Acute cholecystitis
Stones can become lodged in the duct, causing severe and sudden onset of midepigastric pain that radiates to the right upper quadrant and right subscapular region. Biliary colic is due to the distention and pressure to the gallbladder when bile is not allowed to flow in the duct. The patient often experiences nausea, vomiting, sweating, and tachycardia when in severe pain. Acute cholecystitis can cause biliary colic.
Chronic cholecystitis is ruled out because the patient states this is the first occurrence of this pain. Patients with acute pancreatitis generally present with a knifelike pressure in the upper abdomen, abdominal distention and tenderness, tachycardia, hypotension, and jaundice. Patients with pancreatic cysts are generally asymptomatic.
Colicky pain is caused by the obstruction of bile flow. These symptoms can last up to 18 hours and are often more vague with chronic cholecystitis. Biliary obstruction causes clay-colored stools or steathorrhea, the urine color is amber, and the patient may experience jaundice, and pruritus. Fever and chills accompany cholecystitis as a result of an inflammation of the gallbladder and possible sepsis.
Thiamine supplements
Paresthesia, a prickly pins-and-needles sensation, is noted most in alcoholics and is related to a vitamin B1 deficiency affecting the feet, toes, and legs. Thiamine supplements help reverse these symptoms. Iron, calcium, or potassium supplements would not be useful in treating paresthesia.
Patients with acute pancreatitis usually present with pain to the upper abdomen with a knifelike pressure.
The pain is often deep epigastric pain or is referred to the umbilical chest, or flank area.
Abdominal distention and tenderness often accompany acute pancreatitis.
Changes in vital signs related to pain and fluid shifts include tachycardia
and hypotension.
Fever results from the inflammatory process.
Jaundice, which is common in accessory organ dysfunction, is caused by the obstruction of the bile duct.
Hemorrhagic pancreatitis causes bruising and edema to the subcutaneous tissue surrounding the umbilicus, known as Cullen sign.
Grey-Turner sign is another specific clinical sign in which the flank area appears bruised, with bluish discoloration from bleeding behind the peritoneum.
Hepatitis B
Hepatitis is known to cause liver cancer in up to 85% of patients with hepatocellular carcinoma. The hepatitis B virus causes liver cancer by damaging the cells and their DNA. Worldwide, hepatitis B accounts for 23% of liver cancer cases. Individuals with cirrhosis, vinyl chloride, hemochromatosis, and carriers of hepatitis B or hepatitis C virus have a higher risk of hepatocellular carcinoma. In the United States, hepatitis C is responsible for the increased rates and incidence of liver cancer and mortality in recent years.
Factors that increase the risk of primary liver cancer include:
Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases the risk of liver cancer.
Cirrhosis, a progressive and irreversible condition, causes scar tissue to form in the liver and increases your chances of developing liver cancer.
Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson disease.
Diabetes, as
people with this blood sugar disorder have a greater risk of liver cancer than those who don't have diabetes.
Nonalcoholic fatty liver disease, which is an accumulation of fat in the liver, increases the risk of liver cancer.
Exposure to aflatoxins, which are poisons produced by molds that grow on poorly stored crops.
Crops such as corn and peanuts can become contaminated with aflatoxins, which can end up in foods made from these products.
In the United States, safety regulations
limit aflatoxin contamination.
Aflatoxin contamination is more common in certain parts of Africa and Asia.
Consuming more than a moderate amount of alcohol daily, over many years, can lead to irreversible liver damage and increase the risk of liver cancer.
Other liver cancer lifestyle-related risk factors include:
Excess alcohol consumption.
Coffee consumption.
Exposure to aflatoxins.
Obesity.
Oral contraceptive use.
Cholecystitis
Patients with cholecystitis generally have a history that includes intolerance of dietary fat with epigastric heaviness or right upper quadrant (RUQ) abdominal pain after eating. The patient may also complain of flatulence, belching, and regurgitation. Patients with cholangitis and choledocholithiasis present with RUQ pain, fever, jaundice, abdominal tenderness, and pruritus. Patients with acute pancreatitis generally present with a knifelike pressure in the upper abdomen, abdominal distention and tenderness, tachycardia, hypotension, and jaundice.
A.
Cholelithiasis
Rationale: Risk factors for cholelithiasis specific to women include multiparous, users of estrogen replacement therapy, oral contraceptives, and the Five Fs: female, fair, fat, fertile, and forty. Other risk factors include a sedentary lifestyle, diabetes mellitus, regional enteritis, and having family members who have had cholelithiasis.
Cholecystitis is most often caused by a cystic duct stone.
Alcohol abuse and gallstones are the most common causes of acute pancreatitis.
Cigarette smoking and diabetes mellitus are the greatest risk factors for pancreatic cancer.
C.
Cholangitis
Rationale: Clients with cholangitis present with symptoms similar to those of cholelithiasis and acute cholelithiasis. These symptoms include RUQ pain, fever, jaundice, abdominal tenderness, and pruritis. As a
result of elevated bilirubin, the client will have dark-colored urine and clay-colored stools. The client with advanced cholangitis will have clinical signs consistent with sepsis, such as hypotension and changes in mental status. Symptoms of bile duct cancer include intense RUQ abdominal pain, jaundice, weight loss, and a palpable gallbladder. Pancreatic cancer symptoms include vague abdominal discomfort, jaundice, back pain, dark urine, steatorrhea, and pruritus. Hemorrhagic
pancreatitis causes bruising and edema to the subcutaneous layer surrounding the umbilicus, known as the Cullen sign. The Grey-Turner sign is another specific clinical sign, in which the flank area appears bruised, with bluish discoloration from bleeding behind the peritoneum.
D.
Bile duct cancer
Rationale: The CA 19-9 radioimmunoassay (RIA) is a simple blood test that measures the level of tumor-associated antigens found in the blood. Antigens are substances that cause the immune system to make a specific immune response. CA 19-9 antigens are foreign substances released by pancreatic tumor cells. Late symptoms of bile duct cancer include RUQ pain, abdominal pain, jaundice, weight loss, and a palpable gallbladder. Early diagnosis improves the outcome. Serum CA 19-9 will often be elevated in clients with bile duct cancer and other cancers, so a definitive diagnosis must be made by a more invasive method to directly obtain cells. Cholangitis serum tests include an increased alkaline phosphatase and GGT, as well as supporting laboratory tests of elevated AST, ALT, bilirubin, amylase, and lipase. Leukocytosis will be noted with cholangitis. A client with chronic pancreatitis will present with weight loss and abdominal pain, but it radiates to the left upper quadrant or epigastric area. Warning signs of hemorrhagic pancreatitis can include low urine output, hypoxemia, restlessness, confusion, and worsening tachypnea and tachycardia. Clients with hemorrhagic pancreatitis may also present with a Cullen sign or Grey-Turner sign.