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Ch. 23 The Digestive System
Marieb - Human Anatomy & Physiology 7th Edition
Marieb, Hoehn7th EditionHuman Anatomy & PhysiologyISBN: 9780805359091Not the one you use?Change textbook
All textbooksMarieb, Hoehn 7th EditionCh. 23 The Digestive SystemProblem 28
Chapter 22, Problem 28

After a heavy meal rich with fried foods, Debby Collins, an overweight 45-year-old woman, was rushed to the emergency room with severe spasmodic pains in her epigastric region that radiated to the right side of her rib cage. She indicated that the attack came on suddenly, and her abdomen was found to be tender to the touch and somewhat rigid. What do you think is this patient's problem and why is her pain discontinuous (colicky)? What are the treatment options and what might happen if the problem is not resolved?

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Step 1: Identify the anatomical region and symptoms described. The epigastric region is the upper central part of the abdomen, and pain radiating to the right side of the rib cage suggests involvement of organs located in the right upper quadrant, such as the gallbladder or liver. The sudden onset of spasmodic (colicky) pain and tenderness with rigidity indicates an acute abdominal issue.
Step 2: Understand the nature of colicky pain. Colicky pain is typically caused by spasms of a hollow organ trying to push against an obstruction. In this case, the pain is likely due to gallstones obstructing the bile ducts, causing the gallbladder to contract forcefully, leading to intermittent spasms and pain.
Step 3: Diagnose the likely condition. Given the symptoms and the context of a heavy, fatty meal, the most probable diagnosis is acute cholecystitis or biliary colic caused by gallstones (cholelithiasis). The fatty meal stimulates bile release, which can trigger gallbladder contraction against an obstructed cystic duct.
Step 4: Review treatment options. Initial treatment often includes pain management, fasting to rest the gallbladder, intravenous fluids, and sometimes antibiotics if infection is suspected. Definitive treatment may involve surgical removal of the gallbladder (cholecystectomy) if gallstones cause recurrent or severe symptoms.
Step 5: Consider complications if untreated. If the obstruction and inflammation persist, complications such as gallbladder rupture, infection spreading to the abdominal cavity (peritonitis), or pancreatitis can occur, which are serious and potentially life-threatening conditions.

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Key Concepts

Here are the essential concepts you must grasp in order to answer the question correctly.

Cholelithiasis and Biliary Colic

Cholelithiasis refers to the formation of gallstones in the gallbladder, often triggered by fatty meals. These stones can obstruct the bile ducts, causing spasmodic, colicky pain in the epigastric and right upper quadrant regions. The pain is intermittent because it results from temporary blockage and muscle spasms as the gallbladder contracts against the obstruction.
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Pathophysiology of Colicky Pain

Colicky pain arises from the contraction of smooth muscles against an obstruction, causing intermittent spasms rather than continuous pain. In biliary colic, gallstones block bile flow, leading to increased pressure and muscle contractions in the biliary tract, which produce the characteristic sudden, severe, and fluctuating pain.
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Treatment and Complications of Gallstone Disease

Treatment options include pain management, dietary modifications, and surgical removal of the gallbladder (cholecystectomy) if recurrent or complicated. Untreated gallstones can lead to complications such as cholecystitis, pancreatitis, or bile duct obstruction, which may cause infection, tissue damage, or systemic illness.
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Textbook Question

Troy Francis, a middle-aged salesman, complains of a burning pain in the 'pit of his stomach,' usually beginning about two hours after eating and abating after drinking a glass of milk. When asked to indicate the site, he points to his epigastric region. The GI tract is examined by X-ray fluoroscopy. A gastric ulcer is visualized, and drug therapy using a proton pump inhibitor and antibiotics is recommended.

a. Why is this treatment suggested?

b. What are the possible consequences of nontreatment?

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Mr. Holden has had severe diarrhea all day and is severely weakened. Explain why his nurse is concerned about his present condition.

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Explain why activation of pancreatic enzymes is delayed until they reach the small intestine.

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Indicate the function of the stellate macrophages and the hepatocytes of the liver.

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Explain why fatty stools result from the absence of bile or pancreatic juice.

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