Introduction

This is a case study of patient J.E.E., 43 years old, female, who lives in Panapaan
Bacoor , Cavite and born at Cavite on November 20, 1972. She was admitted in University of
Perpetual Help Medical Center on September 18, 2016 at 9:04 PM with a diagnosis of
Cholelithiasis.
According to Smeltzer, S.C., Bare, B.G. Brunner & Suddarths Textbook of MecidalSurgical Nursing 10th Edition, Calculi, or gallstones, usually form in the gallbladder from the
solid constituents of bile and vary greatly in size, shape, and composition. Gallstones can range
in size from a grain of sand to a golf ball, depending on how long they have been forming. The
gallbladder can develop a single large gallstone, hundreds of tiny stones, or both small and large
stones. Gallstones can cause sudden pain in the upper right abdomen.
Stones on the gallbladder or biliary tree are referred to collectively as cholelithiasis. Most
patients have multiple stones, sometimes several dozen. Most gallstones (80%) are cholesterol
gallstones, which form when bile becomes oversaturated with cholesterol. Pigment gallstones,
accounting for the remaining 20% of gallstones are composed of bilirubin and bile substances
other than cholesterol. (McConnell, T. H., The Nature of Disease Pathology for the Health
Professions. 2007)

The condition affects about 20% of

the

population above 40 years of age and is more prevalent in women and in persons with cirrhosis

of the liver. Gallstone risk increases for females especially before menopause and for people near
or above 40 years; the condition is more prevalent among both North and South Amerindians and
among those of European descent than among other ethnicities. Researchers believe that
gallstones may be caused by a combination of factors, including inherited body chemistry, body
weight, gallbladder motility (movement), and perhaps diet. The absence of such risk factors does
not, however, preclude the formation of gallstones. No clear relationship has been proved
between diet and gallstone formation; however, low-fiber and high-fat and cholesterol diets have
been suggested as contributing to gallstone formation. Other factors that may increase risk of
gallstones include rapid weight loss, constipation, eating fewer meals per day, and taking certain
medications for lowering cholesterol.
Other risk factors predisposing cholelithiasis formation include obesity, diabetes mellitus,
estrogen and pregnancy, hemolytic disease, and cirrhosis. A study of natural history of this
disease demonstrates that approximately 35% of patients initially diagnosed with having, but not
treated, cholelithiasis later developed complications or recurrent symptoms leading to
cholecystectomy.
Many patients complain of localized abdominal discomfort, eructation, and intolerance to
certain foods, indigestion, and excessive gas, a feeling of fullness in the abdomen, fever, shaking
with chills, tenderness in the abdomen, particularly the right upper quadrant, jaundice (yellowing
of the skin and eyes), may occur if a gallstone becomes stuck in the common bile duct, which
leads into the intestine blocking the flow of bile from both the gall bladder and the liver, stools of
an unusual color (often lighter, like clay). Others have no symptoms. Gallstones may be
asymptomatic, even for years. These gallstones are called "silent stones" and do not require
treatment. Symptoms commonly begin to appear once the stones reach a certain size (>8 mm). A
characteristic symptom of gallstones is a "gallstone attack", in which a person may experience
intense pain in the upper-right side of the abdomen, this pain occurs when a gallstone causes a
blockage that prevents the gallbladder from emptying (usually by obstructing the cystic duct),
often accompanied by nausea and vomiting, that steadily increases for approximately 30 minutes
to several hours. A patient may also experience referred pain between the shoulder blades or
below the right shoulder. These symptoms may resemble those of a "kidney stone attack". Often,
attacks occur after a particularly fatty meal and almost always happen at night.

Cholelithiasis (or gallstones) represents one of the most common surgical problems
worldwide and is especially prevalent in most western countries. In the U.S. alone, gallstones
are present in 8-20% of the population by the age of 40 and are more likely to develop in women
than in men by a ratio of about 2-3 to 1. Every year 1-3% of people develop gallstones and
about

1-3%

of

people

become

symptomatic.

