Introduction
Abdominal pain is a common problem among adults characterized by multiple etiologies. Inflammation, perforation, and obstruction may lead to different disorders like appendicitis, cholecystitis, or peritonitis (Govender et al., 2021). A 37-year-old woman is presented with a 2-day history of RUQ pain. This paper focuses on the main characteristics of the patient, her diagnosis with several differential diagnoses, important diagnostic steps, treatment options, and education.
Characteristics
The female reports RUQ pain that radiates to the right scapular region. She also experiences nausea, vomiting, belching, and severe indigestion because of fatty and greasy food intake. In addition, there are cases of cholecystitis in her family medical history (the mother). Her social history is within normal limits: regular relationships with one partner, no smoking/drug use, and rare alcoholic drinks. She takes Tylenol occasionally and has a positive Murphy’s sign.
Diagnosis
Acute cholecystitis is a condition when the gallbladder is inflamed and challenged by extensive digestive fluid blocked by gallstones. In most cases, patients suffer from severe pain in the right abdomen that spreads to the right shoulder, nausea, vomiting, and fever (Bridges et al., 2018). Another important factor in proving the female’s diagnosis is a positive Murphy’s sign. The absence of fever can be explained by her occasional taking of Tylenol and the severity of the disease. My diagnosis for this patient is acute cholecystitis as well because of her family history and the absence of other signs like hematochezia or jaundice.
Differential Diagnoses
Appendicitis is one of the diagnoses to be considered due to abdominal pain in the right quadrant, nausea, and vomiting. Still, its probability is low because fever and appetite problems are not reported, and the pain lasts two days, while appendicitis is characterized by sudden pain. Gastritis is another alternative because a perforated ulcer causes severe pain, vomiting, nausea, and belching (Govender et al., 2021). However, the probability of this condition is also low due to no bleeding, and pain is long-lasting, not with short bursts. Finally, the same symptoms are present in biliary colic, but no jaundice, dark urine, and rapid heartbeat prove a low probability.
Diagnostics
Acute cholecystitis diagnosis is based on the results of several exams and procedures. In addition to a physical examination (Murphy’s sign), a complete blood count test is important to check the number of white blood cells (normal levels in chronic patients and elevated in acute cholecystitis). Computerized tomography (CT) is usually ordered to check the condition of the gallbladder, and if the diagnosis is still unclear, cholescintigraphy is required to detect bile flows (Bridges et al., 2018). Although CT is the most common diagnostic tool in abdominal pain assessment, its evaluation of the biliary tract remains low.
Treatment
The patient has to be hospitalized for further observations, and her treatment should include dietary and pharmacological interventions. Fasting helps minimize stress on the gallbladder, and regular fluid intake prevents dehydration. Antibiotics are administrated depending on the condition’s severity: cephalosporin (mild or moderate cholecystitis) or metronidazole (culture-proven anaerobic infection) (Giles et al., 2020). Laparoscopic cholecystectomy is necessary if severe symptoms do not disappear within the next two days (Giles et al., 2020). The use of other medications should be properly discussed with a doctor.
Education
To succeed in managing acute cholecystitis, communication with the patient plays an important role. Following a liquid diet is recommended to reduce and facilitate the cases of vomiting. High-fat food must be avoided until complete recovery, and counseling with a nutritionist might help choose the most appropriate diet. The patient should stay in bed for at least two days, and nurses monitor her vital signs to check the effectiveness of the chosen treatment course.
Conclusion
The patient’s family history puts her at risk of cholecystitis. This condition is a common health problem, and people need to know how to avoid complications. The patient’s dietary habits must be improved to predict the progress of new abdominal problems. Today, there are many approaches to diagnosing and treating acute cholecystitis. In this case, all precautionary methods and guidelines are followed to ensure the woman gets the best care and education.
References
Bridges, F., Gibbs, J., Melamed, J., Cussatti, E., & White, S. (2018). Clinically diagnosed cholecystitis: A case series. Journal of Surgical Case Reports, 2018(2). Web.
Giles, A. E., Godzisz, S., Nenshi, R., Forbes, S., Farrokhyar, F., Lee, J., & Eskicioglu, C. (2020). Diagnosis and management of acute cholecystitis: A single-centre audit of guideline adherence and patient outcomes. Canadian Journal of Surgery, 63(3), 241-249. Web.
Govender, I., Rangiah, S., Bongongo, T., & Mahuma, P. (2021). A primary care approach to abdominal pain in adults. South African Family Practice, 63(1). Web.