U Assessment

HISTORY. Cholecystitis often begins as a mild intolerance to fatty food. The patient experiences discomfort after a meal, sometimes with nausea and vomiting, flatulence, and an elevated temperature. Over a period of several months or even years, symptoms progressively become more severe. Ask the patient about the pattern of attacks; some mistake severe gallbladder attacks for a heart attack until they recall similar, less severe episodes that have preceded it. An acute attack of cholecystitis is often associated with gallstones, or cholelithiasis. The classic symptom is pain in the right upper quadrant that may radiate to the right scapula, called biliary colic. Onset is usually sudden, with the duration from less than 1 to more than 6 hours. If the flow of bile has become obstructed, the patient may pass clay-colored stools and dark urine.

PHYSICAL EXAMINATION. The patient with an acute gallbladder attack appears acutely ill, is in a great deal of discomfort, and sometimes is jaundiced. A low-grade fever is often present, especially if the disease is chronic and the walls of the gallbladder have become infected. Right upper quadrant pain is intense in acute attacks and requires no physical examination. It is often followed by residual aching or soreness for up to 24 hours. A positive Murphy's sign, which is positive palpation of a distended gallbladder during inhalation, may confirm a diagnosis.

PSYCHOSOCIAL. The patient with an acute attack of cholelithiasis may be in extreme pain and very upset. The experience may be complicated by guilt if the patient has been advised by the physician in the past to cut down on fatty foods and lose weight. The attack may also be very frightening if it is confused with a heart attack.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

White blood

Adult males and

Infection and inflammation

Leukocytosis; WBCs range

cell count

females

elevate the WBC count

from 12,000 to 15,000/^L; if

(WBC)

4500-11,000/^L

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