Pathophysiology: Cholecystitis Modifiable factors -Obesity -Rapid weight loss and diet -Lack of physical activity -Long-term total parenteral nutrition -Oral contraceptives -Pregnancy

Non modifiable factors -Age (40 years old and above) -Gender/sex (female) -Genetic predisposition -Estrogen levels -Ethnicity (Native American & Hispanics)

Genetic & Demography

Change in Bile Composition

Decreased contractility of bile flow

Increased intraluminal Pressure

Bile Stasis Contraction of substances present in bile Precipitation of bile substances

Stimulates smooth muscle contraction

Increase tension to duodenum

Bile substance will increase in size Stones migrate to gall bladder Obstruction of the flow in bile

RUQ abdominal Pain Radiating pain to lower back

Impaired Hepatic uptake of bilirubin

Cholesterol salts In the skin

Collection of soluble bilirubin in the urine

Escape of bilirubin to GUT

No bile reaches the GIT

No bile in small intestine for fat Digestion

Jaundice

Decrease bile in the duodenum Sterobilin

Emulsification of fats Clay-colored stool Presence of Bile in the urine

Nausea and Vomiting

Dark yellow urine Obstructed cystic duct Bile duct obstructed already Gall bladder becomes distended RUQ pain