Every

year,

approximately

500,000

cholecystectomies are performed in the United States. The annual overall cost of cholelithiasis is
approximately $5 billion in the United States, where 75 80% of gallstones are of the
cholesterol type, and approximately 10 25% of gallstones are bilirubinate of either black or
brown pigment. In an Italian study, 20% of women had stones, and 14% of men had stones. In a
Danish study, gallstone prevalence in persons aged 30 years was 1.8% for men and 4.8% for
women; gallstone prevalence in persons aged 60 years was 12.9% for men and 22.4% for
women. In Asia, pigmented stones predominate, although recent studies have shown an increase
in cholesterol stones in the Far East. In the Philippines, an extrapolated prevalence of 5,073,040
peoples are affected by the disease last 2012.
The prognosis is usually good with treatment unless infection occurs, in which case the
prognosis depends on its severity and response to antibiotics.

Objectives
General Objectives:

The students chose this case study primarily because of interest to gain further
understanding regarding the disease condition. This will also help in providing current and
accurate information concerning the latest approaches for the treatment of cholelithiasis and its
complications. To give us an idea of how we could give proper nursing care to our clients with
this condition, and so that we could apply them on our future exposures as students and
eventually as nurses.

Specific Objectives:
This case study aims to determine How the patient acquired the illness and the process
by which the body responds to the situation.
This also specifically attempts to answer the following questions:
1. What is Cholelithiasis?
2. What system, organs or parts of the body are affected by the disease process?
3. Where and how the illness was obtained, how it progressed and affected the body?
4. What were the risk and predisposing factors that lead the patient to acquire the disease?
5. What interventions are needed to manage such condition?

PATIENTS PROFILE

Clients name or Initials

J.E.E.

Age

43 years old

Birthdate and Place

November 20, 1972 / Cavite

Gender

Female

Address

Panapaan Bacoor , Cavite

Civil Status

Single

Religion

Evangelical Christian

Race/Nationality

Filipino

Occupation

School Administrative

Usual source of Medical Care

Hospital

Attending Physician

Dr. Ma. Leisa C. Magboo

Admitting Date and Time

September 18, 2016 at 9:04 PM

Admitting Diagnosis

Cholelithiasis

GORDONS FUNCTIONAL PATTERN OF ASSESSMENT

SEPTEMBER 21, 2016, 11:30 AM
FUCTIONAL PATTERN
Chief complaint or reason for visit
Childhood illness
Childhood immunization
History of allergies
Accidents and injuries
History of hospitalization
Medications
Family history of illness

Health perception and health

management pattern

Nutritional metabolic pattern

BEFORE/DURING
Abdominal pain
The patient stated that she had her
chicken pox when shes 25 years old
already.
The patient said that she was immunized
with the usual immunization given to
every child when she was young.
According to the patient, she doesnt
have any allergies to foods, medications,
or dust.
As stated by the patient, she had no
history of accident or injury.
The patient stated that she was not
hospitalized for a major or serious
illness.
As stated by the patient, her
medications are twysnta 40/5mg tablet,
forxiga 10 mg, follic Acid.
According to the patient her father died
with gastric cancer, while her mother
died with liver cirrhosis. Her auntie which
is 83 years old had pulmonary edema,
while her brother had hyperthyroidism
but eventually resolved. Her
grandparents from father and mother
side, she doesnt remember them having
illness.
The patient fully understand her illness
(Diabetes Mellitus and Hypertension) she
had maintenance for them and she takes
them regularly. For her abdominal pain
she just takes pain reliever and when
she noticed that the pain is recurrent she
then decided to consult her doctor.
Before hospitalization
Prior to admission, the patient usual
meals for breakfast were rice, meat
and coffee. For lunch and dinner
usually, rice, meat and water. She is
fond of eating fried foods. Her snacks
are pasta and sandwiches. The
patient is not fan of eating vegetables
like bitter melon.
According to the patient because of
the nature of her work she finishes her

