I. A. GENERAL DATA 1. Patient’s Name 2. Address 3. Age 4. Sex 5. Birth Date 6. Rank in the family 7. Nationality 8.

Civil Status 9. Date of Admission 10. Order of Admission 11. Attending Physician CHIEF COMPLAINT: : : : : : : : : : : :

PATIENT ASSESSMENT DATA BASE

Mrs. B Tarlac City 37 Female August 6, 1972 1st Filipino Married November 20, 2009 N/A Dra. Josephine Zarate

With the chief complaint of epigastric pain HISTORY OF PRESENT ILLNESS: As for her present illness, a month prior to admission , Mrs. B experienced right upper quadrant pain associated with a sense of bloatedness, without nausea and vomiting. The pain was tolerable so she did not seek medical attention yet. She said she also had an increased level of pain tolerance so she also didn’t mind to take any pain relievers. She was admitted into this hospital (Tarlac Provincial Hospital) and admitted last November 20, 2009. She was been diagnosed with cholecystitis one week prior to admission due to severe epigastric pain. She just did not have her cholecystectomy done immediately due to financial problem. When the money needed for her operation that’s the time she will undergo for her operation. She was diagnosed by Dra. Josephine Zarate according to Mrs. B. PAST HEALTH HISTORY/ STATUS 1. Childhood Illnesses: Mrs. B experienced common illness such as colds, cough, and fever during his childhood 2. Immunization: She also had chicken pox during her childhood. However, she could not recall at what age she got the disease and as well as the management of her chicken pox. 3. Major Illnesses: This is the second time that she got a major illnesses and she had undergone an operation of appendectomy and caesarean section 4. Current Medication: Metronidazole, Ketorolac, Vitamin K, Ciprofloxacin, HNBB 5. Allergies: No allergies stated according to Mrs. B.

FAMILY ASSESSMENT NAME Mike Carmen Elmer Joyce F. RELATION Father Mother Husband Daughter AGE 73 69 40 12 SEX M F M F OCCUPATION Factory worker Housewife Factory worker Student EDUC’L ATTAINMENT High School Graduate High School Graduate High School Graduate First Year High School

SYSTEMS REVIEW

- (Gordon’s 11 Functional Health Patterns Assessment, more patient’s more than 3 y/o)

1. HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN The patient perception of health is the person must be strong, no illness and can do any responsibilities given to her. She stated that illness for can be cured through enough rest. 2. NUTRITIONAL – METABOLIC PATTERN  Appetite:  Usual Daily Menu Food - She eats meats and vegetables Water - She drinks water 8 glasses per day Beverages She drinks coke but not always BREAKFAST LUNCH Rice Coffee Hotdog Rice Water Vegetable

• • •

DINNER Rice Water Meat

3. ELIMINATION PATTERN  Bowel habits: Color: Light Brown

• • •

Odor: Smell awful Consistency: Small amount Laxative use if any: none  Bladder: Color: Dark yellow Odor: Alterations if any: none 4. ACTIVITY – EXERCISE PATTERN  Self – care ability _II__Feeding _II__Bathing _II__Bed mobility 0 I II II IV

• • •

_II__Dressing _II__Toileting _II__Home maintenance

_II__Grooming _II_ Cooking ___others

Legend – full care – requires use of equipment – requires assistance or supervision from others – requires assistance or supervision from another, and equipment and a device – dependent; doesn’t participate

5. COGNITIVE – PERCEPTUAL PATTERN     Hearing: The patient has no problem in hearing. Vision: The patient wearing eye glasses sometimes according to her Sensory perception: She has the ability to feel, taste and smell is both normal. Learning styles: The patient comprehends but she is very passive.

6. SLEEP – REST PATTERN • • • Sleep habits: The patients want to go to sleep but she shower first. Special sleeping problem: She experiencing talking while she is sleep. Hours of sleep: She stated that she sleeps 10 hours a day

• •

Sleeping alterations: She stated that she is disturbed during urination. Sleeping aids: Reading books

7. SELF-PERCEPTION AND SELF-CONCEPT PATTERN • Feeling about current state: Mrs. BS says that she is weak and pale in appearance and limitation of movement. • •

Description of self: She is generous, kind, loving mother to her children and Mother and Father. Known capabilities and weakness: When the patient work hard like washing clothes, etc.

