Pathophysiology Precipitating Factors Obesity Diet Drugs Multiple Parity Process Predisposing Factors Age (40 years old

up) Gender (Female) Pregnancy Hereditary

Nutritional deficiency and exposure to toxins

Super-saturation of cholesterol in bile

Mixture of microscopic particulate matter in bile that occurs when particles of materials precipitate

Bile becomes too thick and can be formed as gallstones

Obstruction of the cystic duct and common bile duct Abdominal distension Bloating Constipation

Sharp pain in RUQ Jaundice

Distension of the gall bladder

Venous congestion and lymphatic stasis

Proliferation of bacteria

Irritation or infiltration or both can take place

Nausea Vomiting

Mucosal swelling and ischemia

Abdominal pain Dizziness

Gangrenous changes and perforation of gall bladder

Mucosal necrosis

Inflammation of gall bladder

Pain (severe)

Pathophysiology Most gallstones result from supersaturation of cholesterol in the bile, which acts as an irritant, producing inflammation in the gallbladder, and which precipitates out of bile, causing stones. Risk factors include gender (women four times as like to develop cholesterol stones as men), age (older than age 40), multiple parity, obesity, use of estrogen and cholesterol-lowering drugs, bile acid malabsorption with GI disease, genetic predisposition, rapid weight loss. Pigment stones occur when free bilirubin combines with calcium. These stones occur primarily in patients with cirrhosis, hemolysis, and biliary infections. Acute cholecystitis is caused primarily by gallstone obstruction of the cystic duct with edema, inflammation, and bacterial invasion. It may also occur in the absence of stones, as a result of major surgical procedures, severe trauma, or burns. Acute cholecystitis can progress to gangrene or perforation of the gallbladder if left untreated. Infection develops in about 20% of patients with acute cholecystitis, and increases the danger from this condition. People with diabetes are at particular risk for serious complications. Chronic cholecystitis results from repeated attacks of cholecystitis, presence of stones, or chronic irritation. The gallbladder becomes thickened, rigid, fibrotic, and functions poorly. Ninety percent of cases of cholecystitis involve stones in the cystic duct (ie, calculous cholecystitis), with the other 10% of cases representing acalculous cholecystitis. Acute calculous cholecystitis is caused by obstruction of the cystic duct, leading to distention of the gallbladder. As the gallbladder becomes distended, blood flow and lymphatic drainage are compromised, leading to mucosal ischemia and necrosis. Although the exact mechanism of acalculous cholecystitis is unclear, several theories exist. Injury may be the result of retained concentrated bile, an extremely noxious substance. In the presence of prolonged fasting, the gallbladder never receives a cholecystokinin (CCK) stimulus to empty; thus, the concentrated bile remains stagnant in the lumen. Less commonly, in debilitated and trauma patients, the gallbladder may become inflamed and infected in the absence of cholelithiasis, and is known as acute acalculous cholecystitis. The gallbladder's wall becomes inflamed. Extreme cases may result in necrosis and rupture. Inflammation often spreads to its outer covering, thus irritating surrounding structures such as the diaphragm and bowel.

Etiology of Cholecystitis Primarily the main etiology of Cholecystitis is due to formation of biliary sludge (formed by cholesterol and bilirubin in bile) but there are factors to be considered. The following are the precipitating and predisposing factors commonly associated with developing of cholecystitis.

A. Predisposing Factors Etiology Age (40 years old up) Actual Absent Justification At this age category, our body systems are deteriorating. The bodys digestion s not that active at our early ages. The estrogen and progesterone hormone reduces the synthesis of bile acid in women. In this condition there is a high risk for gallstone formation as the bile production in the body increase in a certain extent, it is due to the changing hormone levels in the womens body. Having a family history of gall bladder problems are more likely to encounter same condition and situation.

Gender (Women)

Present

Pregnancy

Present

Hereditary

Absent

B. Precipitating Factors Etiology Obesity or rapid weight loss Actual Absent Justification Eating too much fatty foods and drinking too much alcohol cause gall bladder problems. Intake of contraceptive pills reduces the synthesis of bile acids in women. Mrs. SMA is taking trust pills. Intake of too high cholesterol level or fatty foods are at high risk of gallstones where there are possibility of not enough bile to compensate with the fatty foods that we intake. They are in higher risk of gallstones due to changing of hormonal levels in the womens body.

Drugs (containing estrogen)

Present

Diet

Present

Multiple Parity

Absent