Real-Life Challenge: Cholelithiasis
A 43-year-old woman is experiencing an intermittent colicky type of pain in the upper right quadrant (URQ) of the abdomen, radiating to the right scapular region. The onset was approximately 1 week ago. In the past few days, she has had nausea and vomiting, increasing in the past 24 hours. The pain is more severe today, and the emesis is bile colored. Vital signs are temperature, 99.68° F; pulse, 96; respirations, 26; and blood pressure, 144/92. Her skin is warm, dry, and slightly jaundiced. The patient is somewhat obese and has been on oral contraceptives for 15 years. Cholelithiasis is suspected. A CT scan of the gallbladder confirms the presence of stones in the gallbladder and also in the common bile duct. Serum bilirubin is elevated. The patient is scheduled for laparoscopic surgery.
1. When would a patient with gallstones be asymptomatic?
2. How do gallstones develop?
3. Which type of person would be most likely to develop gallstones?
4. Which diagnostic imaging studies would be ordered when gallstones are suspected?
5. Which blood studies would be ordered when gallstones are suspected?
6. What is the usual treatment for asymptomatic gallstones?
7. What is the treatment for symptomatic gallstones?
8. What is the difference between cholelithiasis and cholecystitis?