Self worth: The patient was proud because she knew that having children more than she was expected was hard but she handle the responsibilities. 8. ROLE RELATIONSHIP PATTERN • Perception of major roles and responsibilities in the family: Being a mother was so hard said the patient, but it was so enjoyable. • • Perception of major roles and responsibilities at work: The patient was unable to work because of her sudden situation. Perception of major social roles and responsibilities: The patient doesn’t socialize that much because of his illness.

o o o o o o

9. SEXUALITY-REPRODUCTIVE PATTERN • Menstrual history Age of onset of menarche: 15 y/o Number of menstrual days: 5days Number of pads every menstruation: 2 pads Presence of PMS, dysmenorrheal and other menstrual problems: none • Obstetric history: TPAL: G1P1(0001) Operations: none  For both sexes

Contraception: none Sexual activities: The patient is sexually active

Special health reproductive problems: none History of sex abuse: none 10. COPING-STRESS TOLERANCE PATTERN • Perception of stress and problems in life: Thinking too much problem in life.
• Coping methods and support system used: She said that she used to go to the church and thank God for everything.

11. VALUE-BELIEF PATTERN • Values goals and philosophical beliefs: The patient believed that all superstitious beliefs were true. • Religious and spiritual belief: The patient has strong spiritual beliefs.

G.

HEREDO-FAMILIAL ILLNESS Paternal: Her father is positive for hypertension Maternal: No illnesses stated according to Mrs.B

H.

DEVELOPMENTAL HISTORY THEORIST Eric Erikson Stage 7: Generativity vs. Stagnation (Middle Adulthood) AGE 35-65 yrs. Old SEX Female PATIENT DESCRIPTION Mrs. B doesn’t allow of her husband to work to make sure that the children receive a direct parental guidance in their growing years. Moreover, her husband is a works alone to provide the family’s financial needs.

I.

PHYSICAL ASSESSMENT A. General Survey: Patient is alert, awake, verbally responsive and is oriented to the environment and still with complaint of epigastric pain

B. BP T PR RR C. Hair, head and face: : 110/70 mmHg : 36.5ºC : 62 bpm : 16 cpm

Vital Signs

Regional Exam – utilize IPPA technique Skull size was normocephalic. Skull and face were symmetrical with an equal distribution of hair. Hair was black in color with fair amount of white and gray strands, short, dry, and fine. There was no dandruff or infestation present. No lesions, lacerations, tenderness, masses and depressions noted. The forehead was furrowed with wrinkles. Face portrayed emotions with symmetrical movements. No masses or involuntary movement. The face was round, with no edema, lesions, discolorations present

Eyes: Pupils are equal and round reactive to light and accommodation (PERRLA) Nose: The nose was symmetrical with no deformities, skin lesions, massses present. Nasal septum is intact and in midline. No nasal flaring was observed. No discharges were present. No tenderness in his sinuses upon palpation. Ears: Ears were symmetrical with same size bilaterally and color consistent with face. Pinnas were free from lesions, masses, swelling, redness, tenderness, and discharges and were in line with the eyes. External canals were clear with no cerumen seen. No inflammation, masses, discharges and foreign bodies noted. Gross hearing acuity was good. No pain on the mastoid process was reported upon palpation. Mouth and Throat: Mouth was proportional and symmetrical. Lips were rust colored and were dry with no presence of ulcerations, sores or lesions. Teeth were yellowish in color with some dental caries noted. Right upper first premolar tooth was absent. Tongue was in central position and moves freely with no swelling or ulcerations observed. Gag reflex was present as evidenced by patient swallowing. Tonsils were not inflamed. Halitosis was also noted. Neck and Lymph nodes: Neck was symmetrical with no masses or swelling noted. No jugular vein distention was noted. Range of motion was normal and moves easily without discomfort upon rotation, flexion, extension and hyperextension. Thyroid was not enlarged has no nodules, masses, and irregularities upon palpation. Trachea is symmetrical and in midline without deviation. Skin:

