Case Study on Calculous Cholecystitis Essay

I.IntroductionA. Concepts in nutrition, medical nutrition therapy, and organ systems touch regi manpower is the field of operation of aliment in relation to health. The provender and livelihood Council of the Ameri erect Medical Association defined nutrition as the wisdom of food, the nutrients and other substances on that pointin, their action, interaction and balance in relation to health and affection, and the processes by which the organism ingests, digests, absorbs, transports, utilizes and excrete food substances.Nutrition is overly concerned with the physiological needs of the carcass in terms of specific nutrients, the means of supply these nutrients through adequate nutritions, and the effects of failure to meet nutrient needs. In this similar viewpoint, nutrition is also concerned with the social, economic, cultural, and psychological implications of food and eating. Nutrition follows the four basics concepts, namely 1.) Adequate nutrition is essential for hea lth. 2.) Food items argon classified according to content in terms of mass of nutrients, broadly classified as carbohydrates, proteins, naughtys, minerals, vitamins and irrigate and ar needed passing(a) in the diet of humans. 3.) An adequate diet is the plungeation of good nutrition, and it should inhabit of a wide variety of natural foods. 4.) Nutrients should be provided preformed in food, whereas a few whitethorn be synthesized within the body. 5.) Nutrients are interrelated and there should be metabolic balance in the body. 6.)The body constituents are in a dynamic state of equilibrium. 7.) Human requirements for certain nutrients are cognise quantitatively within certain limits. 8.) The effects of nutritionary inadequacy are much than physical behavioral patterns and mental performance are also compromised, and 10.) Proper education, technical expertise in addition to the use of altogether resources available in the practice of nutrition will wait on heave the nu tritional location of people. (Lagua, Claudio and Ruiz, 2004) Race has been a predisposing factor in underdeveloped gallstones. Westerners usually develop cholesterol stones, while Asians tend to have hue or mixed stones. in that location has been an increasing prevalence of calculous cholecystitis in the Philippines. Whatever the type, size or origin of these stones, they can present with a variety of signs and symptoms.Stones develop in a sluggish, sicknessd gallbladder. Formation of stones may be overdue to infection, stagnation of the rancor or changes in the chemical substance substance composition of the bile, overeating or poor eating habits. Obesity is super associated with prevalence of gallstones. prevalence increases with age, history of diabetes mellitus and elevated serum triglycerides ( Lagua, Claudio, 2011)The gallbladder may contain one large stone or many polished ones. Infection accompanied by formation of gallstones is referred as calculous cholecystiti s. practically times, people with gallstones must have their gallbladder removed through a process called cholecystectomy. Transition diets are prone accordingly after(prenominal)wards operation and if the patient role role advances to an oral diet post-surgery, aspiration of fat is allowed as tolerated. As an accessory organ, the gallbladder is fairly easy to live without. Once it is removed, bile travels from the liver directly into the small intestine.B. IMPORTANCE/ SIGNIFICANCE OF THE STUDY illness of the accessory organs present a significant impact on the absorption and nutritional status of an individual. Failure to give immediate intercession could bring about knottinesss which are more difficult to manage. These complications may or may not possibly lead to death of an individual.This study was conducted to enable the students to practice his/ her skills on Diet Therapy I. It may help the students to understand let on the disease physique, the actions and interact ions of food and medicines to the body and the rationale for the diet prescription for the slip patient. Moreover, it would help the students, as well as the readers to draft a nutritional care plan for patients with calculous cholecystitis upon acquiring training about the disease through information collection. C. Objectives (General and Specific)The study generally aims to analyze, assess and give proper(ip) recommendations to a patient diagnosed with calculous cholecystitis. This study was also conducted to allow students to obligate the knowledge gained in the lecture and laboratory class of Diet Therapy I.The study specifically aims to1) Gather all the necessary information from the patients medical records and the query 2) Assess the patients nutritional status and disease condition base from the information observeed 3) Know the causes, signs and symptoms of the disease condition and its complications 4) Determine and relate the factors and causality for the formatio n of the patients disease 5) Interpret and relate the findings to the patients disease condition 6) make up a nutritional care plan for the patient7) Provide a diet prescription appropriate for the condition of the patient 8) Provide oblivious and long term interference for the patient and other recommendation that could help the prevent disease condition of the patient.D. Limitations of the StudyThe case study is single limited to the disease condition of the patient with calculous cholecystitis and its possible complications if not given immediate intervention. Due to time constraints, the attending physician and sop up were not interviewed for further understanding of the disease. There was also no diet prescription written on the patients medical chart, thus, the hospitals cycle menu was used as a basis for some computations and analysis.II. MethodologyStudents of Diet Therapy I were grouped into pairs and were asked to get a patient for the case study. Approved letters p rovided by instructors of Diet Therapy II, requesting for a case patient with infections, burns, surgery, allergies and diseases of the gastro-intestinal tract were own(prenominal)ly submitted to different hospitals in lagoon. Laguna Provincial Hospital in Sta. Cruz Laguna accommodated the request, with the approval of the medical theater director and assistance of the attending physician, nurse and head nutritionist-dietitian. In the nurses station, the necessary information was gathered on the selected case patient and the medical records were copied as selective information for the study. An interview with the case patient followed afterwards. The patient, together with her aunt, was interviewed to collect necessary data such as personal information, nutritional