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NSG 3850 Exam 4 Notes
Pathophysiology For Nurses II (Galen College of Nursing)
, lOMoARcPSD|59750855
UNIT 9
🟢 DISORDERS OF THE GALLBLADDER
Anatomy & Physiology Review
● Function: Stores and concentrates bile produced by the liver.
○ Capacity: Distensible sack with about 30 to 50 mL capacity.
● Bile Composition: Water, electrolytes, bile acids(salts), pigment, cholesterol, phospholipids.
● Flow Path: Liver ➡ Hepatic Ducts ➡ Cystic Duct ➡ Gallbladder (storage) ➡ Common Bile Duct ➡
Ampulla of Vater ➡ Duodenum.
● Regulation:
○ Fasting: Sphincter of Oddi contracts ➡ bile stored in gallbladder.
○ Eating: Cholecystokinin (CCK) stimulates contraction ➡ bile released for fat digestion.
Cholelithiasis (Gallstones)
Definition: Formation of stones (calculi) within the gallbladder.
Pathophysiology of Cholesterol Stone Formation (3 Phases) 🧠
1. Supersaturation: Bile becomes supersaturated with cholesterol (Most common cause).
2. Nucleation: Cholesterol crystals aggregate (stick together) and form stones.
3. Hypomotility: Stasis of bile allows stones to grow.
● Key Factor: Lecithinnormally stops crystallization by emulsifying fats. If lecithin drops, stones form.
Risk Factors (The "F"s & Medical Causes)
● Female: 2x more common than in men.
● Fat (Obesity): BMI > 30.
● Rapid Weight Loss: Mobilizes cholesterol.
● Forty: Age correlation.
● Fertile: Pregnancy, oral contraceptives.
● Ethnicity: Native American, Asian, Caucasian.
● Medical: TPN (Total Parenteral Nutrition), Spinal Cord Injuries (stasis), Diabetes, Prolonged Fasting .
Types of Stones
● Cholesterol: Most common in the US.
● Pigment Stones:
○ Black: Associated with cirrhosis or hemolysis.
○ Brown: Common in developing countries; associated with biliary parasites/infection.
Chronic Cholelithiasis
Definition: Gallstones present with intermittent symptoms.
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Clinical Manifestations
● Biliary Colic (Hallmark Symptom): ⚠
○ Persistent epigastric or Right Upper Quadrant (RUQ) pain.
○ Radiation: To the back or right shoulder .
○ Timing: Precipitated by a meal (fatty foods). Lasts 15 mins to 1 hour, then slowly decreases.
○ Mechanism: Periodic obstruction of cystic duct or spasm of sphincter of Oddi.
● Associated Symptoms: Nausea/Vomiting (N/V), sweating, flatus, bloating, belching, epigastric
burning.
● Pediatric Note: Children usually have underlying conditions (sickle cell, cystic fibrosis) and need
surgery. Adults can be asymptomatic.
Management
● Asymptomatic: "Watchful waiting."
● Symptomatic:
○ Surgery: Laparoscopic cholecystectomy (Treatment of Choice).
○ Chemical Dissolution:Oral bile acids (Ursodiol/UDCA). Takes months, causes diarrhea, low
success.
○ Lithotripsy (ESWL): Shock waves to break stones.
Acute Cholecystitis
Definition: Acute inflammation of the gallbladder wall.
● Etiology: Cholelithiasis (stones) present in 90% cases.
of
● Pathophysiology: Stone obstructs cystic duct ➡ Stasis ➡ Inflammation of gallbladder wall and/or
sphincter of Oddi ➡ Fibrosis/Thickening.
Clinical Manifestations 🔥
● Severe RUQ Pain: Radiates to back/shoulder. Increases with deep breath.
● Positive Murphy's Sign: Inspiratory arrest on palpation of RUQ.
● Systemic: Fever, Leukocytosis (High WBCs).
● GI: Nausea, vomiting, anorexia, fat intolerance, abdominal distention, feeling of fullness.
● Labs: Mild elevation in bilirubin and AST/ALT. Jaundice may occur.
Complications (Red Flags ⚠ )
● Gangrene/Rupture:Leads to Peritonitis and Septic Shock .
● Empyema:Abscess (pus-filled gallbladder).
● Cholecystoenteric Fistula: Abnormal connection to bowel (GI tract).
Acalculous Cholecystitis
● Definition: Inflammation without stones.
● Risk Factors: Major surgery, Trauma, Critical illness, Burns, TPN.
● Mechanism: Bile stasis and ischemia.
● Warning: More rapid progression to gangrene/perforation than stone-type.