Skin was warm to touch, slightly dry, rough, and with good skin turgot. Neither jaundice nor cyanosis observed. Papules on the face observed, with nevi noted on the right side of the nose. Patient was not cyanotic. No bruises or discolorations observed. No edema noted. Nails: Pink nail bed and trimmed Thorax and Lungs: No thorax deformity observed. Respiratory rate was 21 cycles per minute with regular breathing pattern. Symmetrical chest expansion was observed during respiration. No use of accessory muscles during breathing observed. Chest wall was intact; no tenderness and masses noted. Uniform temperature also noted. No adventitious breath sounds heard upon auscultation. No cough present. Cardiovascular: With cardiac rate of 75 beats per minute with a regular rhythm. No abnormal beats, palpitations, thrills or murmurs present upon auscultation. Breast and Axilla: No assessment done Abdomen: Abdomen was slighty enlarged and globular when patient was in supine position; with slightly soaked, intact dressing on the right upper quadrant. Pulsations were not visible. The abdomen had hypoactive bowel sounds of two bowel sounds per minute. Extremities: Symmetrical shoulder movement observed during respiration. Spine was located at the midline with no discrepancies noted. Shoulders, arms, elbows and forearms were free from nodules, deformities and atrophy. Range of motion was not limited. Neither pallor nor bone enlargements were noted upon inspection of the upper extremities. Upper extremities were not edematous. Radial and brachial pulses were present. Hip joint and thighs were symmetrical with no deformities present. No edema noted at both legs. No inflammation noted in the lower extremities. Range of motion was active and not limited. Genitals: Unable to perform inspection in the genitourinary region. However, patient verbalized that he had not noted any discharges from his genitalia nor presence of papules or ulcerations. Rectum and Anus: No assessment done Neurological/ Cranial nerves No assessment done II. PERSONAL / SOCIAL HISTORY Habits/vices: No habits or vices stated according to Mrs. B Caffeine – cups/day: She drink twice a day. Once in the morning and once in the evening Smoking – sticks/packs/day: She never smoke according to her Alcohol – brand/ bottles/day: She never drink alcohol

Tea – cups/day: none Drugs – marijuana etc/ OTC drugs: none Lifestyle: Sedentary lifestyle Social affiliation: none Rank in the family: 1st child in the family Travel (within 6 mos): none Educational attainment: High School

III.

ENVIRONMENTAL HISTORY The family not totally belongs to the poverty line. They live in an area near the city. They need to walk far to be able to reach roads where they are vehicles going to the nearest town. That only means they have no immediate access to health centers and hospitals when they need to. They were not able to meet some of their basic needs simply because of their living condition

IV. PEDIATRIC HISTORY Maternal and Birth History  Date of birth: August 6,1972  Birth weight: cannot remember  Type of delivery: NSD  Condition after birth: no abnormalities  Hospital:Tarlac Provincial Hospital b. Mother  Complications of delivery: none  Anesthesia: local anesthesia  Exposure to tetranogens: none c. Neonates  Neonatal history  Feeding history  Type of feeding

V. VI.

LABORATORY AND DIAGNOSTIC EXAMINATIONS \ DATE: November 20, 2009 TYPE OF EXAMINATION: Hematology RESULTS Hemoglobin -172 g/dL Erythrocyte – 5.46 109/L Hematocrit - 0.53 Leukocyte – 15.2 X109/L NORMAL VALUES 120 – 150 g/dL 4.0 - 6.0 X109/L 0.40 – 0.60 5.0 – 10.0 X109/L SIGNIFICANCE Signs of anemia including pallor, dyspnea, chest pain, and fatigue Within normal range. Within normal range. Above normal range. An elevated number of leukocytes can result from infectious diseases (usually bacterial origin), and with trauma, surgery, or acute leukemia. Above normal range, indicates neutrophils are found with a number of bacterial infections, inflammatory but non-infectious diseases (collagen disorders, rheumatic fever, pancreatitis), and with malignancies. Within normal range Within normal range

Segmenter – 0.72

Differential Count 0.45 - 0.65

Lymphocytes -0.28 Platelet Count -222 X109/L

0.20 - 0.35 150 – 450 X109/L

VII.

