After studying Module 5: Lecture Materials & Resources and Chapter 23 discuss the following:
Ms. Burton, 48, presents at the clinic complaining of abdominal pain. She is a middle-aged woman, overweight, pale and sweating, with jaundice (yellowish skin and sclerae). Her heart rate is 102 beats/min and BP is 145/98 mm Hg. She describes the pain as “severe” and “steady” over the past night, accompanied by nausea and vomiting. She sits leaning forward and indicates that the pain is in the epigastric region radiating up to the tip of the right shoulder. Ms. Burton’s medical history shows that she has had several episodes of biliary colic (pain caused by gallstones going through the bile duct). She says her current pain is “sort of like that, but it’s lasted longer.” She says her last meal was a seven-cheese pizza the previous night, and that the pain began 3–4 hours after eating. She denies drinking or smoking.
Do any of Ms. Burton’s signs and symptoms suggest that her current problem is related to the biliary system? Why or why not?
Why would pain related to gallstones begin after a high-fat meal?
If Ms. Burton’s current problem is related to obstruction of the biliary ducts, which other signs or symptoms would you expect her to develop?
Full Answer Section
Why Pain After a High-Fat Meal?
Fat in the diet stimulates the gallbladder to contract and release bile into the duodenum to aid in fat digestion. If a gallstone is present, it can block the bile duct, leading to increased pressure and severe pain. This is why fatty meals often trigger biliary colic attacks.
Additional Signs and Symptoms of Biliary Duct Obstruction
If Ms. Burton's condition is due to biliary duct obstruction, she may experience:
- Dark urine: Bilirubin, a bile pigment, can build up in the blood and be excreted in the urine, causing it to darken.
- Clay-colored stools: Bile is essential for the digestion and absorption of fats. Obstruction can lead to decreased bile flow into the intestine, resulting in pale or clay-colored stools.
- Fever and chills: If the obstruction leads to infection (cholangitis), fever and chills may develop.
Given her history of biliary colic and the current presentation, it is likely that Ms. Burton is experiencing another episode of biliary colic or a more serious complication, such as acute cholecystitis or cholangitis.
Sample Answer
Biliary System Involvement
Yes, several of Ms. Burton's signs and symptoms strongly suggest a problem with her biliary system, likely related to gallstones:
- Severe, steady abdominal pain: This is a classic symptom of biliary colic, which is often exacerbated by fatty meals.
- Jaundice: This indicates a blockage in the bile duct, preventing bile from flowing into the intestine.
- Nausea and vomiting: Common symptoms associated with biliary colic and other digestive disorders.