A.

Output Template

1. Study of the Illness Condition

ASSESSMENT ANATOMY PHYSIOLOGY PATHOPHYSIOLOGY ANALYSIS

GALL BLADDER In the exam it was revealed that the
Subjective cues: 1) See page # patient is obese and has hypertension
The patient verbalized that he: The gallbladder is a sac which is a risk factor for acute
- Feels abdominal pain for the located under the liver. It
cholecystitis.
past 3-4 days stores and concentrates bile
- Pain in epigastric area produced in the liver. Bile
The patient is experiencing acute
radiates to RUQ aids in the digestion of fat and
- Took analgesic for pain is released from the cholecystitis due to the formation of
- Experienced similar pain gallbladder into the upper gall stones (cholelithiasis) which
before but did not have any small intestine in response to blocked the cystic duct backing up
diagnostic workup food (especially fats. bile into the gall bladder. This caused
the irritation of the gall bladder wall
Objective cues: BILE DUCT which stimulated the nerves of the
- Looks pale The common bile duct is a
foregut causing pain in the epigastric
- obese / 209 lbs. (94 kg) small, tube-like structure
- one episode of vomiting formed where the common area that radiates to RUQ. The
- tenderness to palpation to hepatic duct and the cystic patient felt this pain but left it
his epigastric and RUQ duct join. Its physiological role unattended by drinking analgesics to
is to carry bile from the minimize the pain. With the continued
Vital Signs: gallbladder and empty it into irritation, it increased gall bladder
- Blood pressure: 140/90 the upper part of the small
lumen pressure and decreased blood
mmHg (hypertensive) intestine (the duodenum).
- Pulse: 70 b / mins The common bile duct is part flow to gall bladder causing
- Temperature: 38 0 C of the biliary system. inflammation which triggered cytokine
(pyrexia) release causing vomiting,
- Respiration rate: 21 b / min tachycardia, and fever. The
(tachypnea) inflammation self-perpetuated
- Height: 5’1” overtime, causing the worsening of
- Weight: 209 lbs. (94 kg)
the condition. The worsening of the
(obese)
Laboratory result:
Blood examination
Haemoglobin – 14.2g/dl (normal)
WBC – 16.2/mm3 (elevated)
Platelets – 250-109/L (normal)
Sodium – 135mmol/L
(hyponatremia)
Potassium – 4.8mmol/L (normal)
Urea – 7.5mmol/L (normal)
Creatinine – 80µmol/L (normal)
Urinalysis
Appearance – clear (normal)
Color – dark yellow (bile duct issue)
pH – 5.0 (normal)
Protein – negative (normal)
Sp. Gravity – 1.005 (normal)
Glucose – negative (normal)
WBC – 0-1 (normal)
RBC – 0-1 (normal)
Fecalysis
Color – light brown (bile duct issue)
Consistency – Soft (normal)
Occult Blood - negative (normal)
Diagnostic Procedures:
CT scan
Abdominal Exam
Reference/s:
https://my.clevelandclinic.org/
health/diseases/15265-
gallbladder-swelling--
inflammation-cholecystitis
Reference/s:
https://www.hopkinsmedicine.
org/health/conditions-and-
diseases/gallbladder-
disease#:~:text=The%20gallb
ladder%20is%20a%20sac,to
%20food%20(especially%20f
ats).
Reference/s:
https://calgaryguide.ucalgary.ca/acute
-cholecystitis/
https://www.hopkinsmedicine.org/heal
th/conditions-and-
diseases/gallbladder-
disease#:~:text=The%20gallbladder%
20is%20a%20sac,to%20food%20(es
pecially%20fats).
condition caused the pain felt by the
patient to persist and increase.
Discuss the indications for the
laboratory examinations:
The laboratory examination showed
abnormal results for:
WBC: due to the inflammation the
WBC release is triggered causing
elevation. This also signifies of an
infection which is complimented by
the fever.
Sodium level: Sodium decreases as
infection ascends from gallstone
colonization to bactibilia to bacteremia
Urinalysis:
Dark urine (dark yellow) – due to the
inflamed vessels, it becomes more
permeable causing fluid leakage from
blood into the colon.
Fecalysis:
Light brown: light colored stool are
signs of infection, inflammation, or
blockage of bile duct
Diagnostic Procedure:
CT scan: Computed tomography (CT)
scan is a useful diagnostic tool for
detecting diseases and injuries. It
uses a series of X-rays and a
computer to produce a 3D image of
soft tissues and bones. CT is a
painless, noninvasive way for your
healthcare provider to diagnose
conditions.

Abdominal exam: The abdominal

examination is performed with the
patient lying supine. The examiner
should begin by giving their formal
introduction and then approach the
patient and perform the examination
from the right side of the patient.