DRUG STUDY GENERIC NAME: Vitamin K BRAND NAME: Aqua-Mephyton CLASSIFICATION: Fat soluble vitamin DOSAGE: 10g IV OD INDICATION: Prevention of bleeding, Vitamin K malabsoption, hypoprothrombinemia Mechanism of Action Side effects Vitamin K is essential for Dizziness, flushing, the hepatic synthesis of factors II, VII, IX, and X, all of which are essential for blood clotting. Vitamin K deficiency causes an increase in bleeding tendency, demonstrated by ecchymoses, epistaxis, hematuria, GI bleeding. transient hypotension after IV administration, rapid and weak pulse, diaphoresis, erythema, pain swelling and hematoma at injection site Contraindication Hypersensitivity, severe of pregnancy Adverse reaction Anaphylaxis or usually after rapid IV administration Nursing consideration 1. Assess for contraindication. 2. Assess for baseline data. 3. Monitor protime during treatment; monitor for bleeding, pulse and BP. 4. Teach patient not to take other supplements, unless directed by prescriber, to take this medication as directed. 5. Tell patient that he may experience side effects brought

hepatic disease, last few weeks anaphylactoid reactions,

about by the drug and to report intolerable ones so as prompt interventions be done. 6. Instruct patient to report symptoms of bleeding: bruising, nosebleeds, bleack tarry stools, hematuria. 7. Stress the need for periodic lab tests to monitor coagulation level. 8. Instruct patient to report adverse effect that he may experience.

GENERIC NAME: Ranitidine BRAND NAME: Zantac CLASSIFICATION: Histamine 2 antagonist DOSAGE: 50mg IV q8 INDICATION: Mechanism of Action Side effects Contraindication Competitively inhibits headache, rash, dizziness, Hypersensitivity to ranitidine, the action of histamine at vertigo, parietal cells f the abdominal constipation, lactation. discomforts, the H2 receptors of the diarrhea, nausea, vomiting, stomach, inhibiting basal local burning or itching at gastric acid secretion and IV site gastric acid secretion that is stimulated by food, insulin, cholinergic histamine, agonist, Adverse reaction malaise, insomnia, somnolence, urticaria, tachycardia, bradycardia, leukopenia, pancytopenia, thrombocytopenia, gynecomastia, impotence, hepatitis Nursing consideration 1. Assess patient for contraindication. 2. Assess baseline data. 3. Tell patient that he may experience side effects brought about by the drug. 4. Instruct patient to take his meal if nausea or vomiting occurs. 5. Oral care if for

gastrin, and pentagastrin.

vomiting occurs. 6. Adjust lighting and temperature and avoid noise if he experiences headache and instruct him to report if it is intolerable so that medication may be given. 7. Instruct report him to intolerable

side effects so as prompt intervention could be done. 8. Instruct report experience. him to adverse

effects that he may

GENERIC NAME: Ketorolac BRAND NAME: Toradol CLASSIFICATION: NSAID, non-opiod analgesic DOSAGE: 30 mg IVq8 INDICATION: For short-term management (up to 5 days) of moderately severe acute pain that otherwise would require narcotics. It most often is used after surgery. Mechanism of Action Side effects Contraindication Adverse reaction Reduces the production rash, ringing in the ears, Hypersensitivity to ketorolac, gastric or duodenal ulcer, of prostaglandins, headaches, nausea, dizziness, renal abdominal allergy diarrhea, heartburn, retention, insomnia, dry mucous sweating, Impariment, aspirin renal platelet neutropenia, pancytopenia, thrombocytopenia, marrow depression bone impairment, liver chemicals that cells of drowsiness, the immune system make pain, fever, and pain and in of pain. to of fluid that somnolence, the membrane, It that cause the redness, constipation, inflammation important production inflammatory cells use failure, dysuria, bleeding, inhibition, leukopenia, Nursing consideration 1. Assess patient 2. 3. Assess Infuse for for contraindication. baseline data. slowly as a bolus over no less than 15 seconds. 4. Administer with ranitidine to avoid ulceration. 5. Tell patient

also are believed to be dyspepsia,

non- peripheral edema, GI pain

blocks the enzymes that make

prostaglandins (cyclooxygenase 1 and 2). As a result, pain as well as inflammation and its signs and symptoms redness, swelling, fever, and pain - are reduced.

