This week my presentation was on cholelithiasis, also known as gallstones, and cholecystitis, which is inflammation of the gallbladder.
This week my presentation was on cholelithiasis, also known as gallstones, and cholecystitis, which is inflammation of the gallbladder.
YesterdayApr 17 at 5:14pm
This week my presentation was on cholelithiasis, also known as gallstones, and cholecystitis, which is inflammation of the gallbladder. In my presentation, I distinguished between the pathophysiology, clinical manifestations, and treatments. The idea that makes the most sense to me is exactly how the gallstones form in the gallbladder and biliary tract. The reason gallstones form is generally due to a supersaturation of cholesterol in the bile (Rogers, 2022). Although there are many different reasons for the bile to be supersaturated in cholesterol, some of the reasons are an increase in hepatocyte synthesis of the cholesterol ingested, the decreased secretion of bile acids that subsequently increases the solubility of cholesterol, the gallbladder muscle motility decreases causing prolonged exposure to bile and even genetic disposition (Rogers, 2022). About 20-30% of the population is predisposed to problems in cholesterol transport and breakdown as well as mucin activation, which all increase the risk of gallstones (Rogers, 2022). Another idea that makes sense is the manifestation of pain in both cholelithiasis and cholecystitis. In both cholelithiasis and cholecystitis, pain occurs during gallbladder contraction (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDKD], 2017). The gallbladder contracts as a response to cholecystokinin, which is released during food digestion, which thus increases the pressure and distention of the gallbladder, causing pain (NIDDKD, 2017). That is why pain is seen right after eating meals.
This relates to what I see in clinical practice as I care for many people with epigastric pain as we try to rule out myocardial infarction. As we know epigastric pain can be anything from gastroesophageal reflux disease, pancreatitis, gastritis, gallbladder diseases, hepatobiliary diseases and so on (Sogunro, 2021). So, understanding that there are different causes of pain, I can help distinguish what is the cause of the patient’s pain. This topic also relates to current events as one of the main risk factors for developing cholelithiasis and cholecystitis is high cholesterol or eating a diet high in fats (Rogers, 2022). In the U.S. over 94 million people aged 20 and over have high cholesterol while 7% of children in the U.S. also have high cholesterol (Centers for Disease Control and Prevention [CDC], 2023). Because high cholesterol can impact almost all organs of the body, it is one of the main risk factors for each leading cause of death in the U.S. as well (CDC, 2023). The leading causes of death in the U.S. are heart disease, cancer, covid-19, accidents, strokes, diabetes, and chronic liver diseases (CDC, 2023). Understanding just how much cholesterol impacts the human body, can help us understand how to better educate our patients.
What will make this problem more treatable is prevention. There is no preventative immunization or medication that can be taken to prevent gallstones and inflammation of the gallbladder specifically. But helping to prevent the formation of gallstones, can help prevent the inflammation and subsequent disease process. So, taking statins to lower cholesterol levels, eating diets low in bad fats, high in good fats (Rogers, 2022). Additionally, increasing fiber intake can increase motility of the colon, which thus increases bile acids to speed up transport of cholesterol (Rogers, 2022).
References
Centers for Disease Control and Prevention. (2023, March 20). High cholesterol facts. U.S. Department of Health & Human Services. https://www.cdc.gov/cholesterol/facts.htm#:~:text=Nearly%2094%20million%20U.S.%20adults,levels%20above%20200%20mg%2FdL.
National Institute of Diabetes and Digestive and Kidney Diseases. (2017, November). Gallstones. U.S. Department of Health & Human Services. https://www.niddk.nih.gov/health-information/diges…
Rogers, J. (2022). McCance & Huether’s Pathophysiology (9th Ed.). Elsevier Health Sciences. https://online.vitalsource.com/books/9780323789899
Sogunro, O. A. (2021, February 5). What are the differential diagnoses for abdominal pain by region? MedMastery. https://www.medmastery.com/guides/abdominal-examin…
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