Introduction

Cholelithiasis, commonly referred to as gallstone disease, is a multifaceted condition influenced by

various factors such as bile composition, gallbladder function, and lifestyle choices. It involves the
process of stone formation in the gallbladder, with gallstones being composed of a mixture of
cholesterol, calcium salts of bilirubin or palmitate, proteins, and mucin. The condition can lead to
complications such as acute and chronic cholecystitis, impacting the gallbladder's health and function.

Here are the three types of stones:

1. Cholesterol-rich stones: These stones are primarily composed of cholesterol and are the most
common type of gallstones.

2. Pigment stones: These stones are made up of bilirubin and are less common than cholesterol stones.

3. Mixed stones: These stones contain a combination of cholesterol and bilirubin, making them a mix of
both cholesterol-rich and pigment stones.

Stages of gallstones

Cholelithiasis progresses through four stages:

1. Lithogenic State: Conditions favor gallstone formation within the biliary system.

2. Asymptomatic Gallstone: Gallstones are present but cause no symptoms.

3. Symptomatic Gallstone: Gallstones cause symptoms like biliary colic, often triggered by fatty meals.

4. Complicated Gallstone: Gallstones lead to complications like cholecystitis, choledocholithiasis, or

pancreatitis, requiring medical intervention.

Signs and Symptoms of Cholelithiasis:

1. Biliary Colic: The most common symptom characterized by intense, cramping pain in the upper right
abdomen that can radiate to the back or right shoulder. The pain can be severe and typically lasts for
several hours.

2. Nausea and Vomiting: Patients may experience nausea and vomiting, especially during episodes of
biliary colic.

3. Fever: In cases of complications such as cholecystitis or cholangitis, patients may develop a fever.

4. Jaundice: Yellowing of the skin and whites of the eyes (icterus) due to the buildup of bilirubin in the
bloodstream.

5. Dark Urine and Pale Stools: Bilirubin accumulation can lead to dark urine and pale or clay-colored
stools.
6. Back or Shoulder Pain: Pain may radiate to the back or right shoulder blade.

7. Abdominal Bloating: Patients may experience abdominal bloating and discomfort.

8. Indigestion: Some individuals may report symptoms of indigestion, such as gas, bloating, or general
discomfort after meals.

9. Fatty Food Intolerance: Difficulty digesting fatty foods may be reported, although this is not a specific
symptom of cholelithiasis.

10. Episodes of Pain: Pain often occurs after consuming heavy or fatty meals and can be recurrent or
intermittent.

Etiology

Gallstones form due to an imbalance in the composition of bile, leading to the precipitation of its
components. The most common types of stones are cholesterol-rich stones, followed by pigment stones
and mixed stones. This imbalance can be triggered by various factors, including dietary choices, obesity,
hormonal influences, and certain medications. These factors disrupt the equilibrium of bile components,
ultimately leading to the crystallization and formation of gallstones.

Here are the factors contributing to gallstone formation in a list:

- Dietary Choices: A high-fat diet, low in fiber, and rich in cholesterol can increase the risk of gallstone
formation.

- Obesity: Being overweight or obese is a significant risk factor for developing gallstones, as it can lead to
increased cholesterol levels in bile.

- Hormonal Influences: Hormonal changes, particularly high estrogen levels during pregnancy or
hormone therapy, can affect bile composition and promote gallstone formation.

- Medications: Certain medications, such as cholesterol-lowering drugs or those affecting hormone

levels, may contribute to the development of gallstones.

Epidemiology

Cholelithiasis, or gallstone disease, exhibits a significant epidemiological presence globally, with a

notable impact on public health. The condition's prevalence is widespread, affecting a substantial
portion of the adult population, albeit with variations across different regions and ethnic groups.
Advancing age and female gender are key risk factors for gallstone formation, with women, particularly
during their reproductive years, being more susceptible. Lifestyle factors such as obesity, dietary habits,
and sedentary lifestyles play a crucial role in the development of gallstones. The disease's complications,
including cholecystitis and pancreatitis, contribute to its morbidity and healthcare burden. Diagnostic
advancements, particularly the use of ultrasonography, facilitate early detection and management,
improving patient outcomes. Prognosis is generally favorable with timely intervention, underscoring the
importance of understanding the epidemiology of cholelithiasis for effective prevention and treatment
strategies.

STATISTICS

GLOBALLY

Globally, cholelithiasis impacts a significant portion of the population, with estimates suggesting a
prevalence of 10-15% among adults.

REGIONALLY

Gallstone disease prevalence (claims-based, 2019) was 0.72% among commercial insurance enrollees
and 2.09% among Medicare beneficiaries and rose over the previous decade in both groups. Recently, in
the U.S. population, gallstone disease contributed to approximately 2.2 million ambulatory care visits,
1.2 million emergency department visits, 625,000 hospital discharges, and 2,000 deaths annually.
Women had higher medical care rates with a gallstone disease diagnosis, but mortality rates were higher
among men. Hispanics had higher ambulatory care visit and hospital discharge rates compared with
Whites, but not mortality rates. Blacks had lower ambulatory care visit and mortality rates, but similar
hospital discharge rates compared with whites.