that effects 6.

he

may side brought

experience

upon by the drug. Encouraged oral fluid intake to avoid dry mucous membrane. 7. Provide comfort measures if headache occurs. 8. report side prompt intervention. 9. report Instruct signs to of Instruct effects to for intolerable

bleeding such as black tarry stool, weakness dizziness standing. 10. report Instruct if to he and upon

experiences

adverse effects.

VIII.

LIST OF IDENTIFIED PROBLEMS ACCORDING TO PRIORITY • Acute Pain related to inflammation and distortion of tissues

Anxiety related to gallbladder removal surgery

IX.

NURSING CARE PLAN NSG. DX SCIENTIFIC BACKGROUND Acute Pain related to Characterized by its inflammation and intensity, location distortion of tissues and duration. It is initiated by stimulation of nociceptors in the peripheral nervous system, or by damage to or malfunction of the peripheral or central nervous systems. GOALS After 8 hours of rendering proper nursing intervention, the client will verbalize pain scale rated from 7/10 to 4/10. INTERVENTION 1. V/s taken and recorded 2. Observe and document location, severity and character of pain. RATIONALE  Serve as baseline data  Assists in differentiating cause of pain and provides information about disease progression/ resolution, development of EVALUATION Goal met: The patient verbalized pain scale rated to 4/10.

ASSESSMENT S: “Masakit ang tiyan ko,” as verbalized by the patient. Pain scale rated as 7/10 O:  Grim aced face  With guarding behavior

 Restle ssness  Rigidi ty of the abdomen  Splint ed respiration with short and shallow breathing  V/s taken as follows: BP: 130/90mmHg T: 36.7°C PR: 89bpm RR: 32cpm

complications and effectiveness of interventions. 3. Administer analgesic as prescribed 4. Promote bedrest, allowing patient to assume position of comfort.  To relieve the pain  Bedrest in Fowler’s position reduces intraabdominal pressures; however, patient will naturally assume least painful position.  Promotes rest, redirects attention, may enhance coping.

5. Encourage use of relaxation techniques such as deep breathing exercises. Provide diversional activities such as watching television. 6. Make time to listen to complaints and maintain frequent contact with the patient.

 Helpful in alleviating anxiety and refocusing attention, which can relieve pain.

ASSESSMENT S: Natatakot akong maoperahan,” as verbalized by the patient. O:  Weak in appearance  Pale looking  Sleep disturbance  V/s taken as

NSG. DX

SCIENTIFIC BACKGROUND Anxiety related to Generalized mood gallbladder removal condition that occurs surgery without an identifiable triggering stimulus. As such, it is distinguished from fear, which occurs in the presence of an observed threat.

GOALS

INTERVENTION

RATIONALE  Establishes rapport, promotes expression of feelings. Demonstrates concern and willingness to help.  Helps recognition of extent of anxiety and

EVALUATION

After 4 hours of 1. Be available to rendering proper the patient. nursing intervention, Maintain the client will be frequent able to verbalize contacts with awareness of the patient. Be feelings of available for anxiety and health ways to listening and deal with them talking as and report needed. anxiety is reduced to a 2. Identify manageable patient’s level. perception of the threat

follows: BP: 120/80mmHg T: 37°C PR: 83 bpm RR: 22 cpm

represented by the situation.

identification of measures that may be helpful for the individual.  Helps patient to accept what is happening and reduce level of anxiety. False reassurance is not helpful, because neither nurse nor patient knows the final outcome.
 Aids in

3. Encourage patient to acknowledge reality of stress without denial or reassurance that everything will be alright. Provide information about measures being taken to correct or alleviate condition. 4. Use therapeutic touch to help patient remain calm

meeting basic human need, decreasing sense of isolation and assisting the pt. to feel less anxious.

