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Catanduanes State Colleges COLLEGE OF HEALTH SCIENCES Department Of Nursing Virac, Catanduanes

Case Study
(GALLBLADDER POLYPS)
Submitted by:

San Juan, Geneva G. Tomagan, Jessica M. Toledana, Aiza T.


BSN-4A / Group 2

Submitted to:

MARILOU R. LOPEZ, RN, MAN.


Clinical Instructor

I.

Personal Data
Name: Tito Pineda Vargas Jr. Age: 27 y/o Gender: male Address: Lanao,Virac , Catanduanes Birthday: 11-02-1985 Religion: Roman Catholic Civil Status: Single Date of Admission: 09-22- 13 Time Admitted: 1: 42 pM Attending Physician: Dr. Del Prado/ Panti Chief Complaint: abdominal pain Admitting Diagnosis: T/C bladder polyp

II.

Health History Present Health History:


The client was brought to Eastern Bicol Medical Center (EBMC) last September 22, 2012 under the care of Dr. Panti. 4 days prior to admission, he has been experiencing intermittent abdominal pain associated sometimes with fever, he also experienced episodes of vomiting that appears greenish and sour as indicated by the patient.

Past Health History:


His past health history includes past hospitalizations at the same hospital with the same chief complaint. His recent hospitalization prior to admission was about last year as he claimed, but no surgical management was not yet done to him. He had also received all necessary immunizations during childhood, and has no allergies to foods and drugs. Past illnesses only include fever, cough and colds, which is usually cured by using over-the counter medications.

III.

Developmental Task
THE YOUNG ADULT (INTIMACY VS. ISOLATION)

The developmental crisis of the young adult is achieving a sense of intimacy versus isolation. Intimacy is the ability to relate well with other people, not only with members of the opposite sex but also with one's own sex to form long-lasting friendships. A sense of intimacy grows out of earlier developmental tasks, because people need a strong sense of identity before they can reach out fully and offer deep friendship or love. Because there is always the risk of being rejected or hurt when offering love or friendship, individuals cannot offer it if they do not have confidence they can cope with rejection or if they did not develop a sense of trust as an infant. Parents without a sense of intimacy may have more difficulty than others accepting a pregnancy and beginning to love a newborn child.

IV.

Anatomy And Physiology Of Gallbladder The gallbladder is part of the digestive system.The gallbladder is a sac about 3 to 4 inches (7.5 to 10 cm) long located on the undersurface of the right lobe of the liver. Bile in the hepatic duct of the liver flows through the cystic duct into the gallbladder (see Fig. 166), which stores bile until it is needed in the small intestine. The gallbladder also concentrates bile by absorbing water (see Box 162: Gallstones). When fatty foods enter the duodenum, the

enteroendocrine cells of the duodenal mucosa secrete the hormone cholecystokinin. This hormone stimulates contraction of the smooth muscle in the wall of the gallbladder, which forces bile into the cystic duct, then into the common bile duct, and on into the duodenum. The body can function without the gallbladder. If doctors need to remove it because of disease, there are no serious long-term effects and the body can still digest food.

The gallbladder is made up of layers of tissue: Mucosa--the inner layer of epithelial cells (epithelium) and lamina propria (loose connective tissue) Muscular layer-- a layer of smooth muscle Perimuscular layer---connective tissue that covers the muscular layer Serosa----the outer covering of the gallbladder

The gallbladder, liver and small intestine are connected by a series of thin tubes or ducts. The common hepatic duct drains bile from the liver through the left and right hepatic ducts.

The cystic duct joins the gallbladder to the common bile duct. The common bile duct is where the hepatic and cystic ducts meet and connect to the small intestine.

