PATHOPHYSIOLOGY (Cholelithiasis) Fatty lifestyle Precipitating Factors (+) Murphys sign Predisposing Factors Pain & marked tenderness

Upon deep inspiration Cholesterol become supersaturated in bile * hepatic cholesterol Fat

Peritonitis secretions * Female & Fertile (Bile breaks into Nucleates estrogen Peritoneal cavity) Gall bladder fundus comes in contact w/ abd. wall Bile mobilization * > Forty * Fair Gangrene perforation in right 9th & 10th costal cartilage metabolism of cholesterol melanin Precipitation (settling of bile salts) (+) low grade fever Inflammation flow bile acid secretion T: 37.6 C (Acute cholecystitis) Sedimentation (mud-like) (facilitate formation of Micelles w/c promotes Gall bladder wall distention Osmosis (move out the sediment) Solidification Drainage is impaired Stones (cholelithiasis) terminal ileum

cholesterol synthesis

bile acid synthesis

bile

Vascular supply processing of dietary fat)

BV @ gall bladder is compressed Gallstone ileus excretion in urine Obstructs narrow tea-colored urine

Jaundice, icterus sclerae serum Bilirubin Urobilinogen Bilirubin cannot Reach

RUQ/epigastric Stones discharged intestine intestines (duodenum) tenderness into small intestines Biliary colic biliary ducts undergo grayish, clay-colored stool Restlessness Inflammation (Cholangitis) stones dislodges to CBD N&V

Obstruction flow of bile impeded Urobilinogen reaching to bile duct

Bile duct distention bile salt @ intestines spasm to dislodge stones Impulses transmitted to vomiting center

Steatorrhea absorption of fat-soluble fats to stool LEGEND: Red Blue -

Excretion of undigested & absorption of fats

Inefficient digestion fat particles

ability to emulsify Vit. K Vit. K defficiency

POSSIBLE MANIFESTATION MANIFESTED BY THE CLIENT Serum level of time 2.8 of Vit. K Prothrombin