PANPACIFIC UNIVERSITY NORTH PHILIPPINES

URDANETA CITY

CHOLECYSTITIS
CASE STUDY
(TPH – Surgery Ward)

Prepared by:
ANDAYA, PHILIP A.
BSN 4C/Group 19

Prepared to:
Mr. Almer Cabida, RN
Clinical Instructor

I. PATIENT ASSESSMENT DATA BASE

A. GENERAL DATA

1. Patient’s Name : Mrs. B

 2. Address : Tarlac City
3. Age : 37
4. Sex : Female
5. Birth Date : August 6, 1972
6. Rank in the family : 1st
7. Nationality : Filipino
8. Civil Status : Married
9. Date of Admission : November 20, 2009
10. Order of Admission : N/A
11. Attending Physician : Dra. Josephine Zarate

CHIEF COMPLAINT:
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 RELATION AGE SEX OCCUPATION EDUC’L ATTAINMENT

Mike Father 73 M Factory worker High School Graduate
 Carmen Mother 69 F Housewife High School Graduate

Elmer Husband 40 M Factory worker High School Graduate

Joyce Daughter 12 F Student First Year High School

F. 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 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__Dressing _II__Grooming
_II__Bathing _II__Toileting _II_ Cooking
_II__Bed mobility _II__Home maintenance ___others

Legend
0 – full care
I – requires use of equipment
II – requires assistance or supervision from others
II – requires assistance or supervision from another, and equipment and a device
IV – 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.

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

• 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 AGE SEX PATIENT DESCRIPTION

Eric Erikson 35-65 yrs. Old Female Mrs. B doesn’t allow of her husband to work to make sure that
the children receive a direct parental guidance in their growing
Stage 7: Generativity vs. Stagnation
years. Moreover, her husband is a works alone to provide the
(Middle Adulthood) 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. Vital Signs
BP : 110/70 mmHg
T : 36.5ºC
PR : 62 bpm
RR : 16 cpm
 C. Regional Exam – utilize IPPA technique

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:
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. LABORATORY AND DIAGNOSTIC EXAMINATIONS

DATE: November 20, 2009

TYPE OF EXAMINATION: Hematology

RESULTS NORMAL VALUES SIGNIFICANCE

Hemoglobin -172 g/dL 120 – 150 g/dL Signs of anemia including pallor, dyspnea,
chest pain, and fatigue
Erythrocyte – 5.46 109/L 4.0 - 6.0 X109/L Within normal range.
Hematocrit - 0.53 0.40 – 0.60 Within normal range.
Leukocyte – 15.2 X109/L 5.0 – 10.0 X109/L Above normal range. An elevated
number of leukocytes can result
from infectious diseases (usually
bacterial origin), and with trauma,
surgery, or acute leukemia.
Differential Count
Segmenter – 0.72 0.45 - 0.65 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.
Lymphocytes -0.28 0.20 - 0.35 Within normal range
Platelet Count -222 X109/L 150 – 450 X109/L Within normal range
VI. 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 Contraindication Adverse reaction Nursing consideration

Vitamin K is essential for Dizziness, flushing, Hypersensitivity, severe Anaphylaxis or 1. Assess
for contraindication.
the hepatic synthesis of transient hypotension after hepatic disease, last few weeks anaphylactoid reactions,
2. Assess
factors II, VII, IX, and X, IV administration, rapid of pregnancy usually after rapid IV for baseline data.
3. Monitor
all of which are essential and weak pulse, administration
protime during
for blood clotting. diaphoresis, erythema, pain treatment; monitor
for bleeding, pulse
Vitamin K deficiency swelling and hematoma at
and BP.
causes an increase in injection site 4. Teach
patient not to take
bleeding tendency,
other supplements,
demonstrated by unless directed by
prescriber, to take
ecchymoses, epistaxis,
this medication as
hematuria, GI bleeding. 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 Adverse reaction Nursing consideration

Competitively inhibits headache, rash, dizziness, Hypersensitivity to ranitidine, malaise, insomnia, 1. Assess patient for
the action of histamine at vertigo, constipation, lactation. somnolence, urticaria, contraindication.
the H2 receptors of the diarrhea, nausea, vomiting, tachycardia, bradycardia, 2. Assess for
parietal cells f the abdominal discomforts, leukopenia, pancytopenia, baseline data.
stomach, inhibiting basal local burning or itching at thrombocytopenia, 3. Tell patient that
gastric acid secretion and IV site gynecomastia, impotence, he may experience
gastric acid secretion that hepatitis side effects brought
is stimulated by food, about by the drug.
insulin, histamine, 4. Instruct patient to
cholinergic agonist, take his meal if
gastrin, and pentagastrin. 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 him to
report intolerable
side effects so as
prompt intervention
could be done.
8. Instruct him to
report adverse
effects that he may
experience.
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 Nursing consideration