X.

ONGOING APPRAISAL It was being recommended by the attending physician that the patient needs to stay at the hospital for further observations since it was seen that the disease at this point of the treatment process still cannot managed at home by medications only.

XI.

DISCHARGE PLAN (HEALTH TEACHINGS) DIET Advised the patient to a diet as tolerated but preferably avoiding salty and fatty foods. 1. Encouraged patient to increase fluid intake 2. 3. Encouraged patient to eat foods rich in Encourage patient to avoid salty and fatty Vitamin and Nutritious foods foods 4. Encourage patient to have enough rest

MEDICATION TREATMENT Instructed the patient to continue medication as Instructed the patient to continue the medication ordered

EXERCISE Instructed the patient to do exercise as tolerated such as walking

CLINIC FOLLOW UP Instructed to come back for follow-up check-up

DANGER SIGNS

XII.

INTRODUCTION Cholecystitis

Cholecystitis is inflammation of the gallbladder, a small organ near the liver that plays a part in digesting food. Normally, fluid called bile passes out of the gallbladder on its way to the small intestine. If the flow of bile is blocked, it builds up inside the gallbladder, causing swelling, pain, and possible infection. Causes A gallstone stuck in the cystic duct, a tube that carries bile from the gallbladder, is most often the cause of sudden (acute) cholecystitis. The gallstone blocks fluid from passing out of the gallbladder. This results in an irritated and swollen gallbladder. Infection or trauma, such as an injury from a car accident, can also cause cholecystitis. Acute acalculous cholecystitis, though rare, is most often seen in critically ill people in hospital intensive care units. In these cases there are no gallstones. Complications from another severe illness, such as HIV or diabetes, cause the swelling. Long-term (chronic) cholecystitis is another form of cholecystitis. It occurs when the gallbladder remains swollen over time, causing the walls of the gallbladder to become thick and hard. Sign and symptoms The most common symptom of cholecystitis is pain in your upper right abdomen that can sometimes move around to your back or right shoulder blade. Other symptoms include:
• • • • •

Nausea or vomiting. Tenderness in the right abdomen. Fever. Pain that gets worse during a deep breath. Pain for more than 6 hours, particularly after meals. Older people may not have fever or pain. Their only symptom may be a tender area in the abdomen.

XIII.

ANATOMY AND PHYSIOLOGY

LIVER A. Location and size of the liver- largest gland in the body, weighs approximately 1.5 kg; lies under the diaphragm; occupies most of the right hypochondrium and part of the epigastrium. B. Liver lobes and lobules- two lobes separated by the falciform ligament 1. Left lobe- forms about one sixth of the liver 2. Right lobe- forms about five sixths of the liver; divides into right lobe proper, caudate lobe, and quadrate lobe 3. Hepatic lobules- anatomical units of the liver; small branch of hepatic vein extends through the center of each lobule C. Bile ducts 1. Small bile ducts form right and left hepatic ducts 2. Right and left hepatic ducts immediately join to form one hepatic duct 3. Hepatic duct merges with cystic duct to form the common bile duct, which opens into the duodenum D. Functions of the liver

1. Glucose Metabolism -after a meal, glucose is taken up from the portal venous blood by the liver and converted into glycogen (glycogenesis), which is stored in the hepatocytes. Glycogen is converted back to glucose (glycogenolysis) and release as needed into the blood stream to maintain normal level of the blood glucose. -glucose can be synthesized by the liver through the process gluconeogenesis 2. Ammonia Conversion -use of amino acids from protein for gluconeogenesis result in the formation of ammonia as a by product. Liver converts ammonia to urea 3. Protein Metabolism -Liver synthesizes almost all of the plasma protein including albumin, alpha and beta globulins, blood clotting factors plasma lipoproteins 4. Fat Metabolism -Fatty acid can be broken down for the production of energy and production of ketone bodies 5. Vitamin and Iron Storage -stores vitamin A, D, E, K 6. Drug Metabolism 7. Bile Formation -bile is formed by the hepatocytes -composed of water, electrolytes such as sodium, potassium, calcium, chloride, bicarbonate, lecithin, fatty acids, cholesterol, bile salts -collected and stored in the gallbladder and emptied in the intestine when needed for digestion a. Lecithin and bile salts emulsify fats by encasing them in shells to form tiny spheres called micelles b. Sodium bicarbonate increases pH for optimum enzyme function c. Cholesterol, products of detoxification, and bile pigments (e.g. bilirubin) are wastes products excreted by the liver and eventually eliminated in the feces

