Pathophysiology: Cholecystitis Non modifiable factors -Age (40 years old and above) -Gender/sex (female) -Genetic predisposition

-Estrogen levels Modifiable factors -Obesity -Rapid weight loss and diet -Lack of physical activity -Long-term total parenteral nutrition -Oral contraceptives -Pregnancy

Genetic & Demography

Change in Bile Composition

Decreased contractility of bile flow Bile Stasis

Increased intraluminal Pressure

Contraction of substances present in bile Precipitation of bile substances Bile substance will increase in size Stones migrate to gall bladder Obstruction of the flow in bile

Stimulates smooth Increase muscle contraction tension to duodenum

RUQ abdominal Pain Radiating pain to lower back

Impaired Hepatic uptake of bilirubin

Collection of soluble bilirubin in the urine

No bile reaches the GIT

Cholesterol salts In the skin Jaundice

Escape of bilirubin to GUT

No bile in small intestine for fat Digestion Emulsification of fats

Decrease bile in the duodenum Sterobilin Clay-colored stool

Presence of Bile in the urine Dark yellow urine

Nausea and Vomiting

Obstructed cystic duct Bile duct obstructed already Gall bladder becomes distended RUQ pain

Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects the gallbladder to the hepatic duct. The presence of gallstones in the gallbladder is called c h o l e l i t h i a s i s . C h o l e l i t h i a s i s i s t h e p a t h o l o g i c s t a t e o f s t o n e s o r c a l c u l i w i t h i n t h e gallbladder lumen. A common digestive disorder worldwide, the annual overall cos t of c h o l e l i t h i a s i s i s a p p r o x i m a t e l y $ 5 b i l l i o n i n t h e U n i t e d S t a t e s , w h e r e 7 5 - 8 0 % o f gallstones are of the cholesterol type, and a p p r o x i m a t e l y 1 0 - 2 5 % o f g a l l s t o n e s a r e bilirubinate of either black or brown pigment. In Asia, pigmented stones predominate ,although recent studies have shown an increase in cholesterol stones in the Far East. Gallstones are crystalline structures formed by concretion (hardening) or accretion( a d h e r e n c e o f p a r t i c l e s , a c c u m u l a t i o n ) o f n o r m a l o r a b n o r m a l b i l e c o n s t i t u e n t s . According to various theories, there are four possible explanations for stone formation. First, bile may undergo a change in composition. Second, gallbladder stasis may lead to bile stasis. Third, infection may predispose a person to stone formation. Fourth, genetics and demography can affect stone formation. Risk factors associated with development of gallstones include heredity, Obesity, rapid weight loss, through diet or surgery, age over 60, Native American or Mexican American racial makeup, female gender-gallbladder disease is more common in women t h a n i n m e n . W o m e n w i t h h i g h estrogen l e v e l s , a s a r e s u l t o f p r e g n a n c y , hormone replacement therapy, o r t h e u s e o f b i r t h c o n t r o l p i l l s , a r e a t p a r t i c u l a r l y h i g h r i s k f o r gallstone formation, Diet-Very low calorie diets, prolonged fasting, and low-fiber /high-cholesterol/high-starch diets all may contribute to gallstone formation. Sometimes, persons with gallbladder disease have few or no symptoms. Ot hers, however, will eventually develop one or more of the following symptoms; (1) Frequent bouts of indigestion, especially after eating fatty or greasy foods, or certain vegetables such as cabbage, radishes, or pickles, (2) Nausea and bloating (3) Attacks of sharp pains i n t h e u p p e r r i g h t p a r t o f t h e a b d o m e n . T h i s p a i n o c c u r s w h e n a g a l l s t o n e c a u s e s a blockage that prevents the gallbladder from emptying (usually by obstructing the cysticduct). (4) Jaundice (yellowing of the skin) may occur if a gallstone becomes stuck in

the common bile duct, which leads into the intestine blocking the flow of bile from both the gallbladder and the liver. This is a serious complication and usually requires immediate treatment. The only treatment that cures gallbladder disease is surgical removal of t h e gallbladder, called cholecystectomy. Generally, when stones are present and causing symptoms, or when the gallbladder is infected and inflamed, removal of the organ is usually necessary. When the gallbladder is removed, the surgeon may examine the bile ducts, sometimes with X rays, and remove any stones that may be lodged there. The ducts are not removed so that the liver can continue to secrete bile into the intestine. Most patients experience no further symptoms after cholecystectomy. However, mild residual symptoms can occur, which can usually be controlled with a special diet and medication