a faster recovery period than open cholecystectomy is. Absolute contraindications to this procedure include the inability to withstand general anesthesia, an intractable bleeding disorder, and end-stage liver disease.3,5 In patients who are unable or unwilling to undergo surgery, endoscopic decompression by internal gallbladder stent can help prevent complications from developing and can serve as palliative long-term treatment.5 Nonoperative therapy, which includes dissolution of gallstones using oral bile acids and shock wave lithotripsy, may be another option in such patients. However, nonoperative therapy is time consuming and is associated with high cost, low effectiveness, and a high recurrence rate Symptoms of Gallbladder Disease Essay

The Causes of Gallbladder Attacks Outline I. Introduction: It is estimated that approxiamately 10 to 20 percent of the population in the United States and Western Europe are currently being affected by Gallbladder attacks. Thesis statement: These attacks are mainly caused by the development of gallstones in the gallbladder. II. Definition. A. Gallbladder B. Gallstones III. Causes. A. Obesity B. Estrogen C. Ethnicity D. Age and gender IV. Symptoms. A. Chronic indigestion B. Sudden, steady and moderate-to- intense pain in your upper abdomen C. Nausea and vomiting V. Diagnosis. A. Ultrasound B. Cholecystogram Conclusion It might sound interesting to explore the reason why…show more content…
Obesity is one of the major risk factors for gallstones, especially in women. A large clinical study showed that being even moderately overweight increases one’s risk for developing gallstones. Secondly, excess estrogen from pregnancy, hormone replacement therapy or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones. Ethnicity is another important factor. According to scientists, Native Americans have a genetic predisposition to secrete high levels of cholesterol in bile. In fact, they have the highest rates of gallstones in the United States. A majority of Native American men have gallstones by age 60. Among the Pima Indians of Arizona, 70 percent of women have gallstones by age 30. Mexican-Americans men and women of all ages also have high rates of gallstones. The fourth factor is Cholesterol-lowering drugs. Drugs that lower cholesterol levels in blood actually increase the amount of cholesterol secreted in bile. This in turn can increase the risk of gallstones. Another factor is rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones. Gallstones may sometimes cause certain symptoms. These symptoms include Chronic Indigestion, which have symptoms such as nausea, heartburn and bloating. Symptoms of Gallbladder Disease Essay

 

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