IV.

THE PATIENT AND HER ILLNESS

Pathophysiology (Book Based)

Modifiable Risk Factors: Non Modifiable Risk Factors:

•Pregnancy •Oral Contraceptives Age (middle age bet 20 to 50
•Estrogen •Cirrhosis •Obesity yrs. old)
•Rapid weight loss •Diabetes mellitus Sex (6 times more common
•Treatment w/ high dose Estrogen in woman)
(E.g. in prostate cancer) •Low dose therapy

Hepatobiliary Mechanism

Extrahepatic Obstructive Jaundice

Super saturated cholesterol Bile stasis Alteration in the normal

component of bile

Intrahepatic Obstructive Hematologic

v
Jaundice Sluggishness in the mechanism
Gallbladder

Unconjugate pigments
in bile forms
precipitate

Hypermotility of
Gallbladder
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Irritation of Gallbladder
 Hemolytic jaundice
Hepatocellular Damage Thickening/ Trauma to the Gallbladder
or obstruction of bile Saturation
canaliculi of bile
Stones start to adhere in the Gallbladder wall

Hypermotility of gallbladder

Spasm of the Gallbladder

Excessive lysis of RBC

Stone formation

Spasm of the Gallbladder

Stones in the gallbladder passed out and

lodge in the common bile duct
Epigastric pain
Liver unable to
conjugate and excrete Breakdown of
-bilirubin in the small hemoglobin into heme
intestine globin

Obstuction of cystic duct

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 Blood flocked w/
Food containing fats present bilirubin
in the duodenum is unable Fever
to disintegrate and be
absorbed Pain
•indigestion •fat intolerance RUQ radiating at the back)
•flatulence •clay colored Inflammation
stool
•N/V •belching
Trapped bile is reabsorbed
(Chemical irritation) Abdominal distention

Vomiting
Irritation

Distention of the
Gallbladder Hepatocytes cannot
conjugate and excrete
bilirubin as rapidly as
it is formed so
bilirubin enters the
blood stream
Bile unable to pass due to bile duct
obstruction

Due to absence of bile in

Conjugate bilirubin the duodenum fats unable
accumulates in liver & enters to disintegrate and be
blood stream absorb

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 Unconjugated hyper
Conjugated •Indigestion •Flatulence bilirubinemia
hyperbilirubinemia •Fat intolerance
•Clay colored stool

Excretion of Vit. Deficiency (A, D, E & K)

bilirubin in urine
•Dark colored urine

Bilirubin Deposition in tissues

•Jaundice •Pruritus

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