The present case scenario examines the story of a 46-year-old woman who had been experiencing RUQ pain for the past 24 hours. Notably, the pain started one hour after dinner, with episodes of nausea and vomiting already present in the patient’s history before the visit. The woman’s baseline vital signs (temperature, HR, BP) and neurological patterns are normal, although she suffers from grade II diabetes and gout and has several allergies, including medications.
Based on the above information, it can be assumed that one of the causes of these symptoms, given the location of the pain, is biliary colic. Evidence suggests that biliary colic is caused by eating large quantities of fatty foods, which leads to the formation of gallstones in the cystic duct, resulting in obstruction (Sigmon et al., 2022). Causes for stone formation are excess cholesterol and bilirubin in the patient’s diet; when the gallbladder contracts, bile is released into the duodenum for further emulsification. If gallstones have been formed, the release causes them to become stuck, forcing sharp but constant pain (Sigmon et al., 2022). It can be concluded that the woman has probably already suffered from gallstones for some time, and the pain increased after consuming fatty foods. Increased levels of ACT in the blood may indicate damage to the liver structures, including the gallbladder, which allows confirmation of this diagnosis (Robinson, 2021). It is possible to rule out other disorders related to alcohol or drug use, or psychological illness based on tests and the patient’s history. The patient’s skin condition also allows ruling out acute cholangitis, as there is no history of jaundice or pruritus.
It is worth clarifying that biliary colic is a temporary painful condition, which can progress as dietary prescriptions are not followed. Treatment is based on laparoscopic cholecystectomy, surgery to remove the gallbladder (Sigmon et al., 2022). After removal, the woman must follow a strict diet for several months, minimizing fatty foods and increasing drinking water intake. Indeed, the patient can refuse surgical intervention in favor of drug therapy. However, it is worth warning her that the gallbladder may contain several stones, which increase the likelihood of recurrence. Drug therapy uses symptomatic medications, including antiemetics and pain relievers, as well as ursodeoxycholic acid (Actigall, Urso, Urso Forte), which dissolves gallstones (Ursodiol, 2019). Using this drug therapy will reduce pain and gradually dissolve gallstones without surgery.
References
Robinson, J. (2021). What is an aspartate aminotransferase (AST) test? WebMD. Web.
Sigmon, D. F., Dayal, N., & Meseeha, M. (2022). Biliary colic. NIH.
Ursodiol. (2019). Medline Plus. Web.