X.

PATHOPHYSIOLOGY

CHOLEDOCHOLITHIASIS

Non Modifiable Modifiable

- Age: 58 years old
- 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 pass from the gall bladder to common bile duct

Tx:
- Cholecystomy
Intraoperative
Cholangiogram Obstruction in the common bile duct
- T-tube insertion
- Exploration of the
Bile duct

Body tries to dislodge No bile reaches the GIT Backflow of conjugated

the stones bilirubin to liver

Spasm of the decreased bile in decrease bile in duodenum Conjugated bilirubin

biliary tracts small intestine for enters blood stream
fat digestion decreased Sterobilin
S/Sx: S/Sx:
- Biliary colic decreased emulsification S/Sx: - Jaundice
- RUQ pain of fats - Clay-colored stool - Icterus Sclera
- Yellow skin
S/Sx:
- Nausea and vomiting
X. PATHOPHYSIOLOGY

Elevated intramural pressure

Walls of the biliary tract becomes

distended/inflammation occurs

Occlusion of lymphatic Diminished host antibacterial defenses

channels then the venous
return and arterial Immune system dysfunction
supply to the biliary
tract becomes undermined Bacteria form access to the biliary tree

Reduced blood supply

to the biliary tract

Decrease oxygenation

Walls of the biliary Bacteria

tract starts to break starts to Bacteremia
multiply

Retro gate ascends from duodenum

to the hepatic ducts

S/Sx:
- Charcots triad:
Fever. RUQ pain, and Jaundice
- Reynolds pentad:
Altered mental status, Hypotension,
Fever. RUQ pain, and Jaundice

Symbols:
Leads to :
Diagnostics :
Signs and Symptom :
Patient based : Bold Letter

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