Question

Gastrointestinal Disorders Case Study 4 Name - Class/Group Date Group Members INSTRUCTIONS: All questions apply to this case study. Your responses should be brief and to the point. Adequate space has been provided for answers. When asked to provide several answers, they should be listed in order of priority or significance. Do not asume Information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it. rd than lying in bed. He this. He feels only slightly an acute onset af Scenario T.B., a 60-year-old retiree, is admitted to your unit from the ED lemergency department). Upon arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. Indicates that he has severe RUQ (right upper quadrant) pain that radiates to his back, and he is more comfortable walking bent forward than lying in bed. He admits to having had several similar bouts of abdominal pain in the last month but none as bad as this." He feels only slightly nauseated but has experienced NV (nausea and vomiting) during previous episodes. T.B. experienced an acute onset after eating fish and chips at a fast-food restaurant. His daughter insisted on taking him to the hospital. Assessment findings are AAO (awake, alert, oriented) x 3 and MAEW (moves all extremities well). Moves restlessly and continually, C/O of notable fatique. Breath sounds clear throughout, anterior and posterior. Heart sounds clear without adventitious sounds, heart rate regular, all pulses 3+ bilaterally Bowel sounds audible, abdominal guarding noted with exquisite tenderness to light palpation over R side, especially RUQ (right upper quadrant). Has sharp inspiratory arrest with palpation of the RUQ. Reports light-colored stools x 1 week. Voids medium amber urine per urinal without difficulty. Skin and sclera slightly jaundiced. Admit VS are 164/100, 132, 26, 36° C. 1. What structures are located in the RUQ of the abdomen? 2. Which of the above mentioned organs are palpable in the RUQ? Abdominal ultrasound demonstrates several retained stones in the common bile duct. T.B.is admitted to your floor and is scheduled for a laparoscopic cholecystectomy with T-tube insertion in the AM. The doctor plans to retrieve stones from the common bile duct during an ERCP (endoscopic retrograde cholangiopancreatography) with sphincterotomy within 24-48 hours of the "lap-chole." The T-tube will be removed after the ERCP. 3. Given T.B.'s diagnosis, what laboratory values would be important to evaluate? 4. List four preop preparations that need to be done.

Answer 1

1. RUQ contains liver, gallbladder, pancreas, kidney, small and large intestine.

2 Liver is palpable with taking deep breath.

3. CBC, CRP, ESR, liver panel, lipase. Ultrasound, MRI, CT scan etc.

4. preoperative preparations:

• Dont eat or drink 4 hours before surgery.
• Dont drink clear fluids 2 hours before surgery.
• take a shower and clean the abdominal area with mild soap.
• dont shave the area