You are called to a 57-year-old female with sudden onset abdominal pain. The pain started the day before and she was able to manage this with co-codamol, however today, it has been severe with associated nausea and vomiting. The pain is located to her upper right abdomen. She is bent over in pain and describes it as sharp and 10/10. You are unable to complete an assessment or observations as the patient is writhing in pain so you look at giving pain relief as soon as possible. She has no allergies, and she hasn’t taken any co-codamol today.
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What pain relief would be suitable for your patient?
You gain IV access quickly and give your IV paracetamol and morphine. As the patient’s pain settles, you can complete your observations and gain some more history. You record observations of; 24 RR, 98% Sp02, 112 HR, 138/78 BP, 4.9 blood sugar reading and 38.1 Temperature.
She has never experienced pain like this before but over the last few months has changed her diet as fatty and spicy foods caused a lot of abdominal discomfort.
What is this patients NEWS score?
The patient explains she has been nauseated but hasn’t vomited. You consider giving Ondansetron for this symptom but see that there are associated contraindications and cautions regarding a prolonged QT interval. What figures would give a prolonged QT interval?
Your ECG monitor should read a ‘corrected’ QT interval reading (QTc) you can use to check for this. What value is corrected to allow comparison of ECGs and detection of risk of abnormalities?
You complete your ECG and it looks normal, so you give Ondansetron. You then look at completing an abdominal assessment. There are no abnormalities on inspection or percussion and find hypoactive bowel sounds on auscultation. Do hypoactive bowel sounds indicate the patient must have an intestinal blockage somewhere?
You continue to palpate and find the patient has guarding and tenderness on the upper right abdomen. There is no rebound tenderness, no flank pain, and no rigidity. You ask the patient to complete a deep inhalation as you palpate under the ribs on the right upper quadrant. The patient is unable to complete the full breath. What is this a positive sign for?
What condition does a positive Murphy’s sign relate to?
When assessing the abdomen, you can have the patient lay supine with the knees flexed at 90 degrees to relax the abdominal wall?
You are confident that your patient has acute cholecystitis. You have the patients’ pain under control and her nausea has subsided, she is a lot more comfortable. What first choice destination would benefit this patient where available?
Approximately what percentage of A&E acute abdominal pain presentations are for acute cholecystitis?
What pathophysiology describes an acute cholecystitis diagnosis?
90-95% of acute cholecystitis patients have associated gallstones?
What risk factors are associated with gallstones and are therefore in directly acute cholecystitis?
What complications can be associated with acute cholecystitis?
Early recognition and treatment of uncomplicated acute cholecystitis is associated with very low mortality rates and excellent prognosis?