Elimination pattern

Activity exercise pattern

Sleep rest pattern

Cognitive /perceptual pattern

work very late and at that time she is

tired and because of that she tends to
reward herself by eating the food that
she wants.
During hospitalization
The patient is on low salt, low fat diet.
The patient is controlling the foods
shes taking. The patient said that she
lost 2-3 pounds during her stay in the
hospital.
Before hospitalization
Patient claimed that she regularly
urinates with yellow color and her
bowel elimination is usually 3-4 times
a day with brown color. The patient
stated that shes not taking any
laxatives.
During hospitalization
During confinement, she urinates
regularly with yellow color, and
defecates twice a day with brown
color.
Before hospitalization
According to the patient, she doesn't
engage in any exercises because of
the nature of her work. She physically
goes on work at around 1 pm. She
only does phone calls most of the
time. She tried to do walking as her
exercise, but feels tired easily. She
feels dizzy especially waking up in the
morning.
During hospitalization
The patient always on bed but is
ambulatory.
Before hospitalization
According to the patient, she can only
sleep 5-6 hours because of the nature
of her work.
During hospitalization
The patient stated that during the first
few days of her confinement she was
not able to sleep well because of the
pain that she felt. She also fell dizzy
that she wanted to vomit.
Before hospitalization
The patient has a strong sense of
sight, smell and hearing. The patient
had also a very good memory
according to her.
During hospitalization

Self-conception and self-concept pattern

Role-relationship pattern

Sexuality reproductive pattern

Coping and stress tolerance pattern

Value belief pattern

The patients eyesight, sense of smell,

and sense of hearing is still the same.
As for the memory, its still very good
according to the patient. The patient
response very well and is cooperative.
The patient added that her
hospitalization didnt affect her
memory and understanding.
Before hospitalization
The patient describes herself as a
silent but strict person when it comes
to work. She also said that she feels
okay about herself but there are times
that she feels insecure when it comes
to her body frame.
During hospitalization
According to the patient, her
hospitalization didnt affect her
impression about herself.
Before hospitalization
The patient said that they are only two
siblings and shes the eldest and she
is the one who act as the mother and
father because they are already dead.
During hospitalization
The patient receives care and a full
support from her brother, relatives,
and friends.
The patient opted not to answer about
her sexuality because she is still single
and doesnt want to talk about it.
Before hospitalization
Upon interview, the patient stated that
her stress is her work and the only
management for it is to rest and eat,
and according to her it is effective.
During hospitalization
According to the patient, she was
worried about her operation.
Before hospitalization
The patient is a Born Again Christian.
She reads bible, she always pray, and
does fellowship according to her. She
also stated that she has a strong faith
to God.
During hospitalization
The patients faith becomes stronger
even though she cannot go to church.
The patient managed to see her
Pastor when he visited her to pray and
that gives her more strength and faith

to God.

Family History (GENOGRAM)

Grandmother

Grandfath
er

Father

Brother

Grandfath
er

Mother

J.E.E

Grandmother

Auntie

Legend:
Red

= Male

= Deceased

Green = Female

= Liver Cirrhosis

= Hypertension

= Gastric Cancer

= Pulmonary Edema

= Gastric Cancer

= Gastric Cancer

= Gastric Cancer
PHYSICAL ASSESSMENT
September 21, 2016 11:30AM

GENERAL APPEARANCE
Area Assessed
Body Built
Posture and Gait

Technique Used
Inspection
Inspection

Actual Findings
Not proportionate
Not coordinated

Normal Findings
Proportionate
Coordinated and

Analysis
Obese
Obese

Body Odor
Signs of distress
Effect of Mood
Speech

Inspection
Inspection
Inspection
Inspection

and erect
No body odor
No distress
Cooperative
Coherent

Erect
No body odor
No distress
Understandable
Coherent

Normal
Normal
Normal
Normal

Analysis
Normal

VITAL SIGNS during the assessment

Area Assessed
Temperature

Technique Used
Measured using

Actual Findings
36.7 degree

Normal Findings
36-37.5 degree

a thermometer

Celsius

Celsius

Pulse Rate

through axillary
Measured using

86 beats per

60-100 beats per

Normal

Respiratory Rate

a Pulse Oximeter
Inspection

minute
18 cycles per

minute
12-20 cycles per

Normal

Not Applicable

minute
150/100 mmHg

minute
90/60 120/80

Because of

Blood Pressure

mmHg

pain and
anxiety

SKIN
Area Assessed
Color

Technique Used
Inspection

Actual Findings
Brown

Analysis
Normal

Symmetrical

Normal Findings
Light brown to
brown
Symmetrical

Symmetry of

Inspection

color
Edema
Skin lesions
Moisture
Temperature
Skin Turgor

Inspection
Palpation
Inspection
Palpation
Palpation

Absent
No lesions
Moist
Warm to touch
Good skin turgor

Absent
No lesion
Moist
Warm to touch
Good skin turgor

Normal
Normal
Normal
Normal
Normal

Normal Findings
Convex 160o
Firm
Pinkish
Intact
Less than 4

Analysis
Normal
Normal
Normal
Normal
Normal

Normal

NAILS
Area Assessed
Nail Curvature
Texture
Nail bed color
Surrounding tissue
Capillary refill

