Gallbladder

gallbladder

a pear-shaped, hollow, saclike organ that is 7.5 to 10 cm (3 to 4 inches) long, lies in a shallow depression on the inferior surface of the liver, to which it is attached by loose connective tissue.

7.5 to 10: (3 to 4 inches)

The gallbladder, a pear-shaped, hollow, saclike organ that is _______ cm (______) long, lies in a shallow depression on the inferior surface of the liver, to which it is attached by loose connective tissue.

30 to 50 mL

The capacity of the gallbladder is _______ of bile. Its wall is composed largely of smooth muscle.

common bile duct (CBD)

The gallbladder is connected to the ________ by the cystic duct

PANCREAS

it is located in the upper abdomen.

• It has both exocrine (secreting externally; hormonal secretion from excretory ducts) and endocrine (secreting internally; hormonal secretion of a ductless gland) functions

exocrine:endocrine

The pancreas has both ______ (secreting externally; hormonal secretion from excretory ducts) and ______ (secreting internally; hormonal secretion of a ductless gland) functions

exocrine function

The _______ include secretion of pancreatic enzymes into the gastrointestinal (GI) tract through the pancreatic duct.

endocrine functions

The_______ include secretion of insulin, glucagon, and somatostatin directly into the bloodstream.

stones

Gallbladder disease with _______ is the most common disorder of the biliary system.

CHOLECYSTITIS

Inflammation of the gallbladder which can be acute or chronic, causes pain, tenderness, and rigidity of the upper right abdomen that may radiate to the midsternal area or right shoulder and is associated with nausea, vomiting, and the usual signs of an acute inflammation

empyema

An _________ of the gallbladder develops if the gallbladder becomes filled with purulent fluid (pus)

CALCULOUS CHOLECYSTITIS

Is the cause of more than 90% of cases of acute cholecystitis.

• A gallbladder stone obstructs bile outflow.

autolysis

Bile remaining in the gallbladder initiates a chemical reaction; ______ and edema occur; and the blood vessels in the gallbladder are compressed, compromising its vascular supply

50%

• Gangrene of the gallbladder with perforation may result. Bacteria play a minor role in acute cholecystitis; however, secondary infection of bile occurs in approximately ______ of cases.

ACALCULOUS CHOLECYSTITIS

Acute gallbladder inflammation in the absence of obstruction by gallstones.

• occurs after major surgical procedures, orthopedic procedures, severe trauma, or burns.

• It is speculated that it caused by alterations in fluids and electrolytes and alterations in regional blood flow in the visceral circulation.

Bile stasis:increased viscosity

_________and________ of the bile are also thought to play a role. The occurrence of acalculous cholecystitis with major surgical procedures or trauma makes its diagnosis difficult.

CHOLELITHIASIS

Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition

. • They are uncommon in children and young adults but become more prevalent with increasing age

(choledocholithiasis

stones in the CBD

20 and 55 year

It is estimated that the prevalence of gallstones ranges from 5% to 20% in women between the ages of ______.

25% to 30%

from ________ in women older than 50 years.

50%

Cholelithiasis affects approximately______ of women by the age of 70 years.

Pigment stones

________ probably form when unconjugated pigments in the bile precipitate to form stones; these stones account for about 10% to 25% of cases in the United States.

cirrhosis,hemolysis, infections of the biliary tract

Increased risk in patients with _______, ______, and ______. Pigment stones cannot be dissolved and must be removed surgically

Cholesterol stones

_______ account for most of the remaining 75% of cases of gallbladder disease in the United States.

PAIN AND BILIARY COLIC

• Happens when gallstone obstructs the cystic duct, the gallbladder becomes distended, inflamed, and eventually infected (acute cholecystitis).

• The patient develops a fever and may have a palpable abdominal mass.

• The patient may have _______ with excruciating upper right abdominal pain that radiates to the back or right shoulder

_____________ is usually associated with nausea and vomiting, and it is noticeable several hours after a heavy meal.

• The patient moves about restlessly, unable to find a comfortable position. In some patients, the pain is constant rather than colicky

JAUNDICE

occurs in a few patients with gallbladder disease, usually with obstruction of the common bile duct.

• The bile, which is no longer carried to the duodenum, is absorbed by the blood and gives the skin and mucous membranes a yellow color.

• This is frequently accompanied by marked pruritus (itching) of the skin

CHANGES IN URINE ANDSTOOLCOLOR

• The excretion of the bile pigments by the kidneys gives the urine a very dark color.

• The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored

VITAMIN DEFICIENCY

• Obstruction of bile flow interferes with absorption of the fat-soluble vitamins A, D, E, and K.

• Patients may exhibit deficiencies of these vitamins if biliary obstruction has been prolonged.

• For example, a patient may have bleeding caused by vitamin K deficiency (vitamin K is necessary for normal blood clotting)

CHOLECYSTECTOMY

Removal of the gallbladder

As a result, surgical risks have decreased, along with the length of hospital stay and the long recovery period required after standard surgical cholecystectomy. In relatively rare instances, a standard surgical procedure may be necessary

laparoscopic cholecystectomy

(removal of the gallbladder through a small incision through the umbilicus

NUTRITIONAL AND SUPPORTIVE THERAPY

Approximately 80% of the patients with acute gallbladder inflammation achieve remission with rest, IV fluids, nasogastric suction, analgesia, and antibiotic agents

The diet immediately after an episode is usually low-fat liquids

Ursodeoxycholic acid (UDCA): chenodeoxycholic acid (chenodiol or CDCA)

have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol.

cystic duct occlusion:pigment stones

Patients with frequent symptoms,________, or _______ are not candidates for pharmacologic therapy. Laparoscopic or open cholecystectomy is more appropriate for symptomatic patients with acceptable operative risk

mono-octanoin or methyl tertiary butyl ether [MTBE]

DISSOLVING GALLSTONES

• Several methods have been used to dissolve gallstones by infusion of a solvent (_____________________________) into the gallbladder

ERCP endoscope.

After the endoscope is inserted, a cutting instrument is passed through the endoscope into the ampulla of Vater of the common bile duct.

It may be used to cut the submucosal fibers, or papilla, of the sphincter of Oddi, enlarging the opening, which may allow the lodged stones to pass spontaneously into the duodenum. Another instrument with a small basket or balloon at its tip may be inserted through the endoscope to retrieve the stones

Intracorporeal Lithotripsy

Stones in the gallbladder or CBD may be fragmented by means of laser pulse technology.

A laser pulse is directed under fluoroscopic guidance with the use of devices that can distinguish between stones and tissue. The laser pulse produces rapid expansion and disintegration of plasma on the stone surface, resulting in a mechanical shock wave

Extracorporeal shock wave lithotripsy

has been used for nonsurgical fragmentation of gallstones.

is a noninvasive procedure that uses repeated shock waves directed at the gallstones in the gallbladder or CBD to fragment the stones. The waves are transmitted to the body through a fluid- filled bag or by immersing the patient in a water bath

CHOLEDOCOSTOMY

s reserved for the patient with acute cholecystitis who may be too ill to undergo a surgical procedure.

• This procedure involves making an incision in the common duct, usually for removal of stones.

• After the stones have been evacuated, a tube is usually inserted into the duct for drainage of bile until edema subsides. This tube is connected to gravity drainage tubing; the patient is monitored closely, and a laparoscopic cholecystectomy is planned for a future date after acute inflammation has resolved

Endoscopic ultrasound (EUS)

is a guided gallbladder drainage procedure that is an effective treatment option with success rates comparable to percutaneous drainage