Pathophysiology Non modifiable factors -Age (56 years old) -Gender/sex (female) -Genetic predisposition -Estrogen levels -Ethnicity

Modifiable factors -Rapid weight loss -Lack of physical activity -Diabetes Mellitus type 2 -Peptic ulcer -Nonalcoholic fatty liver disease

Genetic & Demography

Change in Bile Composition

Decreased contractility of bile flow Bile Stasis

Increased intraluminal Pressure

Contraction of substances present in bile Precipitation of bile substances Bile substance will increase in size Stones migrate to gall bladder Obstruction of the flow in bile

Stimulates smooth muscle contraction

Increase tension to duodenum

RUQ abdominal Pain Radiating pain to lower back

Impaired Hepatic uptake of bilirubin

Collection of soluble bilirubin in the urine

No bile reaches the GIT

Cholesterol salts In the skin Jaundice

Escape of bilirubin to GUT

No bile in small intestine for fat Digestion Emulsification of fats

Decrease bile in the duodenum Sterobilin Clay colored stool

Presence of Bile in the urine Dark yellow urine

Nausea and Vomiting

Obstructed cystic duct Bile duct obstructed already Gall bladder becomes distended RUQ pain

Cholecystitis

nausea and vomiting Risk for deficient fluid volume r/t active fluid loss

Scheduled for LAPARASCOPIC cholecystectomy WITH BIOPSY OF THE LIVER NODULE Anxiety r/t upcoming surgery LAPARASCOPIC cholecystectomy WITH BIOPSY OF THE LIVER NODULE Acute pain r/t tissue trauma secondary to laparoscopic cholecystectomy Ineffective tissue perfusion Impaired tissue integrity r/t tissue trauma secondary to laparoscopic cholecystectomy

REFERENCES: > http://nursingcrib.com/pathophysiology/pathophysiology-of-cholelithiasischolecystitis/ >http://bestpractice.bmj.com/best-practice/monograph/873/basics/pathophysiology.html