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Case Analysis on
Obstructive Jaundice
Secondary To
Choledocholithiasis

Submitted to:
Mrs. Maria Glenda L. Morales, RN MAN

Submitted by:
Lady Karen V. Mangahas
3nu07 – Group 1

August 3, 2010
 Choledocholithiasis
Choledocholithiasis is the presence of a gallstone in the common bile duct. The
stone may consist of bile pigments or calcium and cholesterol salts.

About 15% of people with gallstones will develop stones in the common bile
duct, the small tube that carries bile from the gallbladder to the intestine.

Risk factors include a previous medical history of gallstones. However,

choledocholithiasis can occur in people who have had their gallbladder removed.

Signs and Symptoms

Symptoms usually do not occur unless the stone blocks the common bile duct.
Symptoms that may occur include:
• Abdominal pain in the right upper or middle upper abdomen
• Fever
• Loss of appetite
• Jaundice (yellowing of skin and whites of eyes)
• Nausea
• Vomiting

Diagnostics
Tests that show the location of stones in the bile duct include the following:
• Abdominal CT scan
• Abdominal ultrasound
• Endoscope retrograde cholangiography (ERCP)
• Endoscopic ultrasound
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTCA)
Your doctor may order the following blood tests:
• Bilirubin
• Liver function tests

Treatment

The goal of treatment is to relieve the blockage. Treatment may involve:

• Surgery to remove the gallbladder and stones
• ERCP and a procedure called a sphincterotomy, which makes a surgical cut into
the muscle in the common bile duct.

Prognosis
Blockage and infection caused by stones in the biliary tract can be life
threatening. However, with prompt diagnosis and treatment, the outcome is usually very
good.
Patient: Mrs. ABC
Age: 38 years old Gender: Female
Date of Admission: 8/01/10

Medications
• Pankreoflat
• Cefoxitin (Monowel)
• Phytomenadione (Konakion)
• Sedoz Antloc (Midozolam)
• Pantroprazole (Pantoloc)

Laboratory Tests/Exams

Liver Function Test (Blood Specimen)

Normal Range Result
SGPT/ALT 30-65 U/L 638 U/L
SGOT/AST 15-35 U/L 278 U/L
Total Bilirubin 0.00-1.00 mg/dL 2.18 mg/dL
Conjugated Bilirubin 0.00-0.30 mg/dL 2.02 mg/dL
Unconjugated Bilirubin 0.00-0.80 mg/dL 0.16 mg/dL
Alkaline Phosphatase 50-136 U/L 259 U/L
Total Protein 3.4-5.0 g/dL 8.3 g/dL
Globulin 2.30-3.50 g/dL 4.3 g/dL
Albumin 3.4-5.0 g/dL 4 g/dL

Complete Blood Count

Normal Range Result
Hemoglobin 11.6-15.5 g/dL 13.3 g/dL
Hematocrit 36-47.0 g/dL 38.8 g/dL
Red Blood Cell 4.20-5.40 mil/mm3 4.41 mil/mm3
Monocyte 3-9 % 9%
White Blood Cell 4800-10800 mm3 5400 mm3
Platelet 150000-400000 mm3 409000 mm3

Chest X-ray
Normal Chest
Nursing Care Plan