Technique Used
Inspection
Inspection
Inspection
Inspection
Palpation

Actual Findings
Convex
Firm
Pinkish
Intact
2 seconds

seconds
HEAD
Area Assessed
Hair Distribution
Hair Thickness
Texture & Oiliness
Infestations
Body Hair
Size and Shape
Contour
Facial Features
Edema/Hallownes

Technique Used
Inspection
Inspection
Palpation
Inspection
Inspection
Inspection
Inspection
Inspection
Inspection

Actual Findings
Evenly distributed
Thick
Silky
None
None
Normocephalic
Smooth
Symmetrical
No edema

Normal Findings
Evenly distributed
Thick or Thin
Silky
None
None
Normocephalic
Smooth
Symmetrical
No edema

Analysis
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal
Normal

s
Facial Movements

Inspection

Symmetrical

Symmetrical

Normal

EYES
Area Assessed
Eyebrows
Eyelashes
Eyelids
Conjunctiva
Lacrimal Gland
Cornea

Pupils

Technique Used
Inspection
Inspection
Inspection

Actual Findings
Evenly distributed
Evenly distributed
Intact skin,

Normal Findings
Evenly distributed
Equally distributed
Intact skin and

Analysis
Normal
Normal
Normal

Inspection
Palpation
Inspection

bilateral blinking
Pinkish
No tenderness
Clear
Black, Equal in

bilateral blinking
Pinkish
No tenderness
Clear
Black, Equal in

Normal
Normal
Normal

size, Pupils are

size, Pupils are

equally round and

equally round and

reactive to light

reactive to light

and

and

accommodation.

accommodation.

Inspection

Normal

Extraocular

Inspection

Coordinated

(PERRLA)
Coordinated

Normal

Movements
Visual Acuity

Inspection

Able to read

Able to read

Normal

newsprint

newsprint

Actual Findings
Uniform in color,
symmetrical

Normal Findings
Uniform color with

EARS
Area Assessed
Pinna

Technique Used
Inspection

Analysis
Normal

skin, and

Inspection

Presence of

symmetrical
Presence of

Tympanic

Inspection

cerumen/earwax
Grayish tan

serumen/earwax
Grayish tan

Normal

Membrane
Hearing Acuity

Inspection

Responds when

Responds when

Normal

called

called

Actual Findings
Symmetrical
Dark pink, dry,

Normal Findings
Symmetrical
Dark pink, dry,

free of exudates

free of exudates

Ear canal

Normal

NOSE
Area Assessed
External Nose
Nasal Cavity

Technique Used
Inspection
Inspection

Analysis
Normal
Normal

Sinus Tenderness
Nasal Mucosa

Palpation
Inspection

No tenderness
Intact and

No tenderness
Intact and

Normal
Normal

midline

midline

Actual Findings
In midline
Pink
Intact

Normal Findings
In midline
Pinkish
Intact

Analysis
Normal
Normal
Normal

Technique Used
Inspection
Inspection

Actual Findings
Symmetrical
30 pearly normal

Normal Findings
Symmetrical
32 pearly normal

Analysis
Normal
Two teeth

Inspection

teeth
Pinkish, moist,

teeth
Pink, moist, firm,

removed
Normal

Tongue

Inspection

firm, intact
Midline and

and intact
Midline, pinkish

Normal

Palate

Inspection

movable
Light pink, intact

and movable
Light pink intact

Normal

Technique Used
Palpation
Inspection
Inspection
Inspection
Palpation
Inspection

Actual Findings
Symmetrical
Coordinated
Full
Equal
Not palpable
In midline

Normal Findings
Symmetrical
Coordinated
Full
Equal
Not palpable
In midline

Analysis
Normal
Normal
Normal
Normal
Normal
Normal

Actual Findings
Regular
Symmetrical
Aligned

Normal Findings
Regular
Symmetrical
Aligned in

Analysis
Normal
Normal
Normal

PHARYNX
Area Assessed
Uvula
Oropharynx
Gag reflex

Technique Used
Inspection
Inspection
w/ the use of
tongue depressor

MOUTH
Area Assessed
Lips
Teeth
Gums

NECK
Area Assessed
Muscles
Movement
Range of Motion
Muscles Strength
Lymph nodes
Trachea

