11.17 Learning Activities
Learning Activities
GI Case Study 1 (Case Study answers are located in the Answer Key at the end of the book.)[1]
Mrs. G.B. is a 38-year-old female who presents to the emergency department with complaints of severe abdominal pain. G.B reports that she has had similar pain intermittently over the past week; however, tonight her pain has become constant and unbearable. She reports that the pain usually starts on the upper right side of her abdomen and radiates to her back. The pain often occurs at night after eating dinner, particularly after eating fatty foods. She reports nausea but no vomiting and explains that she has taken ibuprofen and antacids but neither have helped her symptoms.
Physical Exam
Upon exam, G.B.’s vitals are found to be as follows:
HR: 106, RR: 16, BP: 148/95, Temp: 100.6 F, Pulse ox: 98%
G.B. appears uncomfortable and is sweating. G.B. reports it feels better for her to lie in bed and not move. When G.B. is assessed, the right side of her abdomen below her rib cage is palpated during inspiration. She reports increased pain to the point that she gently pushes the examiner’s hands away.
Abnormal Laboratory Values
- WBC – 15.4 cells/mm3
- CRP – 18.3
Past Medical History
- Obesity, BMI of 31
- Mother of 2 children, ages 3 and 5 years
- Gestational diabetes with both pregnancies
- Hypertension, diagnosed 1 year ago, mild and not treated with medication at this time
- Cesarean section, age 35 and 33
Pertinent Family History
- Father alive and healthy age 71
- Mother with a history of obesity, hypertension, and gallstones, alive and age 70
- Brother with a history of obesity, alive and age 41
- Sister alive and healthy, age 36
Pertinent Social History
- Client works for a local hospital doing IT assistance, has worked there for ten years
- Client’s hobbies include reading, knitting, and baking
- Client reports difficulty with attempts at weight loss, prefers to not go to the gym or be seen working out in public environment
After assessing the client, the health care provider states, “The client’s pain could be caused by cholecystitis.”
Questions:
- Symptoms of gallbladder disease often resemble those of other GI diseases. Which group of symptoms suggests cholecystitis?
A) Pain in the right lower quadrant, leukocytosis, low-grade fever
B) Pain in the right upper quadrant, low-grade fever, bloody stools
C) Pain in the right upper quadrant that radiates to the right shoulder or back, positive Murphy’s sign, bloody stools
D) Pain in the right upper quadrant that radiates to the right shoulder or back, positive Murphy’s sign, low-grade fever
- What diagnostic tests can be used to confirm a diagnosis of cholecystitis?
- Why are G.B.’s symptoms triggered by eating and/or eating fatty foods?
- Which best describes the role of the gallbladder?
A) Similar to the appendix, the gallbladder has little known physiologic function. Because of this, it can be removed without any consequence to the client.
B) The gallbladder