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I. INTRODUCTION
Gallstones develop in the gallbladder from crystals of either cholesterol or

bilirubin. Stones can be too small to be seen with the eye or can range from the size of

grains of sand to the size of golf ball. There may be one or hundreds of stones in the

gallbladder. At any point, stones may obstruct the cystic duct which leads from the

bladder to the common bile duct and cause pain (biliarycolic) infection and inflammation

(cholecystitis) or both.

Stone in the gallbladder is the fifth leading cause of hospitalization among adults

and accounts for 90% of all gallbladder and duct disease, seventy to eighty percent of

patients’ gallstone remain asymptomatic throughout their lives. About 1-3 % of these

patients exhibit symptoms in any year. Risk of developing gallstones increases with age.

It afflicts 10-20% of adult population.

Incidence is more common in women, with female ratio approximately 2.4.

Women between the ages of 20 and 60 are twice likely to develop gallstones than men.

Women are at risk because estrogen stimulates the liver to remove more cholesterol

from blood and divert into bile.

Gallstones usually remain asymptomatic initially. They start developing

symptoms once the stones reach a certain size (>8mm).A main symptom of gallstones

is commonly referred to as a gallstone attack, in which a person will experience intense

pain in the upper abdominal region that steadily increases for approximately thirty

minutes to several hours. A victim may also encounter pain in the back, ordinarily

between the shoulder blades or pain under the right shoulder. In some cases, the pain

develops in the lower region of the stomach, nearer to the pelvis, but this is less

common. Nausea and vomiting may occur.

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The following objectives guided the researchers in this case study:

a.) Patient Centered

• Our primary goal is to provide maximum patient care for the patient’s

recovery.

• To impart health teaching to the patient and other members of the family

which may help them better understand the patient’s present condition.

b.) Nurse Centered

• To identify the patient’s problem associated with the disease.

• To gain more information about the disease and the proper management

for the patient suffering from this specific disease.

II. BIOGRAPHICAL DATA

Name : VILORIA, MELO JANE LARA

Birth Date : August 31,1971

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Age : 36 years old

Gender : Female

Civil Status Married

Address : San Pedro, Sta. Cruz, Ilocos Sur

Religious Affiliation :Roman Catholic

III. HISTORY OF PRESENT ILLNESS

According to the patient, she felt something painful at her upper right abdomen.

She was diagnosed at Candon Hospital and the results revealed that she has

gallbladder stones. The medicines prescribed were unrecalled. The persistence of the
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said condition made the family decide to seek consultation at Lorma Medical Center on

September 12, 2007 at 9:17 in the morning. The Admitting Medical Doctor, Dr. Emilio V.

Joven gave a clinical impression of Cholelithiasis. The patient is under the care of Dra.

Hildegunda Santos during her confinement at Lorma Medical Center for 6 days.

IV.PAST HEALTH HISTORY

According to patient MJV, she had never been hospitalized in the past but
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during her childhood, she suffered from chicken pox, measles, fever, cough and colds.

As a typical Ilocana, she eats whatever food on the table, but most of it were salty and

fatty foods like dried fish, pork and chicken barbecues.

She was fond of eating salty foods like dried fish and drinks less than 8 glass of

water per day. She consumed beverage drinks (coke 12oz) 3 bottles a day. She craved

and ate fatty foods for approximately two weeks. She spent her idle time watching TV

while eating salty foods.

Two years ago, patient MJV experienced abdominal pain at the upper right

quadrant accompanied by back pain categorized as cramping pain at the lumbar region.

Furthermore, throughout the year, she also experienced an abdominal pain (upper

quadrant) every after meal as well as severe back pain. She did not seek any medical

attention and no medication taken as well because as stated by the patient, taking a

rest would relieve the pain and she also though that the back pain was only due to

fatigue.

Two days prior to admission, again, she experienced severe back pains. Hence,

decided to seek for consultation at Lorma Medical Center under the care of Dr. Emilio V.

