Gall bladder: Cholelithiasis & Cholecystitis Flashcards
Liver
Largest internal organ in the body; essential for life
Metabolic functions include: carbohydrate, protein and fat metabolism; detoxification of the blood; steroid metabolism
Bile Synthesis functions include: bile production and storage
Mononuclear phagocyte system function includes: breakdown of old RBC’s, WBC’s, bacteria, etc. Breakdown of Hgb to bilirubin and biliverdin
Biliary tract
Made up of the gallbladder and the duct system
Bilirubin
Pancreas
Exocrine (pancreatic enzymes contributing to digestion) and endocrine functions (Islets of Langerhans secreting insulin, glucagon, somatostatin, and pancreatic polypeptide)
Bilirubin metabolism
RBC destruction
Hgb
Unconjugated bilirubin
Insoluble so attached to albumin
Liver
(unconjugated bili combines with gluronic acid to become conjugated bilirubin (soluble))
Excreted in bile
Intestines - bili reduced to urobilinogen by intestinal bacteria
- into bacteria, or travels to liver to be recycled to bile or is secreted into the urine
What is cholelithiasis?
Stones in the gall bladder and the most common disorder of the biliary system.
Immobility, pregnancy, and inflammatory and obstructive lesions of the biliary system all decrease bile flow. This can lead to gall stones.
The stones can remain in the gall bladder or migrate to the cystic or common bile ducts.
When the bile in the gall bladder can’t escape it may lead to Cholecystitis.
Risk factors for cholelithiasis
overweight/obese
increased fat/cholesterol diet
increased 40 y/o
meds that contain estrogen
family hx of gallstone
female
What are gall stones precipitates of
Cholesterol ** predominant
Bile salts
Bilirubin
Calcium
Protein
Gall stones get stuck in the…
Hepatic duct which carries bile to liver
cystic duct which carries bile to and from the gall bladder
common bile duct which collects bile from the cystic and hepatic duct and carries it to the small intestine
blockage to the pancreatic duct can cause pancreatic enzymes to be trapped inside the pancreas which can be very painful and can cause a dangerous inflammation known as pancreatitis
What is Cholecystits
Most commonly associated with instruction caused by gall stones
acalculous cholecystitis: gallbladder inflammation without obstruction
- caused by immobility, fasting, prolonged TPN, diabetes, bacteria
Inflammation is the major pathologic condition
Caused by gall stone obstruction preventing bile outflow (in most cases)
During an acute attack, the gallbladder is edematous and hyperemic
May be distended with bile and pus
Cystic duct is usually involved and may be occluded
The walls become scarred after an attack and decreased functioning can occur
Cholecystitis clinical manifestations
Pain (indigestion - severe pain) “biliary colic”, steady, comes after meal, radiates to shoulder
Jaundice
Leukocytosis, fever - pos murphies sign
N V
Labs of cholecystitis
increased WBC, increased CRP, increased bili, increased alkaline phosphatase, increased lipase
Chronic cholecystitis
Fat intolerance, dyspepsia, heartburn and flatulence
Biliary colic
Spasms due to stones lodging or moving through the ducts. Not usually “colicky” but steady
usually accompanied with excruciating RUQ pain that radiates to the back or right shoulder, nausea and vomiting x 1 hour, with residual pain x 3-6h.
Can be associated with tachycardia, diaphoresis and prostration
Attacks occur approx. 3-6 hours after a heavy meal or when the client assumes a recumbent position.
What are manifestations caused by obstructive bile flow
Jaundice
amber urine which foams when shaken
Clay coloured stools
Pruritis
Intolerance for fatty foods
Bleeding tendencies
Steatorrhea
Complications of cholecystitis and cholelithiasis
Gangrenous cholecystitis
Subphrenic abscess
Acute pancreatitis
Cholangitis
Biliary cirrhosis
Fistulas
Rupture of the gallbladder leading to peritonitis
Most common complications in older clients and those with diabetes are:
Gangrenous cholecystitis
Bile peritonitis
