patho exam 4

What structures are included in the pancreaticobiliary system? 💩

the gallbladder, cystic duct, intrahepatic, hepatic, common bile ducts, and pancreas

What is the purpose of the pancreaticobiliary system? 🚚

It forms a controlled system that delivers bile to the intestines.

Where is bile formed, modified, and stored? 🧪

🏭 Formed: Liver

💚 Modified & stored: Gallbladder

What is the gallbladder?

An expandable sac with about a 30–50 mL capacity that stores bile

What does the cystic duct connect with? 🔗

hepatic duct

Cystic duct + hepatic duct=

Common bile duct

What does cholelithiasis mean?

🪨 Gallstones

Which ethnic groups have the highest risk for gallstones?

🔴 Native Americans

Which ethnic groups have the intermediate risk for gallstones?

🟡 White Europeans

Which ethnic groups have the lowest risk for gallstones?

🟢 Asians

What 3 factors contribute to gallstone development? 🪨

1. 🧈 Supersaturation of bile with cholesterol

2. 💎 Cholesterol crystals aggregate to form stones

3. 🐌 Hypomotility/stasis allows stones to grow

What is the most common cause involved in gallstone development? ⭐

Supersaturation of bile with cholesterol.

What is lecithin and what does it do? 🛡

a component of bile that helps prevent cholesterol from precipitating out as crystals.

How do cholesterol gallstones form? 💎➡🪨

Cholesterol crystals aggregate together to form stones.

How do hypomotility and stasis contribute to gallstones? 🐌

They allow stone growth.

What is gallbladder “sludge”? 🫠

Bile that thickens because it isn’t flowing normally and remains in the gallbladder.

Are gallstones more common in women or men? 👩🏾

Women > Men; 2:1

Why are women 🚺twice as likely to develop gallstones 🪨 then men 🚹

Estrogen increases the amount of cholesterol that is secreted into the bile

What weight-related condition increases the risk of cholelithiasis? ⚖

Obesity

What type of diet increases gallstone risk? 🍔

⬆ High fat
⬆ High cholesterol
⬇ Low fiber

What lipid disorder predisposes someone to gallstones? 🩸

Hyperlipidemia

What neurological injury is associated with gallstones? 🧠

Spinal cord injuries

What type of weight loss increases gallstone risk? 📉

Rapid weight loss

What form of nutrition increases gallstone risk? 💉

TPN; Total Parenteral Nutrition

What hormonal medication can predispose someone to gallstones? 💊

Oral contraceptives

What reproductive condition increases gallstone risk? 🤰🏾

Pregnancy

What endocrine disease predisposes someone to gallstones? 🩸

Diabetes mellitus

Can cholelithiasis be asymptomatic in adults?

Yes

What imaging study is used to diagnose cholelithiasis? 💻

Ultrasound

What is biliary colic? 😖

Spasmodic wave like motion with RUQ abdominal and epigraphic pain

Where can biliary colic pain radiate?➡

To the back

What symptoms can accompany biliary colic? 🤢

🤢 Nausea/vomiting
💦 Sweating
💨 Flatus

Biliary colic may involve spasm of what structure?

Sphincter of Oddi

What type of food is biliary colic related to? 🍕🍟

Fatty foods

What typically causes biliary colic? 🪨🚫

Obstruction of the cystic duct by a gallstone.

What commonly precipitates biliary colic? 🍽

Food

What is the typical timing pattern of biliary colic? ⏰

⬆ Pain steadily increases for 15 minutes–1 hour
⬇ Then it slowly decreases.

⭐What is the pathophysiology of cholelithiasis?

The bile becomes super saturated with cholesterol. The cholesterol precipitates into crystals. The crystals formed together to form a gallstone. The gallbladder becomes hypomodal. This stasis and sludge which is bowel that thickens because it’s not moving, allows additional stone growth.

⭐What would you see in your patient with cholelithiasis?

It may be asymptomatic or they might biliary colic, or right upper abdomen epigastric pain that radiates to the back. They also might have nausea and vomiting, sweating, or excess flats

⭐️What would you teach your patient about cholelithiasis?

A gallstone is a crystal that forms and it blocks the flow of bile, which could lead to inflammation and potential infection. It could be from a fatty diet, so educate about more healthy food choices. The pain is precipitated by a meals and it increases steadily for about 15 minutes to an hour, and then it starts to slowly decrease.

⭐️What is cholecystitis?🔥

Inflammation of the gallbladder wall

What structural changes can cholecystitis cause?

➡ Fibrosis
➡ Thickening

⭐️Cholecystitis is typically related to what? 🪨

The continued presence of gallstones

What are the two types of cholecystitis? 2⃣🔥💚

Acute and chronic

What is acute cholecystitis? 🔥

Acute inflammation of the gallbladder wall and/or sphincter of Oddi

What obstruction is present in almost all patients with acute cholecystitis? 🚫

Obstruction of the cystic duct

Cystic duct obstruction in acute cholecystitis is related to what? 🐌

Stasis of bile

Is bacterial infection the direct cause of inflammation in acute cholecystitis? 🦠

No. Bacterial infection may be present, but it isn’t thought to be the direct cause of inflammation

What does acalculous cholecystitis mean? 🚫🪨

Cholecystitis without a stone

⭐️When can acalculous cholecystitis occur? 🚨

🏥 After major surgery
🤕 Trauma
🚑 Critical illness
🔥 Burns
💉 TPN

What is the characteristic pain of acute/chronic cholecystitis? 😣

Severe right upper abdominal pain that radiates to the back

⭐️What abdominal assessment finding can occur in acute/chronic cholecystitis? 😣🤚🏾

Abdominal tenderness

⭐️What temperature and WBC findings can occur in acute/chronic cholecystitis? 🌡🩸

🌡 Fever
⬆ Leukocytosis

⭐️What bilirubin change may occur in acute/chronic cholecystitis? 🧪

Mild elevation of bilirubin.