Joven (September 12, 2007). During the admission, patient MJV was experiencing an

on and off full pain. She was given an admission diagnosis of

Cholelithiasis/Cholecystitis and further she was confined. The following medications

were prescribed:Ketomed 30 mg IV every 6 hours, Nubain. She was scheduled for

Cholecystectomy on September 13, 2007 at 1:30 P.M

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V. FAMILY HISTORY

Father: Martin Lara

Illness: Cough
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Headache

Fever

Mother: Melicia Lara

Illness: Headache

Sister: Mary Jane Lara

Illness: Cough

Fever

Common colds

Headache

Grandfather: Bernardino Garcia

Age: 80 years old

Illness: Arthritis

VI. PERSONAL AND SOCIAL HISTORY

Patient MJV is a 36 year old woman who was born by normal delivery on August

31, 1971 at Candon Hospital, Candon, Ilocos Sur. Their house is a Bungalow type with

3 bedrooms and a comfort room located inside their house. Their house is located 250m
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away from the national road. She belongs to a nuclear type family. They disposed their

garbage by compost pit and burning. They get their water source from jetmatic pump

and use it for washing clothes, dishes and bathing purposes. They buy purified water for

drinking.

The patient admitted that she was fond of eating salty foods like dried fish and

drinks less than 8 glass of water per day. She consumed beverage drinks (coke 12oz) 3

bottles a day. She craved and ate fatty foods for approximately two weeks. She spent

her idle time watching TV while eating salty foods.

VII. REVIEW OF SYSTEMS/PHYSICAL ASSESSMENT

Patient: MJV Age: 36 years old

Sex: Female Race: Filipino

Date and Time of P.E: September 12, 2007; 10:00 A.M.

Pre-Operative Examination
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GENERAL APPEARANCE

Posture and Gait: slouched, bent posture and coordinated movement

Grooming and Hygiene: clean and neat

Body and Breath Odor: no body odor or minor body odor

MENTAL STATUS

Attitude: Cooperative

Mood: Appropriate to situation

Quantity/Quality and Organization of Speech: understandable and with coherence of

thought

I. INTEGUMENTARY

• SKIN

- Color: Dark brown

- Uniformity of skin color: uniformed except palms and nail beds because

they have lighter pigmentation

- Appearance of skin: No pallor, no cyanosis

• HAIR

- Growth over the scalp evenly distributed

- Color: black

- Hair thickness or thinness: hair is thick

- Hair infestation: no lice and dandruff

• NAILS

- Shape: flattened angle

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- Nail bed color: light pink

II. HEAD

- Shape: rounded (normocephalic)

• EYES

- Pupils are equally round and reactive to light

- Both eyes are coordinated and move in uniform with coordinated

alignment

• EARS

- Color: same as facial skin

- Position: symmetrical

- Hearing acquity: good hearing acquity

• NOSE

- Symmetric and straight

- Uniform in color

- No discharge or bleeding

- No tenderness

• MOUTH

- Lips are slightly pink

- Has complete set of teeth, white in color

- Gums are light pink in color

III. NECK

- Neck Muscles: equal in size, the head is centered

- Temperature: warm to touch

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- Head movement: coordinated

IV. THORAX AND LUNGS

- Chest is symmetrical

- No tenderness, no masses

- Absence of crackles and murmurs

V. ABDOMEN

- Skin: unblemished and uniform in color

- Contour and Symmetry: Flabby

- Auscultation: normal, audible bowel sounds

- Palpation: Soft and no tenderness

VI. EXTREMITIES

- Upper and lower extremities: pulses are palpable, able to flex and extend

- Absence of edema

VII. GENITALIA

- Not examined

VII. RECTAL

- Not examined
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VIII. ANATOMY & PHYSIOLOGY

THE DIGESTIVE SYSTEM

The human digestive system is a complex series of organs and glands that

processes food. In order to use the food we eat, our body has to break the food down

into smaller molecules, and it also has to excrete waste.

Most of the digestive organs (like the stomach and the intestines) are tube-like

and contain the food as it makes its way through the body. The digestive system is
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essentially a long, twisting tube that runs from the mouth to the anus, plus few other

organs (like the liver and pancreas) that produce or store digestive enzymes.

THE DIGESTIVE PROCESS

The digestive process begins in the mouth. Food is partly broken down by the

process of chewing and by chemical action of salivary enzymes (these enzymes are

produced by the salivary glands and break down starches into smaller molecules).

After being chewed and swallowed, the food enters the esophagus. The

esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic,

wave-like muscle movements.

Then, food enters the stomach which is a large, sac-like organ that churns the

food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly

digested and mixed with stomach acids is called chyme.

