Patient Scenario

The disorder of choice is Cholelithiasis (gallstones), and the main factor is behavior. A Native American female at 42 years old presents to our clinic with pain in the upper quadrant that started a couple of hours after taking a fatty meal and kales. Also, she complains of flatulence as well as heartburn. Moreover, the patient has obesity characterized by an unhealthy diet. The patient narrated that she often takes excessive caffeine through soft drinks and fatty food. The laboratory reported high serum cholesterol levels, in the patient’s low-density lipoprotein.

Patient’s Behavior Impacting Cholelithiasis

Unhealthy dietary habits of the patient such as a high intake of fatty foods and excessive caffeine intakes predispose the patient to gallstones disorder. Increased amounts of cholesterol in the live results in high concentrations of cholesterol than its solubility, so there is retain of bile in the gallbladder forming the stones. Therefore, the content of cholesterol, as well as its saturation, are the essential factors for the formation of cholesterol gallstone (Hammer & McPhee, 2014). Recently, there is a relation between high serum low-density lipoprotein and high cholesterol gallstones. However, cholesterol gallstones can be managed through increased healthy diet.

Potential Associated Alterations alongside Symptoms

In most cases, cholelithiasis is asymptomatic and may be diagnosed incidentally. Often, the manifestation of the symptoms is by epigastric as well as right hypochondrium pains. The condition is characterized by fatty foods and kales intolerance occurring in minutes to several hours after their intake. Conversely, there are also vague symptoms associated with gallstones such as heartburn, epigastric discomfort alongside flatulence.The symptomatic pain always occurs when the stones are dislodged in the cystic duct during gallbladder contractions(Huether, &McCance, 2017). The upper quadrant pain can be constant or intermittent radiating to the mid and upper back.

Pathophysiology and Cellular Functions

The gallbladder is muscular like a sac that contains up to 50 ml of fluid. The liver produces bile. The bile flows through the hepatic duct, cystic duct into the gallbladder. On the other hand, contractions of the gallbladder cause bile to move back through the cystic duct and into bile duct with the aid of sphincter of Oddi, and lastly the bile reaches the duodenum. The relaxation of Oddi’ssphincter and gallbladder contractions releases the bile from the gallbladder. This coordination is facilitated by Cholecystokinin hormone (CCK); this hormone is secreted by the I-cells from the visceral fats.

The gallbladder is covered with epithelial cells that produce mucus to prevent infections that may emerge. Once the body is not able to metabolize cholesterol, there is an accumulation of bilirubin, gallstones as well as bile acids. And when the liver produces more cholesterol, then the gallbladder becomes highly concentrated with cholesterol leading to crystallization process. The resulting crystal clumps are forming bigger stones; hence there are gallstones in the gallbladder(Huether, &McCance, 2017).

Decreased muscular contractions and increase in sphincter contractions leads to the formation of gallstone. The decrease in muscular motility is caused by intrinsic effects on the muscular wall, hormonal changes as well as a change in neural control. All these factors lead to the accumulation of the bile within the gallbladder resulting in gallstones formation.

 
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