I.

A.

PATIENT ASSESSMENT DATA BASE

GENERAL DATA
1. Patients 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

:
:
:
:
:
:
:
:
:
:
:

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

B.

CHIEF COMPLAINT:
With the chief complaint of epigastric pain

C.

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
didnt 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 thats the time she will undergo for her operation. She was diagnosed by Dra. Josephine
Zarate according to Mrs. B.

D.

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.

E.

FAMILY ASSESSMENT
NAME
Mike

RELATION
Father

AGE
73

SEX
M

OCCUPATION
Factory worker

EDUCL ATTAINMENT
High School Graduate

Carmen

Mother

69

Housewife

High School Graduate

Elmer

Husband

40

Factory worker

High School Graduate

Joyce

Daughter

12

Student

First Year High School

F.SYSTEMS REVIEW

- (Gordons 11 Functional Health Patterns Assessment, more patients 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
DINNER
Rice
Rice
Rice
Coffee
Water
Water
Hotdog
Vegetable
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; doesnt 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 doesnt socialize that much because of his illness.

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

G.

Values goals and philosophical beliefs: The patient believed that all superstitious beliefs were true.
Religious and spiritual belief: The patient has strong spiritual beliefs.

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

H.

DEVELOPMENTAL HISTORY
THEORIST

AGE

SEX

PATIENT DESCRIPTION

Eric Erikson

35-65 yrs. Old

Female

Mrs. B doesnt 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
familys financial needs.

Stage 7: Generativity vs. Stagnation

(Middle Adulthood)

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.

Vital Signs
BP
T

: 110/70 mmHg
: 36.5C

PR
RR
C.

: 62 bpm
: 16 cpm
Regional Exam utilize IPPA technique

1.

2.
3.
4.

5.

6.

7.

8.
9.

Hair, head and face:

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:

10.
11.
12.
13.

14.
15.
16.
II.

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

PERSONAL / SOCIAL HISTORY

a.
Habits/vices: No habits or vices stated according to Mrs. B
b.

Caffeine cups/day: She drink twice a day. Once in the morning and once in the evening

c.

Smoking sticks/packs/day: She never smoke according to her

d.

Alcohol brand/ bottles/day: She never drink alcohol

e.

Tea cups/day: none

f.

Drugs marijuana etc/ OTC drugs: none

g.

Lifestyle: Sedentary lifestyle

h.

Social affiliation: none

i.

Rank in the family: 1st child in the family

j.

Travel (within 6 mos): none

k.

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
a.
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

NORMAL VALUES
120 150 g/dL

Erythrocyte 5.46 109/L

Hematocrit - 0.53
Leukocyte 15.2 X109/L

4.0 - 6.0 X109/L

0.40 0.60
5.0 10.0 X109/L

Segmenter 0.72

Lymphocytes -0.28
Platelet Count -222 X109/L

Differential Count
0.45 - 0.65

0.20 - 0.35
150 450 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

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
Vitamin K is essential for

Side effects
Dizziness, flushing,

Contraindication
Hypersensitivity, severe

the hepatic synthesis of

transient hypotension after

hepatic disease, last few weeks anaphylactoid reactions,

factors II, VII, IX, and X,

IV administration, rapid

of pregnancy

all of which are essential

and weak pulse,

for blood clotting.

diaphoresis, erythema, pain

Vitamin K deficiency

swelling and hematoma at

causes an increase in

injection site

bleeding tendency,
demonstrated by
ecchymoses, epistaxis,
hematuria, GI bleeding.

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
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,

Adverse reaction
malaise, insomnia,

the action of histamine at vertigo,

somnolence, urticaria,

constipation, lactation.

the H2 receptors of the diarrhea, nausea, vomiting,

tachycardia, bradycardia,

parietal

leukopenia, pancytopenia,

cells

the abdominal

discomforts,

Nursing consideration
1. Assess patient for
contraindication.
2. Assess

for

baseline data.

stomach, inhibiting basal local burning or itching at

thrombocytopenia,

gastric acid secretion and IV site

gynecomastia, impotence,

may experience side

gastric acid secretion that

hepatitis

effects brought about

is stimulated by food,
insulin,
cholinergic

histamine,
agonist,

gastrin, and pentagastrin.

3. Tell patient that he

by the drug.
4. Instruct patient to
take

his

meal

if

nausea or vomiting
occurs.
5. Oral

care

if

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

him

to

report adverse effects

that

he

experience.

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,

dizziness, renal

chemicals that cells of drowsiness,

the immune system make pain,

abdominal allergy

nausea,

diarrhea,

Impariment,

aspirin renal

impairment,

failure, dysuria, bleeding,

platelet

inhibition,

that cause the redness, constipation,

heartburn,

neutropenia,

fever,

retention,

pancytopenia,

insomnia,

thrombocytopenia,

mucous

marrow depression

and

inflammation

pain

of fluid

and

that somnolence,

also are believed to be dyspepsia,

important

in

production

of

inflammatory

the membrane,

dry

sweating,

non- peripheral edema, GI pain

pain.