NATIONAL

Statistics from the Department of Health (DOH) in the Philippines estimate the incidence of gallstones
among the Filipino population to be approximately 6-9%.

Around 4% of those with gallstones will develop symptoms annually, while around 80% will remain
asymptomatic throughout their lifetime.

Incorporating preventive measures and lifestyle recommendations is essential to empower individuals in

mitigating the risk of cholelithiasis. Maintaining a healthy weight, following a balanced diet rich in fiber
and low in saturated fats, engaging in regular physical activity, and managing underlying health
conditions are key strategies to reduce the likelihood of gallstone formation and related complications.

In this study, the BSN 1-C class is tasked with examining Cholelithiasis, also known as gallstone disease,
for our Psychopathophysiology subject. Our focus is on understanding the disease's development,
progression, natural history, and clinical manifestations. Engaging in this research endeavor will enhance
our skills as nursing students, equipping us to apply theoretical knowledge in practical patient
assessment scenarios. Understanding Cholelithiasis in-depth will prepare us to address related clinical
issues effectively and contribute to our growth as competent healthcare professionals.

OBJECTIVES OF STUDY
At the end of the presentation, we the BSN 1 assigned the topic Cholelithiasis, will be able to:

 Define Cholelithiasis.
 Understand the Epidemiology of Cholelithiasis.
 Know the Etiology, Pathophysiology, and Risk Factors of Cholelithiasis.
 Discuss the Anatomy and Physiology of Digestive System.
 Enumerate the Signs and Symptoms of Cholelithiasis.
 Know the Diagnostic Methods and Laboratory Tests used to identify Cholelithiasis.
 Discuss the supportive care and treatment options for individuals with Cholelithiasis.
 Address the complications associated with Cholelithiasis.

DIGESTIVE SYSTEM

What is the digestive system? The digestive system is made up of the gastrointestinal tract—also called
the GI tract or digestive tract—and the liver, pancreas, and gallbladder. The GI tract is a series of hollow
organs joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the
GI tract are the mouth, esophagus, stomach, small intestine, large intestine, and anus. The liver,
pancreas, and gallbladder are the solid organs of the digestive system. The small intestine has three
parts. The first part is called the duodenum. The jejunum is in the middle and the ileum is at the end.
The large intestine includes the appendix, cecum, colon, and rectum. The appendix is a finger-shaped
pouch attached to the cecum. The cecum is the first part of the large intestine. The colon is next. The
rectum is the end of the large intestine.

Bacteria in the GI tract, also called gut flora or microbiome, help with digestion. Parts of nervous and
circulatory NIH external link systems also help. Working together, nerves, hormones, bacteria, blood, and
the organs of digestive system digest the foods and liquids we eat or drink each day.

The digestive system is a complex network of organs responsible for processing food, extracting
nutrients, and eliminating waste. It includes the gastrointestinal tract and accessory organs like the liver
and pancreas. The system functions through ingestion, digestion, absorption, metabolism, and
elimination. Organs like the mouth, esophagus, stomach, small intestine, large intestine, liver, and
pancreas play crucial roles in these processes. The digestive system is vital for nutrient absorption,
energy production, waste removal, and immune function. Understanding its structure and functions is
essential for maintaining overall health and well-being.

Here are the key normal findings for a healthy digestive system:

1. Regular Bowel Movements: Normal bowel habits vary among individuals, but typically, regular and
comfortable bowel movements without excessive straining are considered normal.

2. Absence of Chronic Digestive Symptoms: A healthy digestive system should not exhibit chronic issues
like excessive bloating, gas, abdominal pain, diarrhea, or constipation.
3. Well-Tolerated Foods: Being able to eat a variety of foods without experiencing discomfort, nausea, or
allergic reactions indicates a healthy digestive system.

4. Maintaining a Healthy Weight: A properly functioning digestive system helps in absorbing nutrients
and regulating appetite, often reflecting in maintaining a healthy weight.

5. Energy and Good Spirits: A healthy gut contributes to overall well-being, so feeling energetic and alert
is a positive sign of good digestive health.

Process of Digestion and Metabolism in the Digestive System:

The digestive system plays a vital role in breaking down food, absorbing nutrients, and facilitating
metabolism. Here is an overview of the process of digestion and metabolism within the digestive system:

Digestion Process:

 Mouth: The digestion process begins in the mouth where enzymes in saliva start breaking down
carbohydrates.

 Esophagus. After you swallow, peristalsis pushes the food down your esophagus into your
stomach.

 Stomach: In the stomach, food mixes with stomach acid and enzymes to further break down
proteins and kill harmful bacteria.

 Pancreas: Your pancreas makes a digestive juice that has enzymes that break down
carbohydrates, fats, and proteins. The pancreas delivers the digestive juice to the small intestine
through small tubes called ducts.

 Liver: Your liver makes a digestive juice called bile that helps digest fats and some vitamins. Bile
ducts carry bile from your liver to your gallbladder for storage, or to the small intestine for use.

 Gallbladder: Your gallbladder stores bile between meals. When you eat, your gallbladder
squeezes bile through the bile ducts into your small intestine.

