Gallbladder Flashcards
Cholelithiasis
Stones in Gallbladder
Why does Cholelithiasis happen?
Etiology: Unknown
Cholelithiasis: Risk Factors
- Gender (little higher in females)
- Age (<40)
- Estrogen (higher)
- Lifestyle (obese or sedentary)
- Diet (cholesterol + fat, low fiber)
- Family History
Where does bile come from?
Liver, then stored in gallbladder
Function of Bile
Function: Digest lipids and transport waste
What’s in bile?
Components:
- Bilirubin
- Cholesterol
- Bile salts
- Water
- Protein + Calcium
Cholelithiasis: Pathogenesis
- Bile Stasis
- Super Saturation with cholesterol
- Precipitation
Where do gallbladder stones go?
remain in gallbladder or migrate through bile ducts
Cholelithiasis possible results
- Pain
- Obstruction
- Cholecystitis (inflammation of gallbladder if blocked duct)
Cholelithiasis can be?
Silent
Severity of Cholelithiasis depends on
- Movement of stones
- Obstruction
Major manifestation of Cholelithiasis
Biliary Colic
Biliary Colic
when stones move into biliary tree.
- Steady, Severe pain (1 hr)
- RUQ, may radiate to right shoulder
- 3 to 6 hours after fatty meal
- Tachy, diaphoresis,
Obstructed Bile Flow Manifestations 1
Jaundice:
-Bile cannot flow into duodenum (direct/conjugated)
Dark amber urine that foams when shaken:
-Soluble bilirubin in urine
Clay colored stools:
-Bilirubin does not reach small intestines to be converted into urobilinogen (brown color of stool)
Steatorrhea: (fat in stool)
-No bile salts in duodenum, preventing fat digestion
Obstructed Bile Flow Manifestations 2
Puritis:
-Bile salts deposit in to skin tissues
Intolerance to fatty foods:
-No bile in small intestines to help with fat digestion
Bleeding tendencies:
-Decreased absorption of vitamin K (need bile to absorb)
Gallstones are caused by what?
Abnormal accumulation of bile salts/other substances (Primarily Cholesterol)
Most common cause of Cholecystitis
-Obstruction from gallstones or biliary sludge (sticky and thick like motor oil)
Other causes of Cholecystitis
- Prolonged immobility/fasting
- Bacterial infection
- Parenteral nutrition
- Diabetes mellitus (DM)
In Cholecystitis, the obstruction causes
Inflammation
In Cholecystitis the Gallbladder becomes
- Edematous (edema)
- Hyperemic (increased blood flow to various parts)
- Distended (swollen)
Overtime in Cholecystitis, what happens?
Scaring and decreased function
-eventually will have GB removed due to ineffectiveness
Systemic Symptoms of Cholecystitis
- Fever
- Chills
- N//V
- Restlessness
Cholecystitis Lab values
- Bilirubin (Inc)
- Liver Enzymes (Inc)
- WBC (Inc)
- Amylase (Inc)
Cholecystitis can lead to
Peritonitis
Gallbladder Treatment with drugs
Analgesic: Ketorolac (Toradol)
Antiemetics:
-N/V
Anticholinergics:
-Dec GB secretion and stop smooth muscle spasms (in bile duct)
Bile acids: (rarely used)
-Dissolve stones
