Laparoscopic Cholecystectomy

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  • Topic: Liver, Cholecystectomy, Bile
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  • Published : January 29, 2013
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Decie Collier
Case Study
Brown Mackie College
17 May 2012

Laparoscopic
Cholecystectomy

With a length of about 8cm and a diameter of roughly 4cm, the gallbladder is among the smallest of organs in the digestive system (WebMD, 2011). Although it is small in stature, it is mighty big in terms of functionality and importance to the whole human body. This small pocket of tissues is located just beneath the liver and serves as not only the liver-small intestine go-between, but also a collection tank for the bodily fluid bile. Bile, a bitter, yellow fluid, is a digestive enzyme that is produced by the liver to help in the breakdown of ingested fats (WebMD, 2011).

The liver, gallbladder, and small intestine are connected via small channels, or ducts, and when the liver produces bile, some is funneled directly into the small intestine, but most is diverted into the gallbladder. When in the gallbladder, bile is then squirted down into the small intestine, in varying amounts, as needed. Amazingly, these ducts are not just one way channels starting from the liver and eventually ending in the small intestine; they are actually two-way streets that allow bile to be filtered back into the gallbladder when pressure in the small intestine mounts due to the production of excess bile.

Although this process resembles a flawless system, mishaps can still occur. For reasons unknown to scientists, bile within the gallbladder can sometimes crystallize and harden, forming what are known as gallstones. Multiple gallstones cause Cholecystitis, or severe inflammation of the gallbladder (WebMD, 2011) Cholecystitis causes debilitating pain and profuse vomiting in the individuals it infects. When something goes awry within the gallbladder or ductwork, removal surgery is the most common resolution because one cannot “pass” a gallstone similar to how one would a kidney stone. For this case study, Cecilee M. L. James was just age 18 when she endured textbook gallbladder attacks so severe she would be rendered unconscious. Due to numerous blood panels, ultrasounds, and the inevitable laparoscopic cholecystectomy, this one tiny organ has changed her life. ***

The patient, Cecilee Mary Louise James, was 18 years of age, weighted approximately 130 pounds and stood 5’5” tall in the summer vacation of 2010. During a routine doctor’s appointment needed to go back to school, she complained of having had severe pain that radiated down the right side of her abdomen and extended into her low back. She told her normal family doctor, Dr. Brenda Wolfe, M.D., that these pain attacks started at the beginning of the summer, came about three times a week, and lasted anywhere from 30 to 45 minutes. Ms. James also disclosed to Dr. Wolfe that the pain would eventually stop because she would be overcome by bouts of nausea and vomiting, severe diarrhea, or sometimes black outs. When asked by both her doctor and mom why she did not mention her pain attacks at the beginning of the summer, her response was, “I just thought the pain was a side effect of the new HIV medications.”

Having had HIV infection since she was born, Cecilee has lived through and experienced pretty much every side effect different medicines have to offer. Around the time somewhere in late May/early June of 2010, Cecilee had started four new HIV medications and merely by coincidence this is when her pain attacks also started. For her HIV she was taking 400mg (2 tabs once daily) of Darunavir, 300mg (a tab once daily) of Truvada, 100mg (a tab once daily) of Ritonavir, and 400mg (1 tab every 12 hours) of Raltegravir. This particular HIV regiment has a wide range of possible side effects that mimics gallbladder disease. The Isentress (Raltegravir) and Truvada can cause episodes of dizziness, stomach and back pain, and the Norvir (Ritonavir) and Prezista (Darunavir) can cause severe allergic reactions and diarrhea. Because of the pain her HIV medicines cause, Cecilee is also an avid 200mg...
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