NSG 3850 Exam 4 Notes
Pathophysiology For Nurses II (Galen College of Nursing)
, lOMoARcPSD|59750855
UNIT 9
🟢 DISORDERS OF THE GALLBLADDER
Anatomy & Physiology Review
● Function: Stores and concentrates bile produced by the liver.
○ Capacity: Distensible sack with about 30 to 50 mL capacity.
● Bile Composition: Water, electrolytes, bile acids(salts), pigment, cholesterol, phospholipids.
● Flow Path: Liver ➡ Hepatic Ducts ➡ Cystic Duct ➡ Gallbladder (storage) ➡ Common Bile Duct ➡
Ampulla of Vater ➡ Duodenum.
● Regulation:
○ Fasting: Sphincter of Oddi contracts ➡ bile stored in gallbladder.
○ Eating: Cholecystokinin (CCK) stimulates contraction ➡ bile released for fat digestion.
Cholelithiasis (Gallstones)
Definition: Formation of stones (calculi) within the gallbladder.
Pathophysiology of Cholesterol Stone Formation (3 Phases) 🧠
1. Supersaturation: Bile becomes supersaturated with cholesterol (Most common cause).
2. Nucleation: Cholesterol crystals aggregate (stick together) and form stones.
3. Hypomotility: Stasis of bile allows stones to grow.
● Key Factor: Lecithinnormally stops crystallization by emulsifying fats. If lecithin drops, stones form.
Risk Factors (The "F"s & Medical Causes)
● Female: 2x more common than in men.
● Fat (Obesity): BMI > 30.
● Rapid Weight Loss: Mobilizes cholesterol.
● Forty: Age correlation.
● Fertile: Pregnancy, oral contraceptives.
● Ethnicity: Native American, Asian, Caucasian.
● Medical: TPN (Total Parenteral Nutrition), Spinal Cord Injuries (stasis), Diabetes, Prolonged Fasting .
Types of Stones
● Cholesterol: Most common in the US.
● Pigment Stones:
○ Black: Associated with cirrhosis or hemolysis.
○ Brown: Common in developing countries; associated with biliary parasites/infection.
Chronic Cholelithiasis
Definition: Gallstones present with intermittent symptoms.
, lOMoARcPSD|59750855
Clinical Manifestations
● Biliary Colic (Hallmark Symptom): ⚠
○ Persistent epigastric or Right Upper Quadrant (RUQ) pain.
○ Radiation: To the back or right shoulder .
○ Timing: Precipitated by a meal (fatty foods). Lasts 15 mins to 1 hour, then slowly decreases.
○ Mechanism: Periodic obstruction of cystic duct or spasm of sphincter of Oddi.
● Associated Symptoms: Nausea/Vomiting (N/V), sweating, flatus, bloating, belching, epigastric
burning.
● Pediatric Note: Children usually have underlying conditions (sickle cell, cystic fibrosis) and need
surgery. Adults can be asymptomatic.
Management
● Asymptomatic: "Watchful waiting."
● Symptomatic:
○ Surgery: Laparoscopic cholecystectomy (Treatment of Choice).
○ Chemical Dissolution:Oral bile acids (Ursodiol/UDCA). Takes months, causes diarrhea, low
success.
○ Lithotripsy (ESWL): Shock waves to break stones.
Acute Cholecystitis
Definition: Acute inflammation of the gallbladder wall.
● Etiology: Cholelithiasis (stones) present in 90% cases.
of
● Pathophysiology: Stone obstructs cystic duct ➡ Stasis ➡ Inflammation of gallbladder wall and/or
sphincter of Oddi ➡ Fibrosis/Thickening.
Clinical Manifestations 🔥
● Severe RUQ Pain: Radiates to back/shoulder. Increases with deep breath.
● Positive Murphy's Sign: Inspiratory arrest on palpation of RUQ.
● Systemic: Fever, Leukocytosis (High WBCs).
● GI: Nausea, vomiting, anorexia, fat intolerance, abdominal distention, feeling of fullness.
● Labs: Mild elevation in bilirubin and AST/ALT. Jaundice may occur.
Complications (Red Flags ⚠ )
● Gangrene/Rupture:Leads to Peritonitis and Septic Shock .
● Empyema:Abscess (pus-filled gallbladder).
● Cholecystoenteric Fistula: Abnormal connection to bowel (GI tract).
Acalculous Cholecystitis
● Definition: Inflammation without stones.
● Risk Factors: Major surgery, Trauma, Critical illness, Burns, TPN.
● Mechanism: Bile stasis and ischemia.
● Warning: More rapid progression to gangrene/perforation than stone-type.