⭐️What tests can diagnose acute/chronic cholecystitis? 🏥

💻 Abdominal ultrasound
☢ HIDA scan
💻 CT scan
🧲 Magnetic Resonance Cholangiography
📹 ERCP

⭐️What can an abdominal ultrasound show with cholecystitis?

Presence of stones
Thickened gallbladder wall

⭐️What does HIDA stand for?

Hepatobiliary Iminodiacetic scan

What technology does Magnetic Resonance Cholangiography use? 🧲

MRI technology

⭐️What important risk is associated with ERCP or biopsy in cholecystitis?

⚠ Risk of perforation!

What serious complications can occur if acute cholecystitis is untreated? 🚨

Gangrene of the gallbladder wall
💥 Rupture
🔥 Peritonitis
🦠 Septic shock
🫧 Localized abscess (empyema)
🔗 Cholecystoenteric fistula

What is an empyema

A localized abscess

What is a cholecystoenteric fistula?

An abnormal connection between the gallbladder and GI tract.

What causes chronic cholecystitis? 🪨🔥

Persistent irritation of the gallbladder wall from cholelithiasis

What can untreated chronic cholecystitis increase the risk of? 🚨

🎗 Cancer
🦠 Sepsis

What are the predisposing factors for chronic cholecystitis?

🩸 Diabetes mellitus
⚖ Obesity

What infectious complication can chronic cholecystitis lead to? 🦠🚨💚

Biliary sepsis.

What can chronic cholecystitis cause from repeated scarring and calcification? 🪨🧱💚

Porcelain gallbladder

What is a porcelain gallbladder associated with? 🧱💚⚠🎗

A higher risk for cancer

What major complications can chronic cholecystitis lead to? ♾🔥🚨

Biliary sepsis and a scarred/calcified (porcelain) gallbladder with a higher risk for cancer.

What are the 3⃣ phases of gallstone formation in cholelithiasis? 🪨🧪

1. Supersaturation of bile with cholesterol causing precipitation of cholesterol

2. Nucleation of crystals

3. Hypomotility (stasis of bile), allowing stone growth

What occurs during the supersaturation phase of cholelithiasis? 🧪🪨

Bile becomes supersaturated with cholesterol, causing precipitation of cholesterol.

What may initiate gallstone formation in cholelithiasis? 💎➡🪨

Crystals of cholesterol.

How does hypomotility contribute to cholelithiasis? 🐌🪨

Hypomotility causes stasis of bile, allowing stones to grow

What hormone is associated with gallbladder stimulation in cholelithiasis? 🧪💚

Excessive somatostatin

What nutritional or weight-related factors increase the risk for cholelithiasis? 🍽⏳📉🪨

Prolonged fasting or rapid weight loss

What medication increases the risk for cholelithiasis? 💊♀🪨

Oral contraceptives

What medical disorders increase the risk for cholelithiasis? 🩺🩸🧠🪨

Diabetes and spinal cord injury

What type of nutritional therapy increases the risk for cholelithiasis? 💉🍽🪨

TPN

What reproductive condition increases the risk for cholelithiasis? 🤰🏽🪨

Pregnancy

What are the major risk factors for cholelithiasis? ⚠🪨🧠

Prolonged fasting, rapid weight loss, oral contraceptives, diabetes, spinal cord injury, TPN, and pregnancy

What does the liver secrete to help with fat digestion? 🫀🧈🍽✨

Bile salts

What nutrients does the liver process and store after they are absorbed by the intestines? 🫀📦🍞🥩🧈

Carbs fats proteins

What does the liver process and store besides fats, carbohydrates, and proteins? 🫀📦💊✨

Vitamins and minerals

What three types of hormones does the liver metabolize as an endocrine organ? 🫀🧪⚙♀♂

Glucocorticoids, mineralocorticoids, and sex hormones

What three types of metabolism does the liver regulate as an endocrine organ? 🫀⚖🍞🧈🥩

Carbs, fats, protein, metabolism

Excess glucose is glycogen (stored glucose) that is stored where?

The liver

What does the liver temporarily store as a hematologic organ? 🫀🩸📦⏳

Blood

What substance does the liver remove from the bloodstream? 🫀🩸🧹🟡

bilirubin

What does it mean the liver performs hematopoiesis in certain disease states? 🫀🩸🏭🩺

It means the liver can participate in producing blood cells in certain disease states

What does the liver synthesize to help with blood clotting? 🫀🩸🩹🧪

Blood clotting factor

What pigment does the liver excrete as an excretory organ? 🫀🚮🟡

Bile pigment

How does the liver excrete cholesterol? 🫀🚮🧈➡

Via Bile

What waste product does the liver synthesize as an excretory organ? 🫀🧪🚽

Urea

What does the liver do with ammonia (protein waste product)?

It converts toxic ammonia into urea, which the kidneys excrete in urine

What substances does the liver detoxify as an excretory organ? 🫀💊🧹☠

Drugs and other foreign substances

What are the FOUR major roles of the liver ? 🫀4⃣🧠💕

Digestive, endocrine, hematologic, and excretory organ

What TWO major problems cause the general manifestations of liver disease? 🫀🚨2⃣

Hepatocellular failure and portal hypertension

What does hepatocellular failure mean in liver disease? 🫀🔬❌

Failure of the hepatocytes (liver cells)

Why can liver disease cause jaundice and dark urine? 🫀🟡🩸🚽

Bilirubin builds up in the bloodstream because the liver is not excreting it properly

Where can excess bilirubin be deposited and cause jaundice? 🟡👁👄✨

The sclera, skin, and mucous membranes