Respond to these two discussion.
Discussion 1
The differential diagnosis for DC is gallstones. The diagnosis is based on the patient’s epigastric pain in the upper right quadrant following a large meal that likely had high fat. The patient also described being “gassy” and have “boring” pain into her back. Other symptoms of gallstones can include heartburn, pruritius, jaundice, and food intolerances (McCance & Huether, 2014).
There are two types of gallstones, cholesterol and pigmented. Cholesterol gallstones are saturated with cholesterol produced by the liver. The saturation causes crystal formation, which can turn into larger stones. Pigmented stones and black or brown and can be hard or soft. These stones are primarily calcium bilirubinate. They are usually seen with patient’s with hyperbilirubinbilia and hemolytic diseases (McCance & Huether, 2014).
To confirm the diagnosis of gallstones, I would review the patient medical history and provide a physical examination. I would order a abdominal ultrasound and computerized tomography to review the gallbladder. I would order a hepatobiliary iminodiacetic acid scan or a magnetic resonance imaging (Gallstones, 2018).
The most common procedure is cholecystectomy to remove the gallbladder (Gallstones, 2018). There are two types of cholecystectomy, laparoscopic and open. Laparoscopic is an outpatient procedure where the patient can usually go home the same day. Open cholecystectomy is used for gallbladders that are severely damaged.
There are non-surgical treatments for gallstones. If confirmed that there is a presence of gallstones, the patient could be scheduled for an endoscopic retrograde cholangiopancreatography. Gallstones seen during the ERCP can be removed at that time. The drugs Ursodiol and chenodiol are medications that can break up gallstones. This usually takes months or years to dissolve stones. Shock wave lithotripsy blasts gallstones into small pieces. This is not commonly used (Treatments for Gallstones, nd).
Reference
Gallstones. (2018). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/gallstones/diagnosis-treatment/drc-20354220).
McCance, K., Huether, S. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children, 7th Edition. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780323088541/
Treatment for Gallstones. (nd). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/treatment#nonsurgical
Discussion 2
Right upper quadrant (RUQ) pain can be as a result of several causes. Therefore, it is essential to have a differential diagnosis before making the final determination. The right upper quadrant has several vital organs which include gallbladder, small and large intestines, of the liver, pancreas, and the right kidney (Bennett, 2015). It is, therefore, significant to make the proper diagnosis as pain in the RUQ may be as a result of various diseases or conditions.
The differential diagnosis from the history given by the patient about the pain at the RUQ which is “boring” into her back could be acute pancreatitis, hepatic ulcer, pregnancy, biliary colic, gastroesophageal reflux disease, hepatitis, and pancreatic cancer (Revzin et al., 2017). However, according to the history provided by the patient indicating that the pain came after dinner at an all-you-can-eat buffet, she felt “gassy” and bloated and that the pain had been increasing rules steadily out the other diseases and conditions. The tentative diagnosis could be gastrointestinal issues which may be dyspepsia or peptic ulcers. For final determination, it would be critical to do an endoscopy to look for ulcers which if detected a biopsy should be collected for examination in the laboratory (Bennett, 2015).
Dyspepsia is caused by acid reflux disease or stomach ulcers. When a patient has acid reflux, the stomach acid goes up to the esophagus causing pain in the RUQ (Talley & Ford, 2015). Treatment depends on the cause, and it may include a change in lifestyle and reduce the consumption of spicy and fatty foods and also less chocolate, caffeine, and alcohol. The patient may take antacids to mitigate the effects of stomach acid. The patient may also take H-2-Receptor antagonist to minimize the acid levels in the stomach. Other drugs are Proton Pump Inhibitors which reduce stomach acid especially if the patient has gastroesophageal reflux disease ((Talley & Ford, 2015).