Background: Mr. ABC was admitted to the ward due to severe pain in the upper right center of the abdomen.
He is 72 years old, a native of Ghana
He was visiting his brother in the UK for the first time.
Diagnosed with acute cholecystitis after blood tests and CT (computerized tomography)
Past medical history- Diabetes and Hypertension
Cholecystitis is the inflammation of the gallbladder. It can be calculous or acalculous.
The gallbladder is a pear-shaped sac located beneath the liver. It stores bile- a substance secreted in the liver. Bile contains bile salts that are necessary for emulsification and absorption of fats. When a meal containing fat is ingested a hormone- cholecystokinin- is released. It causes contraction of the gallbladder which releases bile into the bile duct through the cystic duct and small intestines to aid in fat digestion and absorption (Stinton, and Shaffer, 2012, pg. 172)
Calculous cholecystitis is the most common type. It is caused by the irritation of the mucous membrane of the gallbladder after blockage of the cystic duct by gallstones. Gallstones (cholelithiasis) are either cholesterol or pigment stone in the gallbladder (Smelt, 2010, pg. 1630)
The gallstones get lodged in the cystic duct and block bile flow. When the gallbladder contracts it is not able to squeeze bile because of the blocked duct (Barie, and Eachempati, 2015, pg. 190). The bile stasis causes distention of the gallbladder which causes increased intraluminal pressures. The bile becomes a chemical irritant and causes the mucosa to secrete inflammatory cytokines that cause inflammation of the gland- cholecystitis. In addition, there is bacterial overgrowth which causes inflammation (Knab et al., 2014, pg. 160).
Research indicates that cholelithiasis (gallstones) is most prevalent among North American Indians afflicting 64.1% of women and 29.5% of men (Everhart et al., 2002, pg. 1510). In white Americans, it's about 16.6% of women and 8.6% in men (Shaffer, 2006, 990; Shaffer, 2005, pg. 138). The lowest rate which is <5% occur in sub-Saharan Africa.
The biopsychosocial approach enables the physician or health care provider to examine the biological, psychological and social factors and how they interact when delivering health care. (George and Engel, 1980, pg. 535). This model takes a holistic view of the patient and tries to check how the biological, social and psychological interplay are all relevant to the well-being of the patient (Adler, 2009, pg. 610)
The biological factors include gender, immune competence, genetic variability, stress reactivity and physiological response to stress.
Mr. ABC is diabetic, and this increases his risk of cholecystitis (Cho et al., 2010, pg. 331). Another biological factor in play is the fact that he is a male aged above 60 years -72 years- which also increase his risk of cholecystitis. Also, if he has a higher physiological response to stress in that whenever he is ill, he gets abnormally anxious.
Social factors include family support, socioeconomic status, family background and cultural traditions (George and Engel, 1980, pg. 535). If Mr. ABC has strong family support in that the family is there for him and take him through the whole process, he is likely to get better. Also, if he has the finances to enable him to get treated he is likely to get better. Also, if the family knows how to deal with his illness, i.e., the family takes things easy, they do not magnify the sickness, this is likely to make the patient get better. Some cultural traditions do not allow a person to seek medical treatment or take medications, which will influence Mr. ABC wellbeing.
Psychological factors include attitudes, personality, behavior, emotions, psychological response to stress, and coping skills (Smith, and Nicassio, 1995). Cholecystitis is associated with a sharp pain in the right upper quadrant of the abdomen. Mr. ABC's attitude toward the pain and his illness will affect his well-being. If he has a strong personality and positive attitude and thoughts towards illness, he will have a health-promoting behavior. This means he knows and believes he will get well. His adherence to medication and any medical advice will be strict.
He does not allow himself to think of the pain and does not have self-pity nor let the illness defeat him. He chooses not to allow the pain and illness define him nor bring him down. The disease does not define him, and he has an uplifting spirit. With a positive, attitude, thoughts and strong personality, the patient will not give up, and this reduces the cause of illness.
Allen, S.N., 2013. Gallbladder disease: Pathophysiology, diagnosis, and treatment. US Pharm, 38(3), pp.33-41.
Adler, R.H., 2009. Engel's biopsychosocial model is still relevant today. Journal of psychosomatic research, 67(6), pp.607-611.
Barie, P. S., & Eachempati, S. R. (2015). Acute acalculous cholecystitis. In Acute Cholecystitis (pp. 187-196). Springer, Cham.
Campanile, F.C., Giannotti, D., Agresta, F., Vettoretto, N. and Ivatury, R., 2016. Acute calculous cholecystitis. In Emergency laparoscopy (pp. 7-25). Springer, Cham.
Cho, J.Y., Han, H.S., Yoon, Y.S., and Ahn, K.S., 2010. Risk factors for acute cholecystitis and a complicated clinical course in patients with symptomatic cholelithiasis. Archives of Surgery, 145(4), pp.329-333.
Everhart, J.E., Yeh, F., Lee, E.T., Hill, M.C., Fabsitz, R., Howard, B.V. and Welty, T.K., 2002. Prevalence of gallbladder disease in American Indian populations: findings from the Strong Heart Study. Hepatology, 35(6), pp.1507-1512.
George, E. and ENGEL, L., 1980. The clinical application of the biopsychosocial model. American journal of Psychiatry, 137, pp.535-544.
Knab, L.M., Boller, A.M. and Mahvi, D.M., 2014. Cholecystitis. Surgical Clinics, 94(2), pp.455-470.
Shaffer, E.A., 2006. Epidemiology of gallbladder stone disease. Best Practice & Research Clinical Gastroenterology, 20(6), pp.981-996.
Shaffer, E.A., 2005. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century?. Current gastroenterology reports, 7(2), pp.132-140.
Stinton, L.M. and Shaffer, E.A., 2012. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut and liver, 6(2), p.172.
Smelt, A.H.M., 2010. Triglycerides and gallstone formation. Clinica Chimica Acta, 411(21-22), pp.1625-1631.
Smith, T.W., and Nicassio, P.M., 1995. Psychological practice: Clinical application of the biopsychosocial model.
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