 Small Intestine: The majority of digestion and nutrient absorption occurs in the small intestine.
Enzymes from the pancreas and bile from the liver aid in breaking down fats, proteins, and
carbohydrates.

 Large Intestine: In the large intestine, water is absorbed, and waste products are formed into
feces for elimination.

 Rectum. The lower end of your large intestine, the rectum, stores stool until it pushes stool out
of your anus during a bowel movement.

The small intestine is part of the digestive system. Its main function is to break down and absorb
ingested nutrients while mixing and moving the intestinal contents consisting of gastric juices and partly
digested food along the digestive tract into the colon, or large intestine. This digestive tube has an
average length of 3 to 5 meters. The duodenum, jejunum, and ileum are the 3 components comprising
the small intestine.

SMALL INTESTINE {functions}

1. Duodenum

The duodenum neutralizes acidic chyme from the stomach with bicarbonate-rich secretions, creating an
environment less hostile to beneficial bacteria. It receives digestive enzymes from the pancreas and bile
from the liver and gallbladder to break down nutrients, which is crucial in preventing bacterial
overgrowth by ensuring thorough digestion. Additionally, it releases hormones like secretin and CCK to
regulate digestive processes, including the release of antimicrobial bile.

2. Jejunum

The jejunum continues the process of digestion and absorbs most nutrients, including carbohydrates,
proteins, vitamins, and minerals, ensuring the body receives necessary nutrients to maintain immune
function. The folds, villi, and microvilli increase the surface area for efficient nutrient absorption and also
act as barriers to pathogens, preventing them from entering the bloodstream.

3. Ileum

The ileum absorbs remaining nutrients, particularly vitamin B12 and bile salts, which are essential for
maintaining immune health. It contains Peyer's patches, which are small masses of lymphatic tissue that
monitor intestinal bacteria and prevent the growth of pathogenic bacteria. The ileum moves undigested
food to the large intestine and regulates flow with the ileocecal valve, preventing bacterial overgrowth
by controlling the movement of bacteria from the large intestine back into the small intestine.

Metabolism Process:

1. Nutrient Absorption: After digestion, the nutrients from food are absorbed into the bloodstream
through the walls of the small intestine.

2. Liver Metabolism: Nutrients travel to the liver where they are further metabolized. The liver processes
nutrients like carbohydrates, fats, and proteins to provide energy or store for later use.

3. Energy Production: Carbohydrates are converted into glucose, which is used as the body's primary
energy source. Fats are broken down into fatty acids, and proteins are converted into amino acids for
energy production.

4. Storage and Release: Any excess nutrients not needed immediately for energy are stored in the liver or
fat cells for later use. The body can then release stored energy when needed.
5. Regulation: Hormones like insulin and glucagon help regulate blood sugar levels by controlling the
storage and release of glucose in the body.

Importance of Digestion and Metabolism:

- Nutrient Absorption: The digestive system ensures that essential nutrients are absorbed and utilized by
the body.

- Energy Production: Metabolism converts nutrients into energy for bodily functions.

- Waste Elimination: The digestive system eliminates waste and toxins from the body.

- Overall Health: Proper digestion and metabolism are crucial for maintaining overall health and well-
being.

Understanding the intricate processes of digestion and metabolism highlights the importance of a
healthy digestive system for sustaining vital bodily functions and overall wellness.

ANATOMY AND PHYSIOLOGY

The anatomy and physiology of cholelithiasis involve the gallbladder, located beneath the liver on the
right side of the abdomen, storing and concentrating bile produced by the liver. Gallbladder is a
muscular organ that serves as a reservoir for bile, present in most vertebrates. In humans, it is a pear-
shaped membranous sac on the undersurface of the right lobe of the liver just below the lower ribs. It is
generally about 7.5 cm (about 3 in) long and 2.5 cm (1 in) in diameter at its thickest part; it has a capacity
varying from 1 to 1.5 fluid ounces. The body (corpus) and neck (collum) of the gallbladder extend
backward, upward, and to the left.

The wide end (fundus) points downward and forward, sometimes extending slightly
beyond the edge of the liver. Structurally, the gallbladder consists of an outer peritoneal coat (tunica
serosa); a middle coat of fibrous tissue and unstriped muscle (tunica muscularis); and
an inner mucous membrane coat (tunica mucosa).

The liver, situated under the diaphragm, produces bile to aid in fat digestion and absorption in the small
intestine. The function of the gallbladder is to store bile, secreted by the liver and transmitted from that
organ via the cystic and hepatic ducts, until it is needed in the digestive process.

The gallbladder, when functioning normally, empties through the biliary ducts into the duodenum to aid
digestion by promoting peristalsis and absorption, preventing putrefaction, and emulsifying fat.
Digestion of fat occurs mainly in the small intestine, by pancreatic enzymes called lipases. The purpose of
bile is to; help the lipases to work, by emulsifying fat into smaller droplets to increase access for the
enzymes, enable intake of fat, including fat-soluble vitamins: Vitamin A, D, E, and K, rid the body of
surpluses and metabolic wastes cholesterol and bilirubin.