Gastrointestinal Disorder: Case Study
Gastrointestinal Disorder Case Study
T.B, a 60yo retiree, is admitted to your unit from the ED. Upon arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe RUQ (right upper quadrant) pain that radiates to his back, and he is more comfortable walking bent forward than lying in bed. He admits to having had several similar bouts of abdominal pain in the last month but “none as bad as this.” He feels only slightly nauseated but has experienced N/V (nausea and vomiting) during previous episodes. T.B. experienced an acute onset after eating fish and chips at a fast-food restaurant. His daughter insisted on taking him to the hospital.
Assessment findings are AAO (awake, alert, oriented) X 3 and MAEW (moves all extremities well). Moves restlessly and continually, C/O of notable fatigue. Breath sounds clear throughout, anterior and posterior. Heart sounds clear without adventitious sounds, heart rate regular, all pulses 3+ bilaterally.
Bowel sounds audible, abdominal guarding noted with exquisite tenderness to light palpation over right side, especially RUQ. Has sharp inspiratory arrest with palpation of the RUQ. Reports light-colored stools
X 1 week. Voids medium amber urine per urinal without difficulty. Skin and sclera slightly jaundiced.
Admit VS are: 164/100, 132, 26, 96.8.
1. What structures are located in the RUQ of the abdomen?
2. Which of the above mentioned organs are palpable in the RUQ?
Abdominal ultrasound demonstrates several retained stones in the common bile duct. T.B. is admitted to your floor and is scheduled for a laparoscopic cholecystectomy with T-tube insertion in the am. The doctor plans to retrieve stones from the common bile duct during an ERCP (endoscopic retrograde cholangiopancreatography) with sphincterotomy within 24-48hrs of the “lap-chole.” The T-tube will be removed after the ERCP.
3. Given T.B.’s diagnosis, what laboratory values would be
T.B, a 60yo retiree, is admitted to your unit from the ED. Upon arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe RUQ (right upper quadrant) pain that radiates to his back, and he is more comfortable walking bent forward than lying in bed. He admits to having had several similar bouts of abdominal pain in the last month but “none as bad as this.” He feels only slightly nauseated but has experienced N/V (nausea and vomiting) during previous episodes. T.B. experienced an acute onset after eating fish and chips at a fast-food restaurant. His daughter insisted on taking him to the hospital.
Assessment findings are AAO (awake, alert, oriented) X 3 and MAEW (moves all extremities well). Moves restlessly and continually, C/O of notable fatigue. Breath sounds clear throughout, anterior and posterior. Heart sounds clear without adventitious sounds, heart rate regular, all pulses 3+ bilaterally.
Bowel sounds audible, abdominal guarding noted with exquisite tenderness to light palpation over right side, especially RUQ. Has sharp inspiratory arrest with palpation of the RUQ. Reports light-colored stools
X 1 week. Voids medium amber urine per urinal without difficulty. Skin and sclera slightly jaundiced.
Admit VS are: 164/100, 132, 26, 96.8.
1. What structures are located in the RUQ of the abdomen?
2. Which of the above mentioned organs are palpable in the RUQ?
Abdominal ultrasound demonstrates several retained stones in the common bile duct. T.B. is admitted to your floor and is scheduled for a laparoscopic cholecystectomy with T-tube insertion in the am. The doctor plans to retrieve stones from the common bile duct during an ERCP (endoscopic retrograde cholangiopancreatography) with sphincterotomy within 24-48hrs of the “lap-chole.” The T-tube will be removed after the ERCP.
3. Given T.B.’s diagnosis, what laboratory values would be