CHEST AND LUNGS

Area Assessed
Breathing Pattern
Symmetry
Spinal alignment

Technique Used
Inspection
Inspection
Inspection and
Palpation

Skin

Inspection

Smooth, no

midline
Smooth, no

tenderness and

tenderness and

Normal

Auscultation

lesions
Clear

lesions
Clear

Normal

Area Assessed

Technique Used

Actual Findings

Normal Findings

Analysis

Rhythm
Heart Sounds

Auscultation
Auscultation

Regular
S1 louder at

Regular
S1 louder at apex,

Normal
Normal

apex, S2 louder

S2 louder at base

Breath Sounds
HEART

at base
ABDOMEN
Area Assessed
Skin Integrity
Contour
Symmetry

Technique Used
Inspection
Inspection
Inspection

Actual Findings

Normal Findings
Unblemished
Flat/Rounded
Symmetrical
High Pitched,

Analysis

Unblemished
Rounded
Symmetrical
High pitched,

Bowel Sounds

Auscultation

irregular gurgles,

irregular gurgles,

Normal

5-35 times/min in

5-35 times/min in

all quadrants

Percussion
Palpation

Percussion

Generalized

all quadrants
Generalized

Palpation

tympanic sounds
No tenderness

tympanic sounds
No tenderness

Actual Findings

Normal Findings
Equal
Firm
Equal
No tenderness
No tenderness
Full

Normal
Normal
Normal

Normal
Normal

BACK AND EXTREMITIES

Area Assessed
Muscle size
Muscle tone
Muscle strength
Bones
Joints
Range of motion

Technique Used
Inspection
Palpation
Inspection
Palpation
Palpation
Inspection

Equal
Firm
Equal
No tenderness
No tenderness
Full

Analysis
Normal
Normal
Normal
Normal
Normal
Normal

Electrocardiogram Report
Date: September 17, 2016

Morphology
P wave
QRS complex
ST Segment
T wave

Upright
Narrow
Isoelectric
Upright

Interpretation:
Sims Rhythm
Normal Axis
Non Specific ST.T wave charges

Examination: Chest PA
Date: September 17, 2016

No focal parenchymal opacities or consolidation.

Heart is not enlarged.

Hemidiaphragms and costophrenic sulci are normal.

Osteodegenerative changes noted.
Impression:
Normal chest at the time of study.

LABORATORY AND PATHOLOGY SERVICES RESULT

Clinical Chemistry Section

Specimen: Blood
Date: September 18, 2016
Test
HBA1c

Results
11.3%

Normal value
4.3-6.4

Specimen: Body fluids

Date: September 18, 2016 (2:16pm)
Test
Blood typing/ RH typing

Results
Type O, RH positive

Partial Thromboplastin Time

Date: September 20, 2016 (1:15am)
Specimen: Citrated blood
Test: 34.8 secs

Control: 29.0 secs

Prothrombin Time
Date: September 20, 2016 (1:14am)
Control: 14.7 secs
Test: 14.3 secs
INR: 0.97
% Activity: 106%
(Normal value lesser than or equal to 1.2)
(Normal value: 70-130%)
Specimen: Blood
Date: September 20, 2016 (1:35am)

Examination
Alkaline Phosphate
Direct Bilirubin
Indirect Bilirubin
Total Bilirubin

Results
87
1.1
2.80
3.9

Normal Value
46.00-116.00 u/L
0.3umol/L
0-14 umol/L
3-17umol/L

Find out if something is blocking the bile ducts. This may occur ifgallstones, tumors of
the pancreas, or other conditions are present.

Higher than normal levels of direct bilirubin in your blood may indicate your liver isn't clearing
bilirubin properly. Elevated levels of indirect bilirubin may indicate other problems.

Bilirubin testing is usually done as part of a group of tests to check the health of your
liver. Bilirubin testing may be done to:

Investigate jaundice elevated levels of bilirubin can cause yellowing of your

skin and the whites of your eyes (jaundice). A common use of the test is to measure
bilirubin levels in newborns.

