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i-Human Case Week #7 i-Human Case Study

The i-Human Case Week #7 focuses on the evaluation, diagnosis, and management of a 40-year-old female patient presenting with symptoms indicative of potential biliary disease. The case is an excellent opportunity for students to apply clinical reasoning, diagnostic skills, and evidence-based management strategies to address a complex clinical scenario.

At ihumanassignmenthelp.com, we provide expert guidance to help students analyze and solve such cases efficiently. Below is a detailed breakdown of the case, along with insights on how to approach it.

i-Human Case Week #7 i-Human Case Patient Presentation

The patient presents with the following symptoms:

  • Chief Complaint: Intermittent, gnawing, and crampy right upper quadrant (RUQ) pain radiating to the right shoulder for two weeks, now constant for the past two days.
  • Associated Symptoms:
    • Nausea, vomiting, anorexia, and food intolerance.
    • Low-grade fever.
    • Pale-colored stool and dark yellow urine.
  • Physical Exam Findings:
    • Mild scleral icterus.
    • RUQ tenderness with guarding.
    • Positive Murphy’s sign.

Additionally, the patient has a family history of biliary disease, as her mother underwent a cholecystectomy for cholelithiasis.

i-Human Case Week #7 i-Human Case Key Findings and Diagnostic Considerations

1. History Analysis

The patient’s history highlights classic symptoms of biliary disease, including:

  • Right Upper Quadrant Pain: Often associated with gallbladder issues such as cholelithiasis or cholecystitis.
  • Radiating Pain to the Right Shoulder: Suggests irritation of the diaphragm, a hallmark of biliary pathology.
  • Pale Stool and Dark Urine: Indicative of bile flow obstruction, potentially due to gallstones or inflammation.

2. Physical Exam Findings

  • Mild Scleral Icterus: Suggests hyperbilirubinemia, likely from bile duct obstruction.
  • Positive Murphy’s Sign: Highly indicative of acute cholecystitis, as it signals gallbladder inflammation when palpating the RUQ during inspiration.

Differential Diagnoses

  1. Acute Cholecystitis
    1. Rationale: The combination of RUQ pain, nausea, vomiting, anorexia, and a positive Murphy’s sign strongly suggests acute inflammation of the gallbladder.
    1. Supporting Evidence: Family history of biliary disease and symptoms of bile obstruction, such as pale stools and dark urine.
  2. Choledocholithiasis
    1. Rationale: The presence of pale stools, dark urine, and mild scleral icterus raises concerns for a stone in the common bile duct.
    1. Supporting Evidence: Similar symptoms overlap with acute cholecystitis, but imaging is crucial to confirm this diagnosis.
  3. Gallstone Pancreatitis
    1. Rationale: Gallstones can obstruct the pancreatic duct, causing inflammation of the pancreas.
    1. Supporting Evidence: The patient’s symptoms of pain, nausea, and vomiting align with this condition, but the absence of severe epigastric pain reduces its likelihood.

Recommended Diagnostic Studies

  1. Laboratory Tests
    1. Complete Blood Count (CBC): To check for leukocytosis, indicative of infection or inflammation.
    1. Liver Function Tests (LFTs): Elevated bilirubin and alkaline phosphatase levels may suggest bile duct obstruction.
    1. Amylase and Lipase: To rule out gallstone pancreatitis.
    1. C-Reactive Protein (CRP): To assess the severity of inflammation.
  2. Imaging Studies
    1. Ultrasound of the Abdomen: The first-line imaging modality to identify gallstones, assess gallbladder wall thickening, and detect pericholecystic fluid.
    1. Magnetic Resonance Cholangiopancreatography (MRCP): To visualize bile ducts and confirm choledocholithiasis if suspected.
  3. HIDA Scan (Hepatobiliary Iminodiacetic Acid Scan)
    1. Used if ultrasound results are inconclusive. This scan evaluates gallbladder function and confirms acute cholecystitis.

Management Plan

Acute Management

  1. Hospital Admission:
    1. Patients with acute cholecystitis require hospitalization for close monitoring and management.
  2. Medical Management:
    1. NPO (Nothing by Mouth): To rest the gastrointestinal tract.
    1. IV Fluids: To maintain hydration.
    1. Analgesics: For pain control.
    1. Antibiotics: Broad-spectrum antibiotics (e.g., ceftriaxone with metronidazole) to treat potential infections.
  3. Surgical Consultation:
    1. Cholecystectomy: Laparoscopic removal of the gallbladder is the definitive treatment for acute cholecystitis.
    1. In cases of severe inflammation or complications, delayed surgery may be necessary after medical stabilization.

Family Education

  1. Understanding the Condition:
    1. Educate the family about the nature of acute cholecystitis and its link to gallstones.
    1. Explain the importance of timely intervention to prevent complications such as gallbladder perforation or sepsis.
  2. Postoperative Care:
    1. Discuss dietary modifications, such as avoiding high-fat foods, to prevent future biliary complications.
    1. Emphasize the need for follow-up visits to monitor recovery.
  3. Genetic Predisposition:
    1. Address the family history of biliary disease and encourage family members to seek medical evaluation if they experience similar symptoms.

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