Introduction
Pathophysiology is the study of the abnormal processes in human physiology that are caused or connected with injury or disease. A course in pathophysiology is an integral part of nursing education. It helps understand abnormal processes that occur in the human organism and apply an appropriate treatment plan for a particular disease (Huether & McCance, 2017).
Importance of Pathophysiology
The study of pathophysiology is crucial for all healthcare providers in general and for nurses in particular, as it helps recognize the progression and the state of a disease. For nurses, knowledge in pathophysiology helps them in their relationships with other healthcare providers. Additionally, the understanding of mechanisms of diseases enables nurses to explain to the patients why they have this or that particular disease, thereby making it easier for them to understand and accept their disorder (Hammer & McPhee, 2014).
Pathophysiology of Cholelithiasis
Cholelithiasis (or gallstones) is the most common form of the gallbladder. Usually, cholelithiasis is asymptomatic and is discovered during autopsy or surgical procedures for unrelated conditions (Allen, 2013). Gallstones are pebble-like, hard structures that lead to the obstruction of the cystic duct. Biliary sludge, a viscid mixture of cholesterol crystals, calcium deposits, and glycoproteins in biliary ducts or in the gallbladder is usually the main indicator of the forthcoming cholelithiasis.
The gallstones consist of bile that is supersaturated with cholesterol. The acceleration of cholesterol crystallization in the bile can also be caused by a distorted balance between antinucleating and pronucleating proteins. Mucin, the mixture of glycoproteins secreted by epithelial cells in the bile, is a pronucleating protein. It is considered that lysosomal enzymes promoted by the decreased degradation of mucin cause the cellular changes and cholesterol crystals formation (Allen, 2013).
The excessive contraction of the sphincter and the loss of the motility of the gallbladder muscular wall also influence the gallstones formation. This loss of motility leads to the decreased reservoir function and to the prolonged bile stasis. The lack of bile flow promotes its accumulation, thereby increasing the predisposition for the formation of stones. Hypomotility results in the high concentration of hepatic bile that is redirected from the gallbladder to the bile duct and the ineffective filling (Allen, 2013).
Sometimes, gallstones can be composed of bilirubin, a substance that is secreted when red blood cells collapse causing undesirable intra- and extracellular changes. The common causes of the bilirubin stone formation are the increased enterohepatic bilirubin cycling and the biliary tract infection. Bilirubin stones (or pigment stones) are observed mainly in patients with chronic hemolytic diseases of the biliary tract infections (Allen, 2013).
Patient Scenario
There are many risk factors associated with cholelithiasis. In this scenario, the risk factor for this disease is obesity. Thus, the patient is a 52-year-old woman who has class II obesity with BMI 36.2. Recently, she has been diagnosed with cholelithiasis. Her symptoms include pain in the upper belly, vomiting, nausea, and bloating. It is proved that a diet high in carbohydrates and fats increases a patient’s predisposition to obesity, thereby causing the destruction of red blood cells and increasing the synthesis of cholesterol, its hyper saturation, and its biliary secretion. In terms of intracellular changes, the patient has elevated levels of bile acid (38 µmol/L) which have been detected by the farnesoid X receptor.
Regarding extracellular changes, the levels of pH have dropped down to 5.3. Obesity also increases the risk of cholecystectomy and gallstone-related complications. Another cause of cholelithiasis for obese patients is associated with bariatric surgery or the rapid weight loss caused by low-calorie diets. Indeed, the patient had bariatric surgery four months ago. Thus, it can be stated that her cholelithiasis is caused by her being obese (Bonfrate, Wang, Garruti, & Portincasa, 2014).
Conclusion
In conclusion, it can be stated that understanding pathophysiology is crucial for all healthcare professionals in generals and for nurses in particular. Understanding the mechanism of disease improves communication and trust between a nurse and a patient. Cholelithiasis has many risk factors. Obesity is a major risk factor for cholelithiasis that can cause complications in the form of cholecystectomy.
References
Allen, S. N. (2013). Gallbladder disease: Pathophysiology, diagnosis, and treatment. US Pharmacist, 38(3), 33-41.
Bonfrate, L., Wang, D. Q., Garruti, G., & Portincasa, P. (2014). Obesity and the risk and prognosis of gallstone disease and pancreatitis. Best Practice & Research Clinical Gastroenterology, 28(4), 623-635.
Hammer, G. G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.). New York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.