Determine whether there might be blockage in your liver's bile ducts

Help detect or monitor the progression of other liver disease, such as hepatitis

Help detect increased destruction of red blood cells

Help follow how a treatment is working

Help evaluate suspected drug toxicity

Some common tests that might be done at the same time as bilirubin testing include:

Liver function tests. A group of blood tests that measure certain enzymes or
proteins in your blood.

Albumin and total protein. Levels of albumin a protein made by the liver
and total protein show how well your liver is making proteins that your body needs to
fight infections and perform other functions.

Complete blood count. This test measures several components and features of
your blood.

Prothrombin time. This test measures the clotting time of plasma.

Specimen: Blood
Date: September 18, 2016 1:29PM
Examination
Blood Urea Nitrogen
Cholesterol
Creatinine
Fasting Blood Sugar
High Density Lipoprotein
Low Density Lipoprotein
Potassium
SGPT
Sodium
Triglycerides
Uric Acid

Result/s
3.82
4.56
48
11.15
1.20
2.6
4.0
58
136
1.57
249

Normal Values
2.50-6.40 mmol/L
0.00-5.20 mmol/L
49.00-90.00 umol/L
4.10-5.90 mmol/L (H)
0.00-1.55 mmol/L
3.50-5.10 mmol/L
3.50-5.10 mmol/L
14.00-59.00 U/L
137.00-145.00 mmol/L
0.00 2.26 mmol/L
155.00-357.00

Interpretation
Within normal range
Within normal range

Within normal range

Within normal range
Within normal range
Within normal range
Within normal range
Within normal range

Complete Blood Count

Date: September 18, 2016 1:41PM

Complete Blood Count It is a screening test, used to diagnose and manage numerous
diseases. It can reflect problems with fluid volume (such as dehydration) or loss of blood. It can
show abnormalities in the production, life span, and destruction of blood cells. It can reflect
acute or chronic infection, allergies and problem with clotting.
Examination

Indication/Purpose
It is the count of the actual

Normal Values

Results

Interpretation

4.50 5.50x10^12/L

5.07

Within normal
range

0.37 0.47L

0.47

Within normal
range

110.00 150.00g/l

148

Within normal
range

4.50 10.00x10^9/L

5.2

Within normal
range

0.50 0.70

0.56

Within normal
range

0.00 0.05

0.04

Within normal
range

number of red blood cells

Red Blood Cell

per volume of blood. Cells

that deliver oxygen
throughout the body and
make blood look red.
It is traditionally defined as

Hematocrit

the percentage of RBCs per

volume of whole blood.
It is a protein used by red

Hemoglobin

blood cells to distribute

oxygen to other tissues and
cells in the body.
These immune cells form
in the bone marrow to help

White Blood
Cell

fight infection. High levels

may indicate infection.
Low levels may result from

Segmenters

treatment or disease.
Used to determine if there
is infection.
A type of phagocyte that
produces the anti-

Eosinophils

inflammatory protein
histamine. Used to

diagnose allergy, drug

reactions, and parasitic
infections.

Include T-cells, B-cells and

Lymphocytes

NK cells. Viral infections

0.20 0.40

0.30

may increase their number.

It is a type of WBC that is
produced by the bone
Monocytes

marrow and helps to

0.10

150.00 400.00 x
10^9/L

297

80 100 fl

93

Within normal
range

26 34 pg

29.2

Within normal
range

320 360g/L

313

Within normal

foreign invaders, such as

harmful bacteria and
viruses.

Helps to determine the

presence of bleeding.
Mean Corpuscular volume

MCV

is a measurement of the
average size of your

A high
monocyte
count
(monocytosis)
might be a sign
of a chronic
infection, an
autoimmune
disorder or a
blood disorder,
states Merck
Manuals Home
Health
Handbook.
Within normal
range

0.00 0.07 (H)

protect the body from

Platelet Count

Within normal
range

RBCs.
Mean corpuscular
haemoglobin is a
MCH

calculation of the average

amount of
Oxygen-carrying
haemoglobin inside a red
blood cell.
Mean corpuscular

MCHC

haemoglobin in

concentration is a

range

calculation of the average

concentration of
haemoglobin inside a red
cell.
URINALYSIS
September 18, 2016 12:31 PM
Color
Transparency
Reaction
Protein
Glucose
Specific Gravity
RBC
Pus Cells
Epithelial Cells
Bacteria

Yellow
Hazy
6.0
Negative
Positive
1.030
0 2/HPF
1 3/HPF
Moderate
Few

Ultrasound Report
Examination: Whole Body Ultrasound
June 20, 2016
Findings:
The liver is normal in size with a diffuse increase in echogenicity.
The intrahepatic ducts and common duct are not dilated.
No focal lesions are seen.

