B.

CLIENT BASED

NON-MODIFIABLE FACTORS
*Age Increase in age = increase in prevalence of
gallstones (bile becomes more lithogenic)

*Gender Women = more estrogen than

men(Stimulates hepatic cholesterol
secretion into bile)

*Pregnancy Increased progesterone

(Decreased gallbladder Stimulates mucin secretion
motility)

Biliary sludge
Increased
estrogen( Stimulates Made up of hydrophobic
hepatic cholesterol regions that can bind to
secretion into bile) cholesterol, phospholipid and
bilirubin

Gallbladder volume is
doubled(bile stasis)

Accelerates nucleation with

unconjugated bilirubin(st)
Acetyl CoA BILE
cholesterol Produces cholesterol
transferase(A as fatty acid ester
Primary acid: Secondary acid: Tertiary acid:
CAT)
chenodeoxycholate deoxycholate and ursodeoxycholate
Stored in and cholate lithocholate
Low ACAT the liver

enlarged Cholesterol ester pool

Secreted by ATP-binding cassettes
superfamily from hepatocytes into
Stimulates hepatic secretion into bile
ABCG5 with ABCG8 ABCB4 transports ABCB11 transports
trasports cholesterol phospholipids bile acids

Correlates with If mutated(st) Secretion

Gallbladder
arachidonic acid of bile salts

Acidifies bile
Precursor of
prostaglandin
Increase solubility of Stimulates mucin secretion
calcium salts
Biliary sludge
Precipitation
less favorable
Made up of hydrophobic
regions that can bind to
cholesterol, phospholipid and
bilirubin

Accelerates nucleation with

unconjugated bilirubin

STONE
 CHOLESTEROL STONE-undissolved
cholesterol

Stone formation (cholelithiasis)**

Stasis of bile within the gallbladder lumen

Stone becomes impacted in the gastric duct

Damage of gallbladder
mucosa (mucosal trauma)

Chronic obstruction

Releases phosholipase A Activation of inflammatory mediators

Converts lecithin to lysotecithin Inflamed gallbladder nocireceptors which are located in the
liver, GI tract responds to noxious stimuli

Increased prostaglandin production due to

arachidonic acid from damaged cells
 Bilirubin is converted to urobilinogen
through bacterial metabolization Transduction along
nocireceptor fibers of spinal
exchange of sodium and potassium ions at cord to brain stem
The bileare
Some duct that allows the
Somebilirubin
are to the cell membranes activates nocireceptors
drain from the liver to intestine
excreted is blocked
reabsorbed and
through feces reprocessed Neurotransmitters such (ATP,
bradykinin , glutamate,etc.)are released
Urobilinogen in so that pain impulses will be
systemic circulation transmitted through the synaptic cleft

Foreign body sensed by the

Connects to thalamus, cortex
mechano- and chemoreceptors in
and higher levels of the brain
the stomach, jejunum and ileum

somatosensory cortex
Chemoreceptor trigger zone (CTZ)

Vomiting
center located
in the medulla

Contraction of Descent of Opening of

the abdominal the the gastric
and chest wall diaphragm cardia

Rapid and
forceful
evacuation of
stomach
contents
JAUNDICE NAUSEA AND
PAIN
VOMITING
(vomiting reflex)