It

liver

leukopenia,

Nursing consideration
1. Assess patient for
contraindication.
2. Assess for baseline
data.
3. Infuse slowly as a
bolus over no less

bone

than 15 seconds.
4. Administer

with

ranitidine to avoid
ulceration.
5. Tell patient that he

blocks the enzymes that

may

experience

cells

side

effects

use

to

make

prostaglandins

brought upon by

(cyclooxygenase 1 and

the drug.

2). As a result, pain as

6. Encouraged
intake

oral

well as inflammation and

fluid

to

its signs and symptoms -

avoid dry mucous

redness, swelling, fever,

membrane.

and pain - are reduced.

7. Provide

comfort

measures

if

headache occurs.
8. Instruct to report
intolerable

side

effects for prompt

intervention.
9. Instruct to report
signs of bleeding
such as black tarry
stool,

weakness

and dizziness upon

standing.
10. Instruct to report if
he

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

ASSESSMENT

NSG. DX

SCIENTIFIC
BACKGROUND
S: Masakit ang
Acute Pain related to Characterized by its
tiyan ko, as
inflammation
and intensity, location
verbalized by the
distortion of tissues
and duration. It is
patient.
initiated by
Pain scale rated as
stimulation of
7/10
nociceptors in the
peripheral nervous
O:
system, or by
Grimaced face
damage to or
malfunction of the
With guarding
peripheral or central
behavior
nervous systems.
Restlessness
Rigidity of the
abdomen
Splinted
respiration
with short and
shallow
breathing
V/s taken as
follows:
BP:
130/90mmHg
T: 36.7C
PR: 89bpm
RR: 32cpm

GOALS

INTERVENTION

RATIONALE

EVALUATION

After 8 hours of
rendering
proper
nursing intervention,
the
client
will
verbalize pain scale
rated from 7/10 to
4/10.

1. V/s taken and

recorded
2. Observe and
document
location, severity
and character of
pain.

Serve as baseline
data
Assists in
differentiating
cause of pain and
provides
information about
disease
progression/
resolution,
development of
complications
and effectiveness
of interventions.
To relieve the
pain
Bedrest in
Fowlers position
reduces
intraabdominal
pressures;
however, patient
will naturally
assume least
painful position.
Promotes rest,
redirects
attention, may

Goal met:
The patient
verbalized pain scale
rated to 4/10.

3. Administer
analgesic as
prescribed
4. Promote bedrest,
allowing patient
to assume
position of
comfort.
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.

ASSESSMENT
S: Natatakot akong
maoperahan, as

NSG. DX

SCIENTIFIC
BACKGROUND
Anxiety related to Generalized mood
gallbladder removal condition that occurs

GOALS

INTERVENTION

After 4 hours of 1. Be available to the

rendering
proper
patient. Maintain

enhance coping.

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

RATIONALE
Establishes
rapport, promotes

EVALUATION

verbalized by the
patient.
O:
Weak in
appearance
Pale looking
Sleep
disturbance
V/s taken as
follows:
BP:
120/80mmHg
T: 37C
PR: 83 bpm
RR: 22 cpm

surgery

without an
identifiable
triggering stimulus.
As such, it is
distinguished from
fear, which occurs in
the presence of an
observed threat.

nursing intervention,
frequent contacts
the client will be able to
with the patient. Be
verbalize awareness of
available for
feelings of anxiety and
listening and talking
health ways to deal
as needed.
with them and report
anxiety is reduced to a 2. Identify patients
perception of the
manageable level.
threat represented
by the situation.

expression of
feelings.
Demonstrates
concern and
willingness to help.
Helps recognition
of extent of anxiety
and identification of
measures that may
be helpful for the
3. Encourage patient to
individual.
acknowledge reality Helps patient to
of stress without
accept what is
denial or
happening and
reassurance that
reduce level of
everything will be
anxiety. False
alright. Provide
reassurance is not
information about
helpful, because
measures being
neither nurse nor
taken to correct or
patient knows the
alleviate condition.
final outcome.
4. Use therapeutic
Aids in meeting
touch to help patient
basic human need,
remain calm
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)

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

DIET
Advised the patient to a diet as tolerated but
preferably avoiding salty and fatty foods.
1. Encouraged patient to increase fluid intake
2.

Encouraged patient to eat foods rich in

Vitamin and Nutritious foods

3.

Encourage patient to avoid salty and fatty

foods
4. Encourage patient to have enough rest
EXERCISE
Instructed the patient to do exercise as tolerated
such as walking

XII.

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

DANGER SIGNS

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 livers 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
o
o
o
o
o

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

The solute precipitate from

solution as solid crystals

Bile must become

supersaturated with
cholesterol and calcium

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

Jaundice
Distention of the
gallbladder

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
o
o
o
o
o
o

CHOLECYSTITIS

PANPACIFIC UNIVERSITY NORTH

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

PHILIPPINES