The gallbladder is well distended with thin walls.

Multiple stones are seen. The largest measure 0.4 cm.
The pancreas and spleen are normal in size and echopattern.
No focal lesions are seen.

Both kidneys are normal in size, position, and echopattern.

The right kidney measures 11.0 cm x 4.6 cm x 6.0 cm.
The left kidney measures 11.5 cm x 5.1 cm x 6.0.
The central echocomplexes are intact.
No lithiases are seen.
The urinary bladder is unremarkable.

The uterus is surgically absent.

Both ovaries are not visualized, no adrenal masses are seen.
IMPRESSIONS:

FATTY LIVER
CHOLELITHIASES
NORMAL ULTRASOUND OF THE PANCREAS,
SPLEEN, KIDNEYS, AND URINARY BLADDER
ANATOMY AND PHYSIOLOGY

Gallbladder, muscular organ that serves as a reservoir for bile, present in most
vertebrates. In humans, it is a pear-shaped membranous sac on the undersurface of the
right lobe of the liver just below the lower ribs. It is generally about 7.5 cm (about 3 in)
long and 2.5 cm (1 in) in diameter at its thickest part; it has a capacity varying from 1 to
1.5 fluid ounces. The body (corpus) and neck (collum) of the gallbladder extend
backward, upward, and to the left. The wide end (fundus) points downward and
forward, sometimes extending slightly beyond the edge of the liver. Structurally, the
gallbladder consists of an outer peritoneal coat (tunica serosa); a middle coat of fibrous
tissue and unstriped muscle (tunica muscularis); and an inner mucous membrane coat
(tunica mucosa).
The function of the gallbladder is to store bile, secreted by the liver and transmitted
from that organ via the cystic and hepatic ducts, until it is needed in the digestive
process. The gallbladder, when functioning normally, empties through the biliary ducts
into the duodenum to aid digestion by promoting peristalsis and absorption, preventing
putrefaction, and emulsifying fat. Digestion of fat occurs mainly in the small intestine,
by pancreatic enzymes called lipases. The purpose of bile is to; help the Lipases to

Work, by emulsifying fat into smaller droplets to increase access for the enzymes,
Enable intake of fat, including fat-soluble vitamins: Vitamin A, D, E, and K, rid the body
of surpluses and metabolic wastes Cholesterol and Bilirubin.
Removal of the Gallbladder?
In some cases, the gallbladder must be removed. The

surgery to remove

the

gallbladder

is

called

cholecystectomy

(pronounced co-lee-sist-eck-toe-mee). In a cholecystectomy, the gallbladder is

removed through a 5- to 8-inch long cut in your abdomen.
Once the gallbladder is removed, bile is delivered directly from the liver
ducts to the upper part of the intestine.

ANATOMY OF THE LIVER

The

largest

organ in the body located under the diaphragm more on the right side of the body
specifically at the upper right quadrant of the body. The dark, reddish brown colored
liver usually weighs 1.4 kg or about 3 lbs. It is enclosed by a fibrous connective tissue
known as capsule. It has four lobes and is suspended from the diaphragm and
abdominal wall by a delicate mesentery cord, the falciform ligament. It has many
metabolic and regulatory roles; however, its digestive function is to produce bile. Bile
leaves the liver through the common hepatic duct and enters the duodenum through the
bile duct. The functional unit of liver is lobule and hepatocyte is the major cell.
Bile is a yellow-to-green, watery solution containing bile salts, bile pigments
(chiefly bilirubin, a breakdown product of hemoglobin), cholesterol, phospholipids, and
a variety of electrolytes. Of these components, only the bile salts (derived from
cholesterol) and phospholipids aid the digestive process. Bile does not contain enzymes,
but its bile salts emulsify fats by physically breaking large fat globules into smaller ones,
thus providing more surface area for the fat-digesting enzymes to work on.
From the liver, bile drips into the hepatic duct, which soon meets the cystic duct
arriving from the gallbladder. Converging, they form one duct, the common bile duct,
which meets the pancreatic duct, carrying enzymatic fluid from the pancreas. Like a
smaller river meeting a larger one, the pancreatic duct loses its own name at this