Reduces the production rash, ringing in the ears, Hypersensitivity to ketorolac, gastric or duodenal ulcer, 1. Assess
of prostaglandins, headaches, dizziness, renal Impariment, aspirin renal impairment, liver patient for
chemicals that cells of drowsiness, abdominal allergy failure, dysuria, bleeding, contraindication.
the immune system make pain, nausea, diarrhea, platelet inhibition, 2. Assess for
that cause the redness, constipation, heartburn, neutropenia, leukopenia, baseline data.
fever, and pain of fluid retention, pancytopenia, 3. Infuse
inflammation and that somnolence, insomnia, thrombocytopenia, bone slowly as a bolus
also are believed to be dyspepsia, dry mucous marrow depression over no less than
important in the membrane, sweating, 15 seconds.
production of non- peripheral edema, GI pain 4. Administer
inflammatory pain. It with ranitidine to
blocks the enzymes that avoid ulceration.
cells use to make 5. Tell patient
prostaglandins that he may
(cyclooxygenase 1 and experience side
2). As a result, pain as effects brought
well as inflammation and upon by the drug.
its signs and symptoms - 6. Encouraged
redness, swelling, fever, oral fluid intake to
and pain - are reduced. avoid dry mucous
membrane.
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.
VII. LIST OF IDENTIFIED PROBLEMS ACCORDING TO PRIORITY
• Acute Pain related to inflammation and distortion of tissues

• Anxiety related to gallbladder removal surgery

VIII. NURSING CARE PLAN

ASSESSMENT NSG. DX SCIENTIFIC GOALS INTERVENTION RATIONALE EVALUATION

BACKGROUND
S: “Masakit ang Acute Pain related to Characterized by its After 8 hours of 1. V/s taken and  Serve as baseline Goal met:
tiyan ko,” as inflammation and intensity, location rendering proper recorded data The patient
verbalized by the distortion of tissues and duration. It is nursing intervention, verbalized pain scale
patient. initiated by the client will 2. Observe and  Assists in rated to 4/10.
Pain scale rated as stimulation of verbalize pain scale document differentiating
7/10 nociceptors in the rated from 7/10 to location, severity cause of pain and
peripheral nervous 4/10.
and character of provides
O: system, or by
damage to or pain. information about
 Grim
aced face malfunction of the disease
 With peripheral or central progression/
guarding nervous systems. resolution,
behavior development of
 Restle complications
ssness and effectiveness
 Rigidi
of interventions.
ty of the
abdomen 3. Administer
analgesic as  To relieve the
 Splint
ed respiration
with short and prescribed pain
shallow
breathing 4. Promote bedrest,  Bedrest in
 V/s allowing patient Fowler’s position
taken as to assume reduces
follows: position of intraabdominal
BP: comfort. pressures;
130/90mmHg
T: 36.7°C however, patient
PR: 89bpm will naturally
RR: 32cpm assume least
painful position.
5. Encourage use of
relaxation  Promotes rest,
techniques such redirects
as deep breathing attention, may
exercises. enhance coping.
Provide
diversional
activities such as
watching
television.
 Helpful in
6. Make time to alleviating
listen to anxiety and
complaints and refocusing
maintain frequent attention, which
contact with the can relieve pain.
patient.
ASSESSMENT NSG. DX SCIENTIFIC GOALS INTERVENTION RATIONALE EVALUATION
BACKGROUND
S: Natatakot akong Anxiety related to Generalized mood After 4 hours of 1. Be available to  Establishes
maoperahan,” as gallbladder removal condition that occurs rendering proper the patient. rapport,
verbalized by the surgery without an nursing intervention, Maintain promotes
patient. identifiable the client will be
frequent expression of
triggering stimulus. able to verbalize
O: As such, it is awareness of contacts with feelings.
 Weak in distinguished from feelings of the patient. Be Demonstrates
appearance fear, which occurs in anxiety and available for concern and
the presence of an health ways to listening and willingness to
 Pale looking observed threat. deal with them talking as help.
and report needed.
 Sleep anxiety is  Helps
disturbance reduced to a 2. Identify recognition of
manageable patient’s
level. extent of
 V/s taken as
perception of anxiety and
follows:
the threat identification
BP: represented of measures
120/80mmHg by the that may be
situation. helpful for the
 T: 37°C individual.

PR: 83 bpm 3. Encourage  Helps patient

patient to to accept
RR: 22 cpm
acknowledge what is
reality of happening
stress without and reduce
denial or level of
reassurance anxiety. False
that reassurance
everything will is not helpful,
be alright. because
Provide neither nurse
information nor patient
about knows the
measures final outcome.
being taken to
correct or  Aids in
alleviate meeting basic
condition. human need,
decreasing
4. Use sense of
therapeutic isolation and
touch to help assisting the
patient remain pt. to feel less
calm anxious.

IX. 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.

X. DISCHARGE PLAN (HEALTH TEACHINGS)

MEDICATION TREATMENT DIET

 Instructed the patient to continue medication as Instructed the patient to continue the medication Advised the patient to a diet as tolerated but
ordered 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 CLINIC FOLLOW UP DANGER SIGNS

Instructed the patient to do exercise as tolerated Instructed to come back for follow-up check-up
such as walking

XI. 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.

XII. 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
XIII. 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 low-
fiber/high-cholesterol/high-starch diets.
 Bile must become The solute precipitate from Crystals must come together
supersaturated with solution as solid crystals and fuse to form stones
cholesterol and calcium

Gallstones

Obstruction of the cystic duct and common bile duct

Sharp pain in the right part of Jaundice

abdomen

Distention of the
gallbladder

Venous and lymphatic Proliferation of bacteria Localized cellular irritation or Areas of ischemia may occur
drainage is impaired infiltration or both take place

Inflammation of gall bladder

Risk factor CHOLECYSTITIS

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 low-
fiber/high-cholesterol/high-starch diets.