IX.

ECOLOGIC MODEL
A. Hypothesis

Chronic calculous cholecystitis is an inflammation of the gallbladder that occurs most commonly because of an obstruction of the cystic duct from cholelithiasis. It almost always results from gallstones. It is characterized by repeated attacks of pain (biliary colic). In our study of the patients condition we have perceived that the predisposing factors which contributed to the occurrence of chronic calculous cholecystitis are due to alcohol intake, smoking and ingestion of fatty foods.

B. Predisposing Factors 1. Host 38 years old Female

2. Agent Alcohol Smoking Fatty foods (cholesterol)

C.

Ecologic Model

The web model primarily talks of the multiple causation of the disease. It is used to show the relationship among different factors that contribute to the occurrence of the disease. The diagram below shows the possible imbalance of the predisposing factors that could affect the other or as a whole. It emphasizes every factor that could lead to possible complication or involvement of other system.

D. Analysis Most cases of cholecystitis occur as a consequence of gallstones. Gallstones are deposits of cholesterol and other components of the bile. These hardened deposits of cholesterol may eventually block the free flow of the bile from cystic duct. This problem may manifest in the form of gallbladder inflammation.

Gallstones are more common in women than in men. It is postulated that estrogens because increased cholesterol secretion and progesterone promotes biliary stasis. People older than age 60 are more likely to develop gallstones than younger people. As people age, the body tends to secrete more cholesterol into bile. Smoking responsible for changes in all parts of the body, including the digestive system. This fact can have serious consequences because it is the digestive system that converts foods into the nutrients the body needs to live. It also increases the risk of Crohn's disease and possibly gallstones. Smoking seems to affect the liver, too, by changing the way it handles drugs and alcohol. The gallbladder is an adjunct to the liver, whose main function is to break down fats by concentrating bile. Alcohol is not good for the health as it puts strain on the liver, which processes the body fats. Heavy alcohol use or alcohol abuse can bring gall bladder problems in the form of gallstones. Fatty foods breakdown of fats during digestion is rather difficult. This is because the bile and other digestive juices cannot travel to the stomach and the large intestines, as the gall bladder is blocked due to gallstone formation. As the digestive juices do not mix with food, breakdown of fats, becomes a distant possibility. An imbalance between these components of bile -cholesterol, bile salts, and bilirubin -- leads to the formation of gallstones. Cholesterol is normally kept in liquid form by the dissolving action of the bile salts; an increased amount of cholesterol in the bile overwhelms the dissolving capacity of the bile salts and leads to the formation of cholesterol gallstones.
Sources:
http://www.medterms.com/script/main/art.asp?articlekey=2459 http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/

http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/ http://emedicine.medscape.com/article/774352-overview http://www.merck.com/mmhe/sec10/ch140/ch140c.html

E. Conclusions and Recommendations We therefore conclude that our patient has chronic calculous cholecystitis which the cause is due to alcohol intake, smoking and ingestion of fatty foods. It blocks the free flow of the bile from cystic duct which may manifest in the form of gallbladder inflammation. We recommend to her to eat a healthy diet and limit ingestion of fatty foods, alcohol intake and quit smoking.