Maria Gonzalez’s Case Study

QUESTION

Maria Gonzalez is a 46-year-old female. She arrived in the emergency department, complaining of nausea, vomiting and severe upper abdominal pain that she describes a shirt, penetrating and reading to mid back. This pain radiates to her right shoulder. Mrs. Gonzalez explains that she has experience intermittent abdominal pain over the last month after eating.

What structures or organs are you concerned about? AKA what is your differential diagnosis?What lab results would you want for this patient ?

What is the name of the sign when you push on the upper right quadrant and then the patient has severe pain when releasing that pressure? 

An ultrasound reveals Cholelithiasis and biliary sludge  and she is diagnosed with acute biliary pancreatitis. Last glucose stick was four hours ago and was 110 MG/ML.

What is the common type of surgery for removing the gallbladder?

What other organs are affected, if gallstones block, the common Billary duct ?A common organ affected by cholecystitis is the pancreas . What are the signs and symptoms of pancreatitis?

If Maria was a diabetic, should she be worried that she has pancreatitis?

What effect does pancreatitis have on insulin or glucagon?

ANSWER

In the case of Maria Gonzalez, the following structures or organs are of concern

Gallbladder: The severe upper abdominal pain that radiates to the right shoulder, particularly after eating, raises suspicion of gallbladder involvement.

Biliary system: The presence of cholelithiasis (gallstones) and biliary sludge on the ultrasound suggests potential obstruction or inflammation in the biliary system.

Based on the presenting symptoms and the findings suggestive of gallbladder involvement, the differential diagnosis would include

Acute cholecystitis: Inflammation of the gallbladder typically caused by gallstones obstructing the cystic duct.

Biliary pancreatitis: Inflammation of the pancreas that occurs when gallstones obstruct the common bile duct, leading to the backup of digestive enzymes and subsequent pancreatic injury.

To further evaluate Maria Gonzalez, the following lab results would be important

Liver function tests: To assess for any signs of liver dysfunction or obstruction in the biliary system.

Amylase and lipase levels: These pancreatic enzymes are often elevated in cases of pancreatitis.

The sign where severe pain is elicited upon palpation of the upper right quadrant and then released is called Murphy’s sign. It is a clinical finding commonly associated with acute cholecystitis.

The common surgical procedure for removing the gallbladder is laparoscopic cholecystectomy. It involves making several small incisions in the abdomen to insert a laparoscope and other surgical instruments to visualize and remove the gallbladder.

If gallstones block the common bile duct, the affected organs include

Pancreas: Obstruction of the common bile duct can lead to biliary pancreatitis, where the digestive enzymes from the pancreas cannot flow freely into the duodenum. This can cause pancreatic inflammation and injury.

The signs and symptoms of pancreatitis may include

Severe abdominal pain: Typically located in the upper abdomen and can radiate to the back.

Nausea and vomiting.

Elevated amylase and lipase levels.

If Maria Gonzalez is diabetic, she should be concerned about pancreatitis as it can further complicate her condition. Pancreatitis can cause disruption in insulin production and release, leading to uncontrolled blood glucose levels.

Pancreatitis affects the balance between insulin and glucagon, the two hormones involved in regulating blood glucose levels. The inflammation of the pancreas can impair the production and release of insulin, leading to inadequate control of blood sugar levels. Additionally, glucagon, which raises blood glucose levels, may be dysregulated, further contributing to the imbalance in glucose control.

In summary, Maria Gonzalez’s symptoms and ultrasound findings suggest acute biliary pancreatitis likely caused by cholelithiasis. Further evaluation through lab tests, such as liver function tests and amylase/lipase levels, is needed. Surgical removal of the gallbladder through laparoscopic cholecystectomy is the common treatment. Pancreatitis can have significant implications for blood glucose control in diabetic patients, and prompt management is necessary to prevent complications.