The document discusses disease of the gallbladder and gallstones. It describes the gallbladder's function of storing and concentrating bile to help digest fat. Gallstones form when bile becomes supersaturated with cholesterol and other substances. Risk factors for gallstones include obesity, rapid weight loss, pregnancy, and certain diets. Gallstones may cause biliary obstruction, cholecystitis (gallbladder inflammation), or cholangitis (bile duct inflammation). Treatment options include managing symptoms with diet or surgically removing the gallbladder via laparoscopic cholecystectomy. Post-surgery diet focuses on low-fat intake and adequate hydration and fiber to support digestion without a functioning gallbladder.

1. Disease of gall
bladder
by Maam Pakeeza
Maam Pakeeza

2. The gallbladder
 Function of gall-bladder
Its main purpose is to store and concentrate
bile.
Components of bile
Water
Bile salts
Bilirubin
Cholesterol
Fatty acids
Lacithin
NA,K,Ca,Cl,HCO3
The gallbladder is a small, pouch-like organ found underneath the liver.
Maam Pakeeza

3. Bile
• Bile is a liquid produced by
the liver to help digest fats.
• It's passed from the
liver into the
gallbladder through a
series of channels known as
bile ducts.
Maam Pakeeza

4. bile concentration
• The bile is stored in the gallbladder and,
over time, it becomes more concentrated,
which makes it better at digesting fats.
• Bile is normally concentrated in this way
about 5-fold, but it can be concentrated
up to a maximum of 20-fold.
• The gallbladder releases bile into the
digestive system when it's needed
Substance Liver Bile Gallbladder Bile
Water 97.5 g/dl 92 g/dl
Bile salts 1.1 g/dl 6 g/dl
Bilirubin 0.04 g/dl 0.3 g/dl
Cholesterol 0.1 g/dl 0.3 to 0.9 g/dl
Fatty acids 0.12 g/dl 0.3 to 1.2 g/dl
Lecithin 0.04 g/dl 0.3 g/dl
Na+ 145 mEq/L 130 mEq/L
K+ 5 mEq/L 12 mEq/L
Ca++ 5 mEq/L 23 mEq/L
Cl− 100 mEq/L 25 mEq/L
HCO3− 28 mEq/L 10 mEq/L
Maam Pakeeza

5. Cholelithiasis (Gallstones)
Gallstones are small stones, usually made of
cholesterol, that form in the gallbladder.
Types of stones
• There are basically three types of stones:
1. cholesterol
2. Pigment( bilirubin)
3. mixed stones
Cholelithiasis is the formation of stones (calculi) within the gallbladder
or biliary duct system
Maam Pakeeza

6. What causes gallstones?
• Gallstones are thought to develop
because of an imbalance in the
chemical make up of bile inside the
gallbladder.
• Cholesterol, a major component of
bile, is normally kept in solution by
bile acids, lecithin, and
phospholipids.
• However, when bile is
supersaturated with cholesterol, it
crystallizes and gallstones are
formed.
Maam Pakeeza

7. Who is at risk for
gallstones?
 Gender
Gallstones form more commonly in women than men.
 Age
Gallstone prevalence increases with age.
 Obesity:
Obese individuals are more likely to form gallstones than thin
individuals.
 Pregnancy:
Women who have been pregnant are more likely to form gallstones than
women who have not been pregnant. Pregnancy increases the risk
for cholesterol gallstones because during pregnancy, bile contains
more cholesterol, and the gallbladder does not contract normally.
 Diet :
rapid weight loss, fat-restricted diets.
Maam Pakeeza

8. Stages of
gall-stone
disorder
Maam Pakeeza

9. 1:Biliary Obstruction
(choledocholithiasis)
• However, if a gallstone becomes trapped in an
opening (duct) inside the gallbladder, it can
trigger a sudden, intense abdominal pain that
usually lasts between one and five hours.
• This type of abdominal pain is known as
biliary colic
Biliary Obstruction When a gallstone passes from the gallbladder through the cystic duct and
lodges in the common bile duct or in the head of the pancreas, this condition is called
choledocholithiasis.
Maam Pakeeza

10. Biliary obstruction
• The bile is no longer carried to the
duodenum and the excretion of bile
pigments into the urine gives the urine a
dark color.
• The feces are no longer colored by bile
• pigments and hence become grayish (clay
colored).
Maam Pakeeza

11. 2:Cholecystitis
This condition can be
chronic or acute
• Obstruction of the cystic duct
by gallstones is the most
common cause of gallbladder
inflammation, which can lead
to infection and necrosis.
Inflammation of the gallbladder, cholecystitis, generally develops secondary to obstruction,
infection, and ischemia of the gallbladder.
Maam Pakeeza

12. 3:Cholangitis
The infection can ascend into the hepatic
ducts, then
biliary canaliculi, hepatic veins
leading to sepsis.
Cholangitis is an inflammation of the biliary ducts, usually secondary to obstruction of the
common bile duct leading to infection.
Maam Pakeeza

13. 3:Cholangitis
• It is a life threatening complication
of biliary obstruction, particularly in
older adults.
• Initial therapy generally consists of
antibiotics, fluid resuscitation, and
correction of blood clotting.
Maam Pakeeza

14. Treating gallstones
• In most cases they don't cause any symptoms and don't need to be treated. Nearly two-
thirds of patients with gallstones are asymptomatic.
• Treatment is usually only necessary if gallstones are causing:
 symptoms – such as abdominal pain
 complications – such as jaundice or acute pancreatitis
Maam Pakeeza

15. cholecystectomy
• In these cases keyhole surgery to remove the
gallbladder may be recommended.
• This procedure, known as
laparoscopic cholecystectomy,
is relatively simple to perform and has a low risk of
complications.
• You can lead a perfectly normal life without a
gallbladder.
• Your liver will still produce bile to digest food,
but the bile will just drip continuously into the
small intestine, rather than build up in the
gallbladder.
Maam Pakeeza

16. MNT
 There is no specific diet for treating symptoms of gallstones
 A low-fat high fiber and modest protein
content
may assist in controlling symptoms until
surgery is performed to remove the gallstones.
 Small frequent feedings
• Try not to eat too much fat at one mealtime
Small, frequent feedings may also help
improve the total nutrient intake to meet
patients’ needs.
Maam Pakeeza

17. MNT
 Plenty of fruit and vegetables
 Plenty of starchy carbohydrates(fibers )
 Choose low-fat dairy products.
 Some meat, fish, eggs and alternatives such as beans
and pulses.
 Limited amounts of foods high in fats and sugars
 Drink plenty of fluid - at least two litres daily, such as
water or herbal teas.
Maam Pakeeza

18. Post surgery
• The diet is advanced as tolerated to
liquids, though only low-fat liquids
are typically used.
• Due to poor absorption of fat, a
water-soluble form of vitamins A, D,
E, and K may be necessary.
• Post-surgery diarrhea may be
managed through increased fiber
intake (to increase fecal bulk) and
patient avoidance of foods that are
known to cause diarrhea.
Maam Pakeeza