Gallbladder Disease: Pathophysiology

• Gallbladder Disease is the concept of digestion.

Gallbladder Disease: Pathophysiology

• Altered or obstructed bile flow occurs through the hepatic, cystic, or common bile duct.
• Cholelithiasis and cholecystitis are types of gallbladder disease.

Etiology & Incidence

• Cholelithiasis is widespread, affecting 10-15% of the population.
• Approximately 1 million new cases are diagnosed each year.
• Gallstones can be formed because of abnormal bile composition, biliary stasis, or inflammation.
• Acute cholecystitis occurs when stones obstruct the cystic duct or common bile duct.

Clinical Manifestations

• Intense mid-epigastric or right upper quadrant pain may occur with gallbladder disease.
• Pain can radiate to the back, shoulder, and scapula, accompanied by rebound tenderness.
• Nausea and vomiting are common.
• Low-grade fever can sometimes be present.
• Chills, Jaundice, and gray-colored stools are possible.

Complications

• Gallstone Ileus can occur when a gallstone obstructs the small intestine.
• Inflammation of the pancreas can result from gallstones blocking the pancreatic duct.
• Gallbladder cancer can develop as a long-term complication.
• Infections can arise due to inflammation and bile stasis.

Diagnostic Tests

• Gallbladder Ultrasound will be utilized.
• Hepatobiliary Iminodiacetic Acid (HIDA) Scan can be used.
• Serum bilirubin level testing can be performed.
• Complete blood count (CBC) can be performed.
• Serum amylase and lipase level testing can be performed.

Pharmacologic Therapy

• Chenodiol
• Ursodiol
• Antibiotics
• Narcotic analgesic (Morphine) can be administered to reduce pain.

Non-pharmacologic Therapy

• Nasogastric tube insertion is a possible therapy.
• Fat-soluble vitamins (A, D, E, and K).
• Bile salts.

Surgical Intervention

• Laparoscopic cholecystectomy is the gold standard
  • It is the first treatment choice for symptomatic cholelithiasis or cholecystitis.
  • It requires less than a 24-hour hospital stay.
• Cholecystectomy with common bile duct exploration is required when stones are lodged in the ducts.
  • A T-tube is inserted to maintain duct patency.
  • This prevents bile duct closure due to inflammation or scar tissue.
  • Bile fluid flows by gravity into a drainage collection bag outside the body for four weeks.
• Lithotripsy involves the use of ultrasonic shock waves to break up the stones (done along with drug therapy).

Post-Operative care

• Pain Management is key.
  • Air from laparoscopic surgery, called "Lap-chole," may cause increased pain until reabsorbed.
• Prevent Complications
  • Incentive spirometer should be used every hour.
  • Keep incisions clean.
  • Ambulation to improve circulation and lung function.
• Encourage healthy lifestyle
  • Teach patients to eat a low-fat, low-carb diet.
  • Encourage exercise.
  • Manage hyperlipidemia.