ANSWER
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The most probable diagnosis from the case study is cholelithiasis. It is a chronic recurrent hepatobiliary disorder which presents with defective cholesterol metabolism, bilirubin and bile acids that leading to the formation of gallstones in the common bile duct or hepatic bile duct. The rate of the disease has increased due to factors such as; changes in dietary intake, decline of motor activity, and a decrease in physical load. Risk factors associated with the development of the disease include; gender; it is more common in women, age, genetic predisposition, and race (Littlefield & Lenahan, 2019). Other factors are; losing weight rapidly, DM, obesity, pregnancy, drugs, and hypertriglyceridemia.
There are four stages of gallstone disease; the lithogenic stage in which conditions promote formation of gallstones, asymptomatic state, symptomatic gallstones which are expressed by incidents of biliary colic and lastly, and complicated cholelithiasis (Heuman, 2021). The symptoms and complications are as a result of the effects that occur in the gallbladder or from the stones that leave the gallbladder to embed in the common bile duct. The clinical presentation is a biliary colic that takes place when gallstones accidentally lodge in the cystic duct during gallbladder contraction thus increasing the gallbladder wall tension. On most occasions, the pain resolves between 30 to 90 minutes after relaxation of the gallbladder and the obstruction is relieved. The pain is located in the epigastrium or RUQ which at times radiates to the right scapular tip, it is intermittent and has unpredictable episodes, it begins post-prandial after intake of a fatty meal, is described as dull and intense, and is not alleviated by antacids, emesis, defecation or positional changes(Tanaja J; Lopez RA; Meer JM, 2022). It is also accompanied by bloating, belching, nausea, vomiting, and bloating.
On physical examination, the pain is poorly localized and visceral in origin and is not associated with guarding or rebound tenderness. Fever is not also present. From the case study, some of the factors associated with gallstones formation include;
The primary treatment of gallstones is their removal from the bile ducts or gallbladder. The precipitating factors of the disease including; obesity, hemolytic anemia, and diabetes mellitus should be treated. Pain management with NSAIDs is administered. Medical treatment of cholelithiasis includes litholytic therapy which involves stone dissolution (Gutt et al., 2020) About 30% of patients undergo litholytic therapy which uses drugs containing ursodeoxycholic or chenodeoxycholic acid, a gallstone solubilizing agent. They eliminate bile acid and inhibit cholesterol synthesis in the liver and its release into the bile as well as uptake in the intestines, ultimately leading to decreased bile cholesterol levels and stone dissolution (Gutt et al., 2020). In order to achieve for successful therapy, the following criteria should be met; the size of the stone should not be >1.5cm, the stone should be cholesterol or mixed, the gallbladder’s function should be fully preserved; the common bile duct and cystic duct should be patent and the enterohepatic bile acid circulation has to be functional.
The dosage of the drug is dependent on the body weight; the daily dose of bile acids should be more in obese patients. The duration of treatment is between 6 months to 2 years or more with ultrasound guidance and blood tests done every three months during therapy. Intake of a low cholesterol diet should be encourage
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