IV.

THE PATIENT

AND

HER ILLNESS

Pathophysiology (Book Based) Modifiable Risk Factors: •Pregnancy •Oral Contraceptives •Estrogen •Cirrhosis •Obesity •Rapid weight loss •Diabetes mellitus •Treatment w/ high dose Estrogen (E.g. in prostate cancer) •Low dose therapy Non Modifiable Risk Factors: Age (middle age bet 20 to 50 yrs. old) Sex (6 times more common in woman)

Hepatobiliary Mechanism

Extrahepatic Obstructive Jaundice

Super saturated cholesterol

Bile stasis

Alteration in the normal component of bile

Intrahepatic Obstructive Jaundice v

Sluggishness in the Gallbladder Unconjugate pigments in bile forms precipitate

Hematologic mechanism

Hypermotility of Gallbladder

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Irritation of Gallbladder

Hemolytic jaundice Hepatocellular Damage or obstruction of bile canaliculi Thickening/ Saturation of bile Trauma to the Gallbladder

Stones start to adhere in the Gallbladder wall

Hypermotility of gallbladder

Spasm of the Gallbladder Excessive lysis of RBC Stone formation

Spasm of the Gallbladder

Stones in the gallbladder passed out and lodge in the common bile duct Epigastric pain Liver unable to conjugate and excrete -bilirubin in the small intestine Obstuction of cystic duct Breakdown of hemoglobin into heme globin

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Food containing fats present in the duodenum is unable to disintegrate and be absorbed •indigestion •fat intolerance •flatulence •clay colored stool •N/V •belching

Fever Pain RUQ radiating at the back)

Blood flocked w/ bilirubin

Inflammation

Trapped bile is reabsorbed (Chemical irritation)

Abdominal distention

Irritation

Vomiting

Distention of the Gallbladder

Bile unable to pass due to bile duct obstruction

Hepatocytes cannot conjugate and excrete bilirubin as rapidly as it is formed so bilirubin enters the blood stream

Conjugate bilirubin accumulates in liver & enters blood stream

Due to absence of bile in the duodenum fats unable to disintegrate and be absorb

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Conjugated hyperbilirubinemia

•Indigestion •Flatulence •Fat intolerance •Clay colored stool

Unconjugated hyper bilirubinemia

Excretion of bilirubin in urine •Dark colored urine

Vit. Deficiency (A, D, E & K)

Bilirubin Deposition in tissues •Jaundice •Pruritus

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