VI. PATHOPHYSIOLOGY A.

Theoretical Based Predisposing Factors: Age: 40 Gender : Female Ileal Resection/Disease Race Genetics Precipitating Factors: Obesity Pregnancy/ Contraceptives Frequent Starvation/ Total parenteral Nutrition Diet/ weight loss Lifestyle

(Cholesterol Stones)

Decreased level of Bile Acids

Increased levels of fat in the blood stream

Synthesis of cholesterol in the liver

Excretion of cholesterol to the bile

Ratio of bile salts & lecithin with cholesterol is no longer within the area of solubility

Cholesterol concentration > solubility capacity of the bile

No formation of mixed miccelles

Lithogenic bile/ supersaturated bile (creamy)

Mucoprecipitates of organic& inorganic calcium salts become nucleation sites

Nucleation and production of cholesterol monohydrate crystals

Large Cholesterol Stones

Extrusion of stones from Gallbladder

Impaction at cystic and bile duct

Distention of biliary tree and fundus of gallbladder

Bile not excreted to doudenum Backflow of bile and goes to the circulation

Forceful contractions of gallbladder

levels of bilirubin/bile pigments in the circulation

Spasm of smooth muscle in the ducts

conversion of bilirubin to urobilinogen in the intestines

Fat not emulsified

No absorption of fat in the intestines

Renal secretion of bilirubin excretion of urobilinogen in stool

PAIN

Obstructiv e Jaundice Pruritus

Dark urine

Grayish stool

Nausea and Vomiting Fullnes Indigestion Vit. ADEK defeciences

B. Client Based Precipitating Factors: Predisposing Factors: Diet: Oily/ Fatty foods Age: 77 years old Gender: Female

(Cholesterol Stones)

Decreased level of Bile Acids

Increased levels of fat in the blood stream

Synthesis of cholesterol in the liver

Excretion of cholesterol to the bile

Ratio of bile salts & lecithin with cholesterol is no longer within the area of solubility

Cholesterol concentration > solubility capacity of the bile

No formation of mixed miccelles

Lithogenic bile/ supersaturated bile (creamy)

Mucoprecipitates of organic& inorganic calcium salts become nucleation sites

Nucleation and production of cholesterol monohydrate crystals

Large Cholesterol Stones

Extrusion of stones from Gallbladder

Impaction at cystic and bile duct

Distention of biliary tree and fundus of gallbladder

Bile not excreted to doudenum Backflow of bile and goes to the circulation

Forceful contractions of gallbladder

levels of bilirubin/bile pigments in the circulation

Spasm of smooth muscle in the ducts

conversion of bilirubin to urobilinogen in the intestines

Fat not emulsified

No absorption of fat in the intestines

Renal secretion of bilirubin excretion of urobilinogen in stool

PAIN

Dark urine

Nausea and Vomiting

Grayish stool

BIOGRAPHICAL DATA Name: C.A.S Age: 77 Gender: female Civil Status: Married Address: Paranaque City Birth date: March 30, 1935 Birth Place: Paranque City Religion: Catholic Educational Attainment: Elementary Graduate Occupation: Retired Place of Employment: none Language Spoken: English and tagalog Health Financing: Son and daughter Admitting Diagnosis / Impression: Cholelithiasis Source of Information: daughter of the client Reliability (1 4 with 4 very reliable): 4 NURSING HISTORY Chief Complaint: Crampy abdominal pain at the right upper quadrant radiating to the back aggravated by food. History of present illness: 1 day prior to admission the client complain of crampy abdominal pain at the right upper quadrant radiating to the back aggravated by food. During admission client sought abdominal ultrasound and found out the existence of gallstone in her gallbladder with the size of 5.2x2.7cm. Past Medical History Childhood illnesses: chicken fox and pulmonary asthma Immunization Status: complete vaccination Allergies: none Accidents and Injuries: hip injury by fall Hospitalization (Cause / organ damage / Removed / Treatment): when she was 69 years old she had a hip injury due to fall and was hospitalized and undergone hip replacement. Pregnancy (GP TPAL) G: 3,

Family History Health state and ages of (cause of death) Parents: mother (death at 70 y/o) due to heart failure and father(death at 68y/o) due to DM1 Sibling: sister 68 y/o histories of DM and cholecystitis. Spouse: death at age of 75 due to COPD. Children: son age 52 with history of heart problem and daughter age 55 history of cholelithiasis and DM1 Illness in the family similar to the patients: daughter and sister with history of gallbladder problem. Social History (Include home situation, family income and significant others.Quantify any tobacco, alcohol or drug use) Patient was a social drinker way back when she was still 40 years old and below, she loves eating fatty foods most especially during meal time. She was also a social smoker since she was still 28 years old and up to the present.