and dietary history and the 24hr. food recall.Before the said interview, a questionnaire was formulated to systematically and completely obtain all the essential information for a better further analysis. Questions al low the 24-hour food recall of the patient food intake (prior to admission and during confinement), personal data, signs and symptoms experienced, patients tolerance and acceptance to the food given in the hospital, and some other information that would be beneficial to the study. After data gathering, the case was analyzed and a case study was then formulated. This was through with(p) through evaluation of the disease condition of the patient and correlating the symptoms experienced by the patient with the clinical manifestation of the disease.The dietary and the medical intervention given to the patient were also analyzed. This included correlating the principle and rationale of the diet with the patients existent illness. The possible nutrient-drug interaction that can happen due to the prescribed medication to the patient was also analyzed. The result of the laboratory and biochemical findings of the patient was also interpreted. After this, the diet of the patient PTA and DC were analyzed quantitatively and qualitatively. The diet was evaluated quantitatively by computing the CPF of the patients food intake and computing the adequacy of that diet. Qualitative evaluation, on the other hand, was used exploitation RDA. After analyzing the recommendations given to the patient, short-term and long-term diet plan was prompt for the patient.In computing the desirable body weight (DBW), the Tanhaussers Method. The WHO standards for body mass index served as the basis in determining whether the guests nutritional status. Method I was used to determine the patients total energy requirement (TER) for long term intervention and the carbohydrates-protein-fat distribution was distributed using the non-protein calorie method.III. Theoretical ConsiderationsA. Disease Conditioncalculous cholecystitis or cholecystolithiasis, is caused by the precipitation of the substances contained in the bile, mainly cholesterol and haematoidin with accompanying inflammation. The bi le is consisted of bile sodium chlorides, cholesterol, bilirubin, lecithin, sebaceous acids, electrolytes and water usually found in the plasma. The cholesterol formed in the bile has no aim it is only a by-product of bile salt formation and the mien is only linked in the excretion of bile. Cholesterol is normally non-water-soluble in water and this is where lecithin and bile salts combine with it to form micelles. Inside the gallbladder, water and electrolytes are absorbed in the liver bile, causing it to be more concentrated. Lecithin and bile salts are not absorbed in the gallbladder, their concentrations increases alongside cholesterols. This is the mechanism of maintaining the solubility of cholesterol.B. Definitions and ClassificationsCholecystitis inflammation of the gallbladder. There has been an association of cholecystitis with cholelithiasis. There is approximately incessantly a close association with complete or uncomplete obstruction of the stones formed inside the gallbladder.Cholelithiasis gallstones that precipitated from bile, cholesterol or bilirubin due to impaired gallbladder function or excessive production of by-products from fat digestion.C. EtiologyGallstone formation is due to bile salt, pigments and cholesterol salt accumulation. The stones rub off on the walls of the gallbladder, causing pain and inflammation in the subsequent internal structures. There is also a link amongst elevated or abnormal estrogen levels with gallstone formation.D. Incidence/ PrevalenceThere is a 10% incidence of adults getting gallstones. Approximately, there are twice as many women who develop this disease and it increases with age after 60 years old, there is a 10-15% prevalence in men while a 20-40% prevalence in women was noted.E. PathologyGallstones obstruct bile go and causes reflux and subsequent inflammation in the gallbladder. The inflammation is caused by chemical irritation from the concentrated bile, along with the swelling of the muc osal area and ischemia from venous congestion and stasis. Bacterial infections may be a complication and this could account for the infection and could reach the adjacent gallbladder through the circulation. staphylococcus and enterococci are the most common pathogens. Perforation of the gallbladder could lead to gangrene.F. Clinical Manifestations and vestigial MechanismsPain is evident in early cholecystolithiasis. There is similarity in the pain experienced with biliary colic and is usually felt after a fatty meal. Pain is experienced in the right speed quadrant and there is spasm in the right, subcostal region. There is elevation in total serum bilirubin, amino transferase and alkaline phosphatase.G. PrognosisAfter cholecystectomy, patients can return to work in a span of 1-6 weeks.IV. The PatientA. in the flesh(predicate) DataThe patient is Chastine Salazar, 28 years old, female admitted on January 3, 2013 at Laguna Provincial Hospital in Sta Cruz, Laguna. Her physician is Dr. Flores.B. Socio-Economic HistoryThe patient works as a registrar in the Head fleck of AMA in Quezon City, Philippines. Due to her sedentary lifestyle, she and her husband jogs for 2 hours every weekend. Her bourgeoisie income allows her to select food items of higher market value, thus chocolate is always present after every meal. The patient does not smoke nor drink but based on the interview, it was found out that she uses laxatives due to deterioration problems.C. Present illness and chief complaintPatient has cholecystolithiasis with cholecystectomy as the surgical procedure of which 8 marble-sized gallstones were removed. Pain and vomiting was experienced by the patient and was immediately rushed to the hospital on January 3, 2013.D. Past Illnesses and surgery, allergies, hospitalizationThere were no family history of predisposing risk factors to cholecystolithiasis but it was found out from the interview that the patient has allergic reaction to sea foods and patient has allergic coryza of which she has treated before with steroids.E. Physical State of HealthPatient has allergic reaction to sea foods and has allergic rhinitis. Patient also has constipation of which she self-medicates with laxatives.G. Nutritional and dietetical HistoryIt was observed from the 24-hr food recall that the patient has frequent exercise of chocolates and carbonated beverages. There was also a high intake of fatty and fried food and dishes every day. Snacking patterns are also noted as the patient tends to overeat every 3 hours.