Choledocholithiasis Pathophysiology 6zn6l

X. PATHOPHYSIOLOGY CHOLEDOCHOLITHIASIS Non Modifiable - Age: 58 years old

Modifiable - Diet: High fatty foods and alcohol intake - Lack of physical activity

Bile becomes supersaturated with cholesterol/calcium/excess unconjugated bilirubin/both and has decrease bile salt Solutes precipitate from solution to solid crystals Crystals come together to form stones Small stones may from the gall bladder to common bile duct Tx: - Cholecystomy Intraoperative Cholangiogram - T-tube insertion - Exploration of the Bile duct

Body tries to dislodge the stones Spasm of the biliary tracts S/Sx: - Biliary colic - RUQ pain

Obstruction in the common bile duct

No bile reaches the GIT

decreased bile in small intestine for fat digestion decreased emulsification of fats S/Sx: - Nausea and vomiting

decrease bile in duodenum

Backflow of conjugated bilirubin to liver Conjugated bilirubin enters blood stream

decreased Sterobilin S/Sx: - Clay-colored stool

S/Sx: - Jaundice - Icterus Sclera - Yellow skin

X. PATHOPHYSIOLOGY

Elevated intramural pressure Walls of the biliary tract becomes distended/inflammation occurs Occlusion of lymphatic channels then the venous return and arterial supply to the biliary tract becomes undermined

Diminished host antibacterial defenses Immune system dysfunction Bacteria form access to the biliary tree

Reduced blood supply to the biliary tract Decrease oxygenation Walls of the biliary tract starts to break

Bacteria starts to multiply

Bacteremia

Retro gate ascends from duodenum to the hepatic ducts S/Sx: - Charcot’s triad: Fever. RUQ pain, and Jaundice - Reynold’s pentad: Altered mental status, Hypotension, Fever. RUQ pain, and Jaundice

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References: http://emedicine.medscape.com/article/774245-overview#a5 Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, Twelfth Edition Essentials of Anatomy and Physiology, Sixth Edition