Etiology:

Predisposing Factors
Race

Rationale
Americans or generally
Caucasians are more
prone to develop
gallstones according to
statistics
Rates of gallstones are
two to three times higher
among women than men
Increased age increases
hepatic secretion of
cholesterol and decreased
bile salt synthesis
Gallstone formation is
associated with heredity
and accounts for 30%
symptomatic cases

Actual

Actual

Eating a high-fat or highcholesterol diet

Rationale
Increased fats in the body
causes higher
concentration of
cholesterol
Estrogen increases biliary
cholesterol secretion
causing highly
concentrated cholesterol
of bile
Continuous breakdown of
hemoglobin causes
increased formation of
bilirubin
Liver cannot properly
metabolize bilirubin and
leads to abnormal
conjugation in the bile
Increased intake of fat
causes increased
synthesis of cholesterol

Diabetes

Diabetes increases
cholesterol formation

Female

Age over 40 yrs. old

Family History

Precipitating Factors
Obesity

Use of Oral Contraceptives

Patients with hemolysis

condition e.g. hemolytic
anemia
Patients with liver disease
e.g. liver cirrhosis

Frequent Fasting

Fasting causes lessen use

of bile which leads to
lesser gallbladder
contraction

Anatomy and Physiology:

The liver performs numerous metabolic functions. Some of the most important
follow:

Bile is produced.
Blood glucose is regulated. When blood glucose is high, the liver converts
glucose to glycogen ( glycogenesis) and stores the glycogen. When blood
glucose is low, glycogen is broken down (glycogenolysis), and glucose is
released into the blood.
Proteins (including plasma proteins) and certain amino acids are synthesized.
Ammonia (which is toxic) is converted to urea (less toxic) for elimination by
the kidneys.
Bacteria and expended red and white blood cells are broken down. From the
red blood cells, iron and globin are recycled, and bilirubin is secreted in the
bile.
Vitamins (A, D, and B 12) and minerals (including iron from expended red
blood cells) are stored.
Toxic substances (drugs, poisons) and hormones are broken down.

The gallbladder stores excess bile. When food is in the duodenum, bile flows
readily from the liver and gallbladder into the duodenum. When the duodenum is
empty, a sphincter muscle (hepatopancreatic sphincter) closes the
hepatopancreatic ampulla, and bile backs up and fills the gallbladder.

It is abnormal if there is presence of at least one gallstone in the gallbladder

or in the common bile duct. The stone may be made up of bile pigments or calcium
and cholesterol salts.
There are two types of gallstones: cholesterol stones and pigment stones.
Scientists believe that cholesterol stones are caused by bile that contains:

too much cholesterol

not enough bile salts

They may also occur if the gallbladder does not empty completely or often enough.
The cause of pigment stones is not known. They seem to occur in people who have:

cirrhosis of the liver

biliary tract infections

hereditary blood disorders in which the liver makes too much bilirubin

Symptomatology:
Signs and Symptoms

Rationale

Steatorrhea

Resulted because of
blockage of bile duct
from gallstones
Bilirubin shifts into
the blood vessels
instead of in the bile
duct causing
yellowish
discoloration
Bilirubin
accumulation in the
extremities
Presence of bilirubin
in the excretion of
urine
Because of
interference in bile
flow in the duct
Due to distention of
gallbladder from
obstructed bile duct
Inflamed gallbladder
comes in contact
with the abdominal
wall during deep
breathing and
prevents full
inspiration
Due to fat
intolerance
Due to inflammatory
process

Jaundice

Pruritus

Tea-colored urine

Alcoholic stool

Right Upper
Quadrant Pain
Pain upon deep
breathing

Nausea and
Vomiting
Fever and
Leukocytosis

Actual

Pathophysiology:
Precipitating
Factors

Predisposing
Factors

Gallstone formation

Gallstones obstruct bile duct

Fever and
leukocytosis
Obstruction creates
pressure and causes
distention and
inflammation in
gallbladder

Shifting of bilirubin

RUQ Pain
Pain upon deep
breathing
Jaundice
Pruritus

Bile stasis

Decreased
emulsificatio
n of fats

Continuous
growth of
gallstone

Tea-colored
urine
Steatorrhea
Alcoholic stool
Nausea and
vomiting

Good Prognosis:
Early detection of signs and
symptoms

Early Medical or Surgical

Management of Disease

Modification of diet and

lifestyle

Disappearance of signs and

symptoms

Return of optimum
health

Bad Prognosis:

Late detection and poor

management
Complications

Perforation

Pancreatitis

Grangrene

Hemorrhage

Septicemia

Multiple Organ
Failure

Death

Gallstones are not much of a life-threatening disease since it can be treated

immediately if diagnosed early. Surgical Management is highly advised in patients
with gallstones as to completely be relieved from signs and symptoms. It treated
poorly; it can lead to life-threatening complications that wouldve been easily
evaded if the condition was managed properly.

Nursing Care Plans:

Assessment:
Subjective: Sakit man sa ahung apdo dapit sir as verbalized
Objective:

Pain scale of 9/10

Guarding behavior
Facial grimace

Diagnosis:
Acute pain related to obstruction of bile duct secondary to choledocholithiasis
SB: Inflamed gallbladder comes in contact with the abdominal wall during
deep breathing and prevents full inspiration, causing pain
Source: Medical-Surgical Nursing, 10th edition
Planning:
After 4 hours of nursing intervention, the pt will be able to report decreased
pain scale of 3/10 or less
Interventions:

Maintain bed rest when patient experiences abdominal discomfort

Help pt into a comfortable position and use pillows to splint or support painful
areas, as appropriate

Have diversional activities like talking to patient

Make time to listen to and maintain frequent contact with patient.

Rubbing or tapping clients abdomen

Provide a non-stress, noise free, therapeutic environment

Restrict fat intake

Administer analgesic agents as prescribed

Rationale

Reduces metabolic demands and protects the liver

These measures reduce muscle tension or spasm, redistribute pressure on

body parts, and help pt focus on non-pain related subjects

Divert clients attention to limit perception from pain

Helpful in alleviating anxiety and refocusing attention, which can relieve pain

Apply the principles of gate control theory

This promotes health, well-being, and increased energy level important to

pain relief
To avoid stimulating the gallbladder to produce bile

To provide pharmacologic relief from pain