Reference/s:
https://calgaryguide.ucalgary.ca/acute
-cholecystitis/
 PATHOPHYSIOLOGY OF CHOLECYSTISIS

CHOLECYSTITIS RISK FACTORS:

SIGNS & SYMPTOMS

ETIOLOGY  Being female
MANIFESTED  Pregnancy
 Hormone therapy
 Gall stones  Older age
Subjective: Other causes include:  Being Native American or
- Pain for 3-4 day  Injury to the abdomen from Hispanic
- Radiating pain from burns, sepsis or trauma, or  Obesity
epigastric area to RUQ because of surgery  Losing or gaining weight
Objective:
 Shock rapidly
- Vomiting
 Immune deficiency  Diabetes
- Fever
- Tachypnea  Prolonged fasting
- Light brown stool  Vasculitis
- Dark yellow urine
- hyponatremia
INTERVENTIONS/TREATMENT COMPLICATIONS:

DIAGNOSTIC EXAM Peritonitis

Fasting
Fluid through a vein in your arm Gangrene
Antibiotics Perforation
CT scan
Pain medications Gall bladder rupture
Abdominal exam
Surgery (Cholecystectomy) sepsis
 2. Surgical Procedure and Instruments Used
Surgical Procedure
CHOLECYSTECTOMY
A cholecystectomy is surgery to
remove your gallbladder. The
gallbladder is a small organ under
your liver. It is on the upper right side
of your belly or abdomen. The
gallbladder stores a digestive juice
called bile which is made in the liver.
Open (traditional) method. In this
method, 1 cut (incision) about 4 to 6
inches long is made in the upper
right-hand side of your belly. The
surgeon finds the gallbladder and
takes it out through the incision.
Laparoscopic method. This
method uses 3 to 4 very small
incisions. It uses a long, thin tube
called a laparoscope. The tube has a
tiny video camera and surgical tools.
The tube, camera and tools are put
in through the incisions. The surgeon
does the surgery while looking at a
TV monitor. The gallbladder is
removed through 1 of the incisions.
Instruments Category Functions
Name Image
 LAPARASCOPE Laparoscopic Accessories Surgical scopes are one of the oldest
instruments used by medical
practitioners since ancient times.
Modern surgical laparoscopes used for
minimally invasive procedures are a far
cry from the simple hollow tubes that
gradually developed to include lenses
for magnified vision. Today, scopes are
more like an apparatus with multiple
parts that include a CCD camera,
viewing device, lens cleaner, and an
energy-supply device.
 ELECTROCAUTERY Energy sealing and dissecting The hook can be used to clear
HOOK cautery unwanted tissue beside linear
structures by passing the hook into the
tissues parallel to the structure, and
then rotating it to hook up strands of
unwanted tissue. The tissue to be
divided is held away from underlying
tissue to prevent inadvertent damage.
 LAPARASCOPIC Laparoscopic accessory/imaging With this improved image quality
CAMERA cameras, the surgeon can more readily
identify the relevant anatomy.
Nowadays, systems that produce
three-dimensional images are currently
under development and seem to
facilitate surgical performance
 VERESS NEEDLE Laparoscopic accessory Disposable and reusable Veress
needles for creating
pneumoperitoneum are available.
Veress needle is used to create the
initial pneumoperitoneum. A trocar can
be introduced safely because the
distance from the abdominal wall to the
organs is increased. The Veress
needle technique is the most widely
practiced method to access the
peritoneal cavity.

 BIPOLAR Dissector/grasping The bipolar forceps securely grasp

FORCEPS tissue, precisely dissect, and are able
to effectively coagulate small as well as
very large blood vessels (2 mm to 20
mm), alleviating the need for surgical
clips or staples.

 NEEDLE HOLDERS Grasping/holding A needle holder is used by

laparoscopic surgeons to hold suturing
needles when closing wounds. Forming
slip-knots to close wounds and surgical
incisions requires precise skills.
Suturing can often be tricky to use
owing to the property of “memory”
which causes tissue to resist
deformation. Needle holders have
three parts – the jaws, joints, and
handles. The instrument is classified as
straight or curved depending upon the
shape of the jaws.
 HOOK SCISSORS Cutting Hook scissors are particularly suitable
for transecting ligature fibers and for
tissue transection
 SUTURE PASSER Ligation and hemostasis There are various types of sutures
DEVICE passers available for closure of ports
and transfacial ligature. The thread
passer has a side slit to carry the
thread into the peritoneal cavity on one
side to the trocar. Once the thread is in
the peritoneal cavity, the instrument is
introduced on the other fascia side and
the thread is pulled out closing the
fascia defect caused, for example, by
the trocar insertion. This procedure
should be performed under
laparoscopic view and guidance.

 IRRIGATION-SUCTION Accessories and implants Irrigation-suction: During diagnostic

SET and surgical laparoscopy, it is
commonly necessary to drain fluids
and irrigate wound surfaces until they
are clean and can be viewed
adequately. Irrigation is used to clear
debris or blood when bleeding is
encountered, if a strong irrigation
pressure is applied it can be helpful to
clearly identify the origin of a bleeding.
Suction is performed either by means
of a central vacuum supply system or
with an additional suction pump that
works usually better. Different
laparoscopic suction instruments have
been designed to remove irrigation fluid
or intraperitoneal air and smoke.

 TOOTHED FORCEPS grasping Toothed forceps (claw forceps) are

used to grasp and liberate solid organs.
In a laparoscopic cyst extirpation, to fix
the ovary properly and remove the
cystic capsule, it is crucial strong
grasping forceps. Forceps with pointed
 ends are used for tissue dissection and
surgical plane development

Reference/s:
https://my.clevelandclinic.org/health/treatments/7017-laparoscopic-cholecystectomy-gallbladder-removal

https://www.laparoscopic.md/surgery/instruments