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Symptoms
Cholecystitis is usually characterized by abdominal pain in the right upper quadrant (RUQ) or epigastrium that may radiate to the back (Bridges, Gibbs, Melamed, Cussatti, & White, 2018). In 50% of cases, high-fat meals aggravate the pain; however, some patients may have pain only present on palpation of the abdomen (Bridges et al., 2018). The pain is sometimes accompanied by nausea, vomiting, fever, and leukocytosis (Bridges et al., 2018).
Distinguishing Features
According to the National Organization of Rare Disorders (NORD, n.d.), the distinguishing feature of the disorder is the localization of pain in RUQ, which appears tender during palpation. It is common in patients with gallstone obstruction and gallbladder cancer (NORD, n.d.). Females are more likely to develop the disease; however, males usually have more severe symptoms (NORD, n.d.).
First Intervention
Before the examination, it is vital to take the history of the present illness following the PQRSTU mnemonic. It is recommended to avoid giving any medicine orally and immediate surgery may be needed (NORD, n.d.). After that, a physician should proceed to palpation with special attention to the RUQ. In case of the presence of typical symptoms of cholecystitis and a history of gallstones, patients should be prepared for surgery.
Diagnosis Confirmation
There is no single test to confirm the diagnosis; therefore, a series of procedures is required. According to NORD (n.d.), the usual methods are abdominal ultrasound and hepatobiliary scintigraphy. In addition, a blood test should be made and temperature is to be taken to check for inflammation.
Treatment, Referral, and Follow-up Visit
According to Itoi (2017), the standard treatment for the condition is cholecystectomy, which is the removal of the entire gallbladder. Therefore, after the confirmation of the diagnosis, the patient is to be referred to a surgeon for further consultations. The follow-up visit is to be scheduled for two weeks after the surgery.
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.
Itoi, T. (2017). New era in acute cholecystitis treatment: encouraging results for interventional endoscopists. Gastrointestinal Endoscopy, 85(1), 88-89. Web.
National Organization of Rare Disorders. (n.d.). Acute cholecystitis. Web.
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