Cholelithiasis: Nursing

Cholelithiasis refers to the presence of gallstones, or calculi, in the gallbladder as a result of precipitation of bile components, such as cholesterol and bilirubin.

Now, let’s quickly review some anatomy and physiology of the hepatobiliary system, which is made of the liver, gallbladder, and bile ducts. The liver is in charge of producing bile, which is mostly made up of bile salts and acids, cholesterol, phospholipids, proteins, bilirubin and small amounts of various other compounds, like water, electrolytes, and bicarbonate.

Then, bile flows out of the liver through the hepatic ducts towards the gallbladder, where it’s stored. Now, eating fatty foods stimulates the cells in the small intestine to secrete cholecystokinin into the bloodstream.

Cholecystokinin, in turn, stimulates the gallbladder contraction, causing it to release bile through the cystic duct, then the common bile duct, and ultimately into the duodenum. Once in the duodenum, bile acts as a fat emulsifier, which essentially helps to digest lipids from food into small micelles, making them easier to absorb.

Now, gallstone formation is caused by precipitation of bile components, such as cholesterol and bilirubin, respectively leading to the formation of cholesterol gallstones and pigment gallstones.

That being said, the main risk factors for cholesterol gallstones include being assigned female at birth, pregnancy, and oral contraceptive pills are associated with higher estrogen levels, which then increases cholesterol synthesis in the liver. Other common risk factors include obesity and a high cholesterol diet; as well as increasing age, especially after 40. These can be remembered by the 3 Os for stooones, so ovulating, obesity, and older.