The gallbladder and bile ducts are also called the biliary system or biliary tract. Function The gallbladder stores and concentrates bile, a yellowish-green fluid made by the liver. Bile helps the body digest fats. Bile is mainly made up of: bile salts bile pigments (such as bilirubin) cholesterol water

The liver releases bile into the hepatic duct. If the bile is not needed for digestion, it flows into the cystic duct and then into the gallbladder, where it is stored. The gallbladder can store about 4070 mL (814 teaspoons) of bile. The gallbladder absorbs water from the bile, making it more concentrated. When bile is needed for digestion after a meal, the gallbladder contracts and releases it into the cystic duct. The bile then flows into the common bile duct and is emptied into the small intestine, where it breaks down fats.

V.

Overview of the disease


Gallbladder polyps are growths or lesions resembling growths (polypoid lesions) in the wall of the gallbladder. True polypsare abnormal accumulations of

mucous membrane tissue that would normally be shed by the body. Even though most of the gallbladder polyps are benign in nature, malignant polyps are present

in some cases, and early detection and appropriate early measure is important for curative treatment and long-term survival. The primary goal in the management of gallbladder polyps is to prevent the development of gallbladder carcinoma. The term polypoid lesions of the gallbladder represents a wide spectrum of findings. Gallbladder polyps are classified as benign or malignant. Benign GPs are subdivided into: pseudotumors (cholesterol polyps, inflammatory polyps; cholesterolosis and hyperplasia), epithelial tumors (adenomas) and mesenchymatous tumors (fibroma, lipoma, and hemangioma). Malignant GPs are gallbladder carcinomas. The poor prognosis of gallbladder carcinoma patients means it is important to differentiate between benign polyps and malignant or premalignant polyps Polypoid lesions of the gallbladder affect approximately 5% of the adult population. The causes are uncertain, but there is a definite correlation with increasing age and the presence of gallstones (cholelithiasis). Most affected individuals do not have symptoms. The gallbladder polyps are detected during abdominal ultrasonography performed for other reasons. The incidence of gallbladder polyps is higher among men than women. The overall prevalence among men of Chinese ancestry is 9.5%, higher than other ethnic types Pathology Most small polyps (less than 1 cm) are not cancerous and may remain unchanged for years. However, when small polyps occur with other conditions, such as primary sclerosing cholangitis, they are less likely to be benign. Larger polyps are more likely to develop into adenocarcinomas. Risk factors Polyps of gall bladder are tumor-like lesions of this organ. Little has been known about factors associated with the occurrence of gallbladder polyps. The formation of gallbladder polyps is however associated with fat metabolism. Relationship between gallbladder polyps and family history of some diseases suggests to perform some genetic studies. Proposed patient risk factors for malignant gallbladder polyps include age greater than 60, presence of gallstones, and primary sclerosing cholangitis. Polyp risk characteristics include a size greater than 6 mm, solitary, and sessile.

Symptoms and Diagnosis Most polyps do not cause noticeable symptoms. Gallbladder polyps are usually found incidentally when examining the abdomen by ultrasound for other conditions, usually abdominal pain. Some patients with gallbladder polyps which may suffer nausea, vomiting, and occasional pain in the right hypochondrium, due to intermittent obstructions caused by small fragments of cholesterol that become detached from the gallbladder mucosa. There are descriptions of polyps that protrude greatly obstructing the cystic canal or the primary biliary ducts, causing acute cholecystitis or obstructive jaundice, but these are very rare complications. Symptoms may be associated with pseudo-polyps such as a cholesterol polyp, inflammatory or hyperplastic polyp, which include indigestion, right upper quadrant pain, and discomfort, cholecystitis or gallbladder stone. Surgical management The cholecystectomy should only be undertaken in cases where there are clinical signs of gallbladder polyps, polyps with diameters greater than 10 mm, fast-growing polyps, sessile polyps or wide-based polyps, polyps with long pedicles, patient aged over 50, concurrent gallstones, polyps of the gallbladder in fundibulum or abnormal gallbladder wall ultrasound.[1] The surgery of choice is laparoscopic cholecystectomy. A gallbladder polyp greater than 18 mm in size has a high likelihood of being an advanced cancer; it should be removed with open cholecystectomy, partial liver resection, and possible lymph node dissection

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