DEFINITION OF CHOLELITHIASIS

Cholelithiasis also known is Gallbladder. Gallstones are concretions that form in the biliary tract, usually in the gallbladder. Gallstones are formed within the gallbladder, an organ that stores bile excreted from the liver. Further complications of gallbladder disease include gallstone pancreatitis, gallstone ileus, biliary cirrhosis, and gallbladder cancer. Gallstones may be as small as a grain of sand, or they may become as large as an inch in diameter, depending on how long they have been forming. A stone blocking the opening from the gallbladder or cystic duct usually produces symptoms of biliary colic, which is right upper abdominal pain that feels like cramping.

PATHOPHYSIOLOGY CHOLELITHIASIS
PREDISPOSING FACTORS PRECIPITATING FACTORS

AGE

RACE

GENDER

PHARMACOLOGIC INTAKE

BODY WEIGHT

LACK OF PHYSICAL EXCERCISE

DIET

HIGH BILIRUBIN

INCREASED RISK WITH AGE

FAIR-SKINNED (EUROPEANS, HISPANICS, NATIVE AMERICANS)

ASIANS & AFRICAN AMERICAN

FEMALE S

MALE

OBESITY

GALLBLADDER CONTRACTION

HIGH FAT

HIGH STARCH

HIGH PROTEIN

HIGH CHOLESTEROL

HORMONAL CONTRACEPTIVES

PROGESTERONE

PRESENCE OF ESTROGEN

PRODUCTION OF LIVER ENZYMES

INCREASED RISK FOR MULTIPAROUS AND PREGNANT WOMEN

INCREASED CHOLESTEROL SECRETION INCREASED LIPASE INCREASED AMYLASE INCREASE SGOT-AST & LDH LEVELS CYSTIC DUCT OBSTRUCTION

INCREASED BILE SECRETION

DIMINISHED GALLBLADDER EMPTYING

BILIARY STASIS

INCREASED BILE SECRETION (COMPENSATORY)

BACK FLOW

OVERCONCENTRATION AND SUPERSATURATON OF BILE

PANCREATITIS

INFECTION INDIGESTION*

CONSTIPATION

FORMING OF GALLSTONES (CHOLELITHIASIS)**

CHOLECYSTITIS

FORMING OF GALLSTONES (CHOLELITHIASIS)**

SYMPTOMATIC

ASYMPTOMATIC

SILENT ATTACK GALLBLADER DYSPEPSIA (+) MURPHYS SIGN INDIGESTION* UPPER ABDOMINAL /EPIGASTRIC PAIN UNABLE TO FIND COMFORTABLE POSITION

NAUSEA

VOMITNG SOB AT NIGHT BACK PAIN

BILIARY COLIC