Casestudieslivergbpancreas PDF

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Case Studies for Liver, Gallbladder and Pancreatic Disorders Case A: Ms. K is a 43-year-old high school teacher, overweight, with a high-fat diet. Over the last week, she experienced jaundice and abdominal pain. She saw her NP who made a preliminary diagnosis of gallstones; liver function tests are normal and a GB ultrasound was scheduled. However, before the sonogram, Ms. K became acutely ill at a school dinner. When she arrived in the emergency room, she was doubled over in pain and hypotensive, with tachycardia and cool, clammy skin. 1. Which of her signs and symptoms are most likely to be an adaptive response to her illness? Explain the pathophysiology of this. Ms. K is dealing with jaundice which may be due to her larger than normal gallstones that are obstructing the flow. Gallbladder symptoms tend to present themselves after consumption of meal that are high in fat (I should know as I had my gallbladder removed after years of dealing with the pain). A blockage of the common bile duct or cholelithiasis can cause the symptoms of tachycardia, hypotension, and cool clammy skin. These symptoms are similar to obstructed stones in the gallbladder, but it is differentiated by the evidence of jaundice, dark urine, lighter stools, tachycardia, abrupt hypotension, fever, chills, nausea and vomiting and severe right upper quadrant pain. M. K’s symptoms may be showing signs of a current infection of the bile duct. 2. What are possible causes of Ms. K’s pain and symptoms? Ms. K is experiencing colicky biliary abdominal pain. This can come from many different things but what this shows is that there is an obstruction (gallstone) in the biliary flow. Gallstones can be caused by abnormal composition of bile, bile stasis, and an inflammation of the gallbladder. Cholesterol stones would be seen in women who are obese or pregnant. Jaundice occurs from the obstructed flow. Ms. K’s remaining symptoms, tachycardia, hypotension, and cool and clammy skin are most likely due to cholelithiasis. This means there is a stone stuck in the common bile duct which can also lead to jaundice, dark urine, lighter stools, tachycardia, hypotension, fever, chills, nausea and vomiting, and sever right upper quadrant pain. 3. What are some treatment options for Ms. K? One treatment option would be to have the gallbladder removed (cholecystectomy) this can be done with a laparoscopic or open procedure. Other options include an open/laparoscopic choledocholithotomy, nonsurgical removal of the stones, dissolution therapy, lithotripsy, an ERCP with endoscopic sphinectomy and medications to assist with pain control. 4. Ms. K’s blood glucose is elevated. She asks if this means she has diabetes. How would you respond? Ms. K you are not diabetic. The combination of a high intake of sugar and carbs that are converted into sugar can increase your risk of developing gallstones and elevate your blood sugar. A high fat diet can also increase your risk. Your body is also under stress of dealing with the pain and potential gallstones which will increase your blood sugar. In order to combat this, you will want to adapt a low-fat, low-sugar, and low-carb diet.

Case B:

A 24 year old woman comes to the urgent care clinic with complaints of a yellow discoloration of her skin, itching, anorexia, malaise, fatigue and myalgia. Her history includes no chronic diseases, and she denies eating uncooked seafood, use of IV drugs, blood transfusions or tattoos. She has a 2 year old daughter in day care. 1. What are possible causes of her symptoms? There is evidence that she could be experiencing hepatitis A. 2. What tests could be done to confirm the cause? Tests to be used in order to confirm this diagnosis would be AST and ALT (liver enzymes), bilirubin, immunoglobulins (IgM, anti-HAV), and a liver panel. 3. What is the most important mode of transmission of the most likely cause of her symptoms? Hepatitis A is transmitted through fecal-oral route. It is stated that she has a 2-year-old at home which means she very easily could have gotten it from a viral spread around day care. This is due to the oral behavior exhibited in this age group with the lack of potty-training that has occurred. It is also possible that she contracted this disease through an infected food service worker. 4. What methods could be used to protect family members from getting the disease? The biggest way to combat this is strict handwashing. gloves should also be utilized when it is necessary. Do not share personal items. There is also a vaccine for Hep A. Food safety is important as well, ensure that your food is thoroughly washed and cooked through before consuming. The above will help you avoid the mode of transmission which is fecal-oral. 5. She is concerned about the long-term consequences of this disease. What teaching could you provide? Her body should make a full recovery within weeks to months and, there should not be any long-term complications. Once contracting this disease her body will build up an immunity which will prevent her from contracting it again. The only real consequence is she is now ineligible to donate blood. Other teaching, I will provide is to contact her PCP if her symptoms continue or worsen.

Case C:

Mr. M is a 60-year-old man brought to the ED vomiting large amount of bright red blood. He has a history of chronic alcoholism. 1. What are some possible causes of these symptoms? The possible causes of Mr. M’s symptoms is esophageal varices. 2.

Describe the pathophysiologic cause of this disorder? This is caused due to an increase in pressure within the portal vein. The increase in pressure causes lateral channels to develop in the veins of the esophageal walls this is often present in cirrhosis.

While hospitalized Mr. M becomes acutely disoriented. 3. What are some possible causes for this disorientation? What further assessments you be made? Some possible causes of Mr. M’s disorientation can be due to hepatic encephalopathy that occurs from the cirrhosis. His symptoms can also be from the alcohol withdrawal. Further assessments needed would be a CT, blood ammonia levels, a liver panel to test function and enzyme levels, and a mental status examination. I will also be assessing for tremors that can occur while a person is withdrawing from alcohol. 4. What is the pathophysiologic cause of this disorder? There is a buildup of ammonia with hepatic encephalopathy. This is due to the impaired function of the liver from the alcoholism. The liver is unable to convert ammonia into urea which causes a buildup of toxins in the blood and brain cells the damage caused an impaired detox ability which is what contributes to the high levels. 5. What is the recommended treatment for Mr. M during this hospitalization? Lactulose is recommended for treatment during Mr. M’s hospitalization. Lactulose will attract ammonia and remove it from the body through the stool. Mr. M will also be placed on a low-protein diet to decrease the amount of ammonia circulating in his system. Betablockers and clotting factors may also be important due to the bleeding and portal hypertension....