After being in the stomach, food enters the jejunum, the duodenum and then the

ileum of the small intestine. In the small intestine, bile (produced in the liver and stored

in the bladder), pancreatic enzymes and other digestive enzymes produced by the inner

wall of the small intestine help in the break down of food.

After passing through the small intestine, food passes into the large intestines.

Here, some of the water and electrolytes are removed from the food. Many microbes

(like Bacteroides, Lactobacillus acidophilus, Escherichia coli and Klebsiella) in the large

intestines help in the digestion process. The first part of the large intestine is called
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cecum in which the appendix is connected, food then travels upward in the ascending

colon, then travels across the abdomen in the transverse colon to the descending colon

then to the sigmoid colon.

Solid waste is then stored in the rectum until excreted via the anus.

THE GALLBLADDER

The gallbladder is a pear-shaped sac about 7-10 cm (3-4 in.) long. It is located in

a depression on the posterior surface of the liver and usually hangs from the anterior

margin of the liver.

The functions of the gallbladder are to store and concentrate bile (up to tenfold)

until it is needed in the small intestine. In the concentration process, water and ions are

absorb by the mucosa of the gallbladder. When the level of cholecystokinin (CCK)

increases, the smooth muscle in the wall of the gallbladder contracts and forces bile into

the cystic duct and into the small intestine. When the small intestine is empty, a valve

around the hepatopancreatic ampulla (ampula of Vater) closes, and the backed-up bile

flows into the cystic duct to the gallbladder for storage

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IX. PATHOPHYSIOLOGY

Dietary Influences
(increased fat diet, inadequate fluid
intake)

Change in relative concentration of

Bile components

Supersaturation of bile components

(increased cholesterol, decreased bile salt and
lecithin)

Formation of stones in the Gallbladder

Accumulation of Bile

Obstruction of cystic duct by the stone

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Gastric Distention Compression of nerve

endings

Vomiting RUQ pain

X. DIAGNOSTIC EXAMINATION

Candon Hospital

Name: Melo Jane Viloria Age: 36 Sex: F

X-RAY / ULTRASOUND REPORT

Liver and spleen are within normal size and configuration. Hepatic and
splenic echoes are homogenous. The intrahepatic ducts and splenic vessels
within normal caliber. Gallbladder is normal in caliber measuring 64 x 34
mm, with multiple rounded shadowing dense echoes. The walls are
unthickened. Pancreas is not visualized due to overlying bowel gasses.
No free peritoneal fluid seen, within the Morrison's pouch. The kidneys are
normal in position, size and contour. The central echo complexes are
intact with homogenous cortical echoes. There is a rounded shadowing high
echolevel density in the midcortical region, right kidney, measuring 12mm.
Urinary bladder is sonographically intact. Unenlarged uterus with
smooth contour and uniform mymetrial echoes.

IMPRESSION:
>CHOLECYSTOLITHIASIS
>Non-obstructing nephrolithiasis, right kidney
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>Rest of the scanned organs are within normal.
>Sonographic limits

Lorma Medical Center

Laboratory Department

CD1700 SPECIMENT DATA REPORT

Specimen ID #: 26 Analyzed: 09/12/07

Patient: VILORIA, MELO JANE

TEST RESULT REFERENCE RANGE (Limit

3)

WBC 10.0 K/uL 4.0 – 11.0 K/ul

LYM 2.3 23.2%L 0.6 – 4.1 10.0 – 58.5%L
MID 0.3 2.9%M 0.0 – 1.8 0.1 – 24.0%M
GRAN 7.4 73.9 %G 2.0 – 7.8 37.0 – 92.05G

RBC 4.46 M/uL 3.60 – 6.00 M/uL

HGB 12.1 g/dL 12.0 – 18.00 g/dL
HCT 36.8 % 36.0 – 55.0%
MCV 82.6 fL 80.0 – 100.0 fL
MCH 27.1 pg 27.0 – 31.0 pg
MCHC 32.9 g/dL 31.0 – 36.0 g/dL
RDW 14.4 % 11.5 – 14.5%

PLT 243 K/uL 150 – 450 K/uL

BLOOD TYPE “A”

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Clotting Time = 3 minutes

Bleeding Time = 2 minutes & 30 second

CLINICAL SIGNIFICANCE:

The result of patient MJV’s Blood Chemistry was within the parameters
of normal range basing from the range provided by the agency (LMC).