confluence and becomes part of the common bile duct, which empties on demand into
the duodenum. When the sphincter of the bile duct is closed, bile from the liver is forced
to back up into the cystic duct, and eventually into the gallbladder. There it is stored and
concentrated until needed, when it flows back down the cystic duct.
Lobes of liver:
- right and left lobes
* liver receives blood from 2 sources:
Hepatic artery-will supply oxygen blood to the liver cells
Hepatic portal vein- will bring deoxygenated
Functions of liver:
1. Detoxify poisonous and harmful chemicals like drugs and alcohol
2. Maintaining blood glucose levels within normal range (70mg-110mg/dL or 80mg120mg/dL)
Glycogenesis- glucose converted to glycogen and stored in the liver.
Glycogenolysis- stored glycogen converted to glucose
Gluconeogenesis- glucose formation from no-carbohydrate substances such as
fats and proteins. Also known as formation of new sugar
3. Cholesterol metabolism and transport
LDLs- transports cholesterol and other lipids to body cells
-large amounts will be deposited on the arterial walls causing atherosclerosis
-tagged as bad lipoproteins
HDLs- good cholesterol because this is destined to be broken down and be
eliminated from the body
Functions of bile:
- emulsifies fats
- absorption of fat-soluble vitamins(A, D, E, and K)

ANATOMY OF THE GALLBLADDER

Is a small, thin-walled green sac that snuggles in a shallow fossa in the inferior
surface of the liver. When food digestion is not occurring, bile backs up the cystic duct
and enters the gallbladder to be stored. While being stored in the gallbladder, bile is
concentrated by the removal of water. Later, when fatty food enters the duodenum, a
hormonal stimulus prompts the gallbladder to contract and spurt out stored bile,
making it available to the duodenum
Functions of gallbladder:
- Act as storage of to-be-used bile
Remember:
If bile is stored in the gallbladder for too long or too much water is removed, the
cholesterol it contains may crystallize, forming gallstones. Since gallstones tend to be
quiet sharp blockage of the common hepatic duct or bile ducts prevents bile from
entering the small intestine, and it begins to accumulate and eventually backs up into
the liver exerting pressure into the liver cells. Then, bile salts and bile pigments begin to
enter the bloodstream. As it circulates through the body, the tissues become yellow, or
jaundiced.

Jaundice caused by blockage of ducts more often results from actual liver
problems such as hepatitis(liver inflammation) or cirrhosis, a chronic inflammatory
condition in which the liver is severely damaged and becomes hard and fibrous.
Function of liver
The liver has many functions. Some of the functions are: to produce substances
that break down fats, convert glucose to glycogen, produce urea (the main substance of
urine), make certain amino acids (the building blocks of proteins), filter harmful
substances from the blood (such as alcohol), storage of vitamins and minerals (vitamins
A, D, K and B12) and maintain a proper level or glucose in the blood. The liver is also
responsible fore producing cholesterol. It produces about 80% of the cholesterol in your
body.
Function of gall bladder
The function of the gallbladder is to store bile and concentrate. Bile is a digestive
liquid continually secreted by the liver. The bile emulsifies fats and neutralizes acids in
partly digested food. A muscular valve in the common bile duct opens, and the bile flows
from the gallbladder into the cystic duct, along the common bile duct, and into the
duodenum (part of the small intestine).

Function of duodenum
The duodenum is largely responsible for the

breakdown

of

food in the small intestine. Brunner's glands, which secrete mucus, are found in the
duodenum. The duodenum wall is composed of a very thin layer of cells that form the
muscularis mucosae. The duodenum is almost entirely retroperitoneal. The pH in the
duodenum is approximately six. It also regulates the rate of emptying of the stomach via
hormonal pathways.
Function of cystic duct
Bile can flow in both directions between the gallbladder and the common hepatic
duct and the (common) bile duct.
In this way, bile is stored in the gallbladder in between meal times and released
after a fatty meal.
Function of transverse colon
The large intestine comes after the small intestine in the digestive tract and
measures approximately 1.5 meters in length. Although there are differences in the large
intestine between different organisms, the large intestine is mainly responsible for
storing waste, reclaiming water, maintaining the water balance, and absorbing some
vitamins, such as vitamin K.