GALLBLADDER The gallbladder (or cholecyst, sometimes gall bladder) is a small organ whose function in the body is to harbor bile and aid in the digestive process. Anatomy • The cystic duct connects the gall bladder to the common hepatic duct to form the common bile duct.
• •

The common bile romero duct then joins the pancreatic duct, and enters through the hepatopancreatic ampulla at the major duodenal papilla. The fundus of the gallbladder is the part farthest from the duct, located by the lower border of the liver. It is at the same level as the transpyloric plane.

Microscopic anatomy
• • •

The different layers of the gallbladder are as follows: The gallbladder has a simple columnar epithelial lining characterized by recesses called Aschoff's recesses, which are pouches inside the lining. Under the epithelium there is a layer of connective tissue (lamina propria). Beneath the connective tissue is a wall of smooth muscle (muscularis externa) that contracts in response to cholecystokinin, a peptide hormone secreted by the duodenum.

There is essentially no submucosa separating the connective tissue from serosa and adventitia.

Size and Location of the Gallbladder The gallbladder is a hollow, pear-shaped sac from 7 to 10 cm (3-4 inches) long and 3 cm broad at its widest point. It consists of a fundus, body and neck. It can hold 30 to 50 ml of bile. It lies on the undersurface of the liver’s right lobe and is attached there by areolar connective tissue. Structure of the Gallbladder Serous, muscular, and mucous layers compose the wall of the gallbladder. The mucosal lining is arranged in folds called rugae, similar in structure to those of the stomach. Function of the Gallbladder

The gallbladder stores bile that enters it by way of the hepatic and cystic ducts. During this time the gallbladder concentrates bile fivefold to tenfold. Then later, when digestion occurs in the stomach and intestines, the gallbladder contracts, ejecting the concentrated bile into the duodenum. Jaundice a yellow discoloration of the skin and mucosa, results when obstruction of bile flow into the duodenum occurs. Bile is thereby denied its normal exit from the body in the feces. Instead, it is absorbed into the blood, and an excess of bile pigments with a yellow hue enters the blood and is deposited in the tissues. The gallbladder stores about 50 mL (1.7 US fluid ounces / 1.8 Imperial fluid ounces) of bile, which is released when food containing fat enters the digestive tract, stimulating the secretion of cholecystokinin (CCK). The bile, produced in the liver, emulsifies fats and neutralizes acids in partly digested food. After being stored in the gallbladder the bile becomes more concentrated than when it left the liver, increasing its potency and intensifying its effect on fats. Most digestion occurs in the duodenum.

Risk factor XIV. PATHOPHYSIOLOGY
o Heredity o Obesity o Rapid Weight Loss, through diet or surgery o Age Over 60 o Female Gender o Diet-Very low calorie diets, prolonged fasting, and lowfiber/high-cholesterol/high-starch diets.

Bile must become supersaturated with cholesterol and calcium

The solute precipitate from solution as solid crystals

Crystals must come together and fuse to form stones

Gallstones

Obstruction of the cystic duct and common bile duct

Sharp pain in the right part of abdomen Distention of the gallbladder

Jaundice

Venous and lymphatic drainage is impaired

Proliferation of bacteria

Localized cellular irritation or infiltration or both take place

Areas of ischemia may occur

Inflammation of gall bladder

Risk factor

CHOLECYSTITIS

PANPACIFIC UNIVERSITY NORTH PHILIPPINES

o Heredity o Obesity o Rapid Weight Loss, through diet or surgery o Age Over 60 o Female Gender o Diet-Very low calorie diets, prolonged fasting, and lowfiber/high-cholesterol/high-starch diets.

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