Case: Your neighbor Martha is a 64 year-old women who is overweight and suffers
ID: 3512046 • Letter: C
Question
Case: Your neighbor Martha is a 64 year-old women who is overweight and suffers from diabetes. Over the past few weeks you have noticed Martha is exiting her house less and frequently "looks ill" when you do see her. Being a good neighbor you decide to stop by to make sure everything is OK. You bring over some pizza (Martha's favorite) and the two of you sit down for lunch. Martha seems to feel fine before lunch and the two of you talk without any incident. However, shortly after lunch Martha's appearance changes and she seems to be in pain. She informs you that for the last several weeks she has experienced severe pain following meals but has attributed it to indigestion and states "I have diabetes you know!” Upon further investigation you discover the pain is concentrated to the right upper quadrant of her abdomen and wrapping around her back (inferior to scapula) (Figure ). The pain usually last an hour after eating and then diminishes. With your knowledge of anatomy and referred pain, you understand there may be an underlying issue causing the pain, so you offer to take Martha to her physician for a check-up. There, the physician uses an ultrasound machine (Figure 2) to diagnose cholelithiasis (Gallstones) and refers Martha to a surgeon to schedule a gallbladder removal. On the way home Martha has many questions about the gallbladder and surrounding anatomy Goal: Using correct anatomical terminology, explain to Martha the location of the gallbladder and biliary duct system and their relationship to other abdominal structures. Next explain to Martha the most likely reason she is experiencing pain in the locations shown in figure. In order for the surgeon to remove the gallbladder the cystic artery must be ligated, beginning in the right atrium of the heart trace the pathway of blood flowing to the gallbladder noting specific anatomical features (valves, arteries, ect.) along the way. Lastly, briefly explain to Martha the pathway the gallstones would follow through the digestive tract if they were to become dislodged from the gallbladder (noting at least one distinguishing feature/function of each region along the way)Explanation / Answer
Gallbladder is located beneath the liver. Gallbladder receives and stores bile and releases it into duodenum via common bile duct. Bile helps in digestion of fats. Undissolves materials are formed as gall stones and cause pain in upper right corner of abdomen. If gallstone blocks gallbladder, inflammation of gallbladder occurs, if it lodges in the bile system, jaundice occurs, if it blocks pancreas, pancreatitis occurs. Hence it must be removed by surgery.