Chapter 111: Cholelithiasis and Cholecystitis

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient has sudden onset of right upper quadrant (URQ) and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings?

a. Acute acalculous cholecystitis b. Chronic cholelithiasis c. Common bile duct obstruction d. Infectious cholecystitis

ANS: C a. Empirical treatment with antibiotics b. Hospitalization for emergent treatment c. Prescribing ursodeoxycholic acid

This patient has symptoms of cholecystitis with bile duct obstruction, which causes jaundice. The common triad of RUQ pain, fever, and jaundice occurs when a stone is lodged in the common bile duct. Acute acalculous cholecystitis is inflammation without stones. Chronic cholelithiasis does not cause acute symptoms; jaundice occurs with obstruction. Infectious cholecystitis may occur without obstruction.

2. A patient presents with fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient’s symptoms?

NURSINGTB.COM d. Supportive care with close follow-up

ANS: B a. Abdominal computed tomography (CT) with contrast b. Abdominal ultrasound c. Magnetic resonance imaging (MRI) of the abdomen d. Plain abdominal radiographs

This patient has symptoms of acute acalculous cholecystitis and is critically ill. Hospitalization is required. Empirical treatment with antibiotics and supportive care with follow-up do not address critical care needs. Ursodeoxycholic acid is a medication that helps with gallstone dissolution; this patient does not have gallstones.

3. Which diagnostic test will the provider safely order for a 30-year-old woman reporting right upper quadrant abdominal pain, nausea, and vomiting?

ANS: B a. Chemical dissolution of the gallstone b. Lithotripsy c. Open cholecystectomy

Women of childbearing age may safely have ultrasound. Until pregnancy is ruled out, the other studies may be harmful to a developing fetus and should be avoided.

4. A patient with a previous history of liver disease is diagnosed with a bile duct obstruction. Which procedure will be prescribed for this patient?

d. Laparoscopic cholecystectomy

ANS: C

Patients with possible liver disease should have open cholecystectomy. The other procedures are contraindicated. Chemical dissolution is not reliable and may take some time.