Gastrointestinal And Hepatobiliary Disorders Affect The

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

Sample Paper For Above instruction

The case study presents a 46-year-old female with a 24-hour history of right upper quadrant (RUQ) pain following a large dinner, accompanied by nausea and vomiting. Her medical background reveals hypertension, type II diabetes mellitus, gout, history of deep vein thrombosis (DVT), and current medications including lisinopril, hydrochlorothiazide, and allopurinol. Her vital signs and lab results are notable: slightly elevated white blood cell (WBC) count of 13,000/mm3, normal liver function tests, and no signs of jaundice. These symptoms and findings suggest a differential diagnosis primarily centered around gallbladder pathology, with cholelithiasis or cholecystitis being the leading considerations.

The urgency of her presentation, particularly postprandial RUQ pain with nausea and vomiting, strongly correlates with gallbladder issues. Diagnosing cholecystitis or cholelithiasis involves correlating clinical features with imaging, such as ultrasound, which would confirm gallstones or inflammation. Given her symptoms' pattern, physical findings, and laboratory data, cholelithiasis with possible acute cholecystitis appears most probable.

Diagnosis and Rationale

The probable diagnosis for this patient is acute cholecystitis secondary to gallstones (cholelithiasis). This diagnosis is supported by her clinical presentation—postprandial RUQ pain, nausea, vomiting—and her lab results, particularly mild leukocytosis indicating inflammation. Additionally, her pain onset about one hour after a fatty meal points to gallbladder contractile activity responding to a fatty meal, a typical feature of gallstone-related issues. According to the American College of Surgeons, ultrasound imaging is the gold standard in confirming the presence of stones and signs of inflammation in the gallbladder (Kowalski et al., 2020). Such diagnostic considerations align with her presentation, warranting prompt management to prevent progression to complications like empyema or perforation.

Drug Therapy Plan

The management of acute cholecystitis hinges on both symptom relief and addressing the underlying cause—gallstones. Conservative treatment initially involves analgesics for pain control, antiemetics for nausea, and antibiotics if infection or perforation is suspected. Common analgesics include non-steroidal anti-inflammatory drugs (NSAIDs) such as ketorolac, administered carefully considering her renal function and gastrointestinal risk profile (Gan et al., 2019). Antiemetics like ondansetron can mitigate nausea and vomiting. Empiric antibiotics, often ceftriaxone combined with metronidazole, are recommended to cover common pathogens—Escherichia coli and anaerobes—pending culture results (Sørensen et al., 2021).

Considering her medical history, her medications—such as hydrochlorothiazide—should be evaluated cautiously, as they can influence electrolyte balance, which is critical when administering antibiotics and analgesics. Her increased WBC count suggests an inflammatory process where antibiotics should be incorporated early. In cases where imaging confirms gallstones and no contraindication to surgery, a cholecystectomy remains the definitive treatment. However, in high-risk surgical candidates or early in the presentation, medical management aims to stabilize her condition first—a combined approach involving appropriate medications and close monitoring.

Justification of the Therapy Plan

The selected drug therapy plan is justified by her presenting symptoms, medical history, and the potential progression of her condition. The use of NSAIDs provides effective pain relief with a favorable profile if renal function and bleeding risk are monitored. Antiemetics like ondansetron are safe and effective in controlling nausea, facilitating oral intake and hydration. The cornerstone of the antibiotic strategy—ceftriaxone plus metronidazole—targets the most likely pathogens in biliary infections, reducing the risk of progression and complications (Sørensen et al., 2021). Early intervention with antibiotics and symptomatic management decreases the likelihood of surgical intervention becoming urgent or complicated, improving her outcomes.

Furthermore, considering her comorbidities, such as diabetes and hypertension, medications should be selected prudently to avoid adverse interactions or exacerbating her existing conditions. The choice of drugs also aligns with current clinical guidelines supporting early antibiotic therapy and minimally invasive procedures, which are associated with lower morbidity compared to traditional open surgeries (Kowalski et al., 2020). Overall, this comprehensive approach addresses both immediate symptoms and Eling potential complications, offering her the best chance for recovery without unnecessary risks.

Conclusion

In conclusion, the diagnosis of acute cholecystitis secondary to gallstones is substantiated by her clinical presentation and laboratory findings. The recommended management plan involves targeted antibiotic therapy, analgesics, antiemetics, and appropriate monitoring, with surgery considered when her condition stabilizes. This approach aligns with evidence-based guidelines and takes into account her individual health status, facilitating effective and safe care.

References

  • Kowalski, T. J., et al. (2020). Gallbladder Disease and Treatment Options. Journal of Gastroenterology and Hepatology, 35(7), 1240-1248.
  • Gan, K., et al. (2019). Pharmacological Management of Acute Calculous Cholecystitis. Clinical Therapeutics, 41(12), 2349-2357.
  • Sørensen, T. S., et al. (2021). Antibiotic Use in Acute Cholecystitis: Evidence and Recommendations. Surgical Infections, 22(3), 217-226.
  • American College of Surgeons. (2018). Practice Guidelines for the Diagnosis and Management of Cholecystitis. Surgical Practice. https://www.facs.org
  • Lee, S. H., et al. (2022). Diagnostic Approaches to Biliary Tract Disorders. Saudi Journal of Gastroenterology, 28(2), 95-102.
  • Williams, J. N., et al. (2019). The Role of Imaging in Gallbladder Disease. Radiology, 290(2), 351-368.
  • Gordon, P. H., et al. (2022). Evidence-Based Management of Gallstone Disease. American Journal of Surgery, 223(4), 785-790.
  • Harris, A. B., et al. (2021). Advances in Surgical Treatment of Gallstone Disease. World Journal of Gastroenterology, 27(19), 2453-2464.
  • Felsenstein, D., et al. (2020). Medical vs. Surgical Management of Cholecystitis. Clinical Interventions in Aging, 15, 157-167.
  • Rudd, J. H., et al. (2018). Pharmacotherapy in Gastrointestinal Disorders. British Journal of Clinical Pharmacology, 84(9), 2108-2117.

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