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Management of Biliary Disorders

Cholecystitis. Acute inflammation of the gallbladderCauses:90% gallstones. Cholelithiasis-- Overview. Presence of one or more gallstonesStones form when bile hardens Abnormal metabolism of cholesterol/bile saltsEtiology:Familial tendencyDietary habitsSedentary lifestyleImpaired fat metabolismIncreased cholesterol.

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Management of Biliary Disorders

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    1. Management of Biliary Disorders Cholecystitis Cholelithiasis Pancreatitis

    3. Cholelithiasis-- Overview Presence of one or more gallstones Stones form when bile hardens Abnormal metabolism of cholesterol/bile salts Etiology: Familial tendency Dietary habits Sedentary lifestyle Impaired fat metabolism Increased cholesterol

    4. Cholecystitis– Clinical Manifestations episodic or vague pain Anorexia Nausea or vomiting Dyspepsia Eructation Flatulence Feeling of abdominal fullness Rebound tenderness Fever Jaundice, clay-colored stools, dark urine, steatorrhea

    5. Cholecystitis: Assessment and Diagnostics Abdominal x-ray Ultrasound Radionuclide imaging or cholescintigraphy Cholecystography Endoscopic Retrograde Cholangiopandratography (ERCP) Percutaneous transhepatic cholangiography

    6. Cholelithiasis-- Interventions Nonsurgical Nutritional and supportive therapy Drug therapy Stone removal by instrumentation Intracorpreal or Extracorporeal shock wave lithotripsy Percutaneous transhepatic biliary chatheter Surgical Laproscopic cholecystectomy Cholecystectomy Mini-cholecystectomy Choledocholithotomy Percutaneous cholecystectomy Cholecystostomy

    7. Question How does a cholecystostomy differ from a cholecystectomy? When would a cholecystostomy be incicated?

    8. T-Tube

    9. Nursing Care Measure Relieve pain Improve respiratory status Promote skin care Promote biliary drainage Improve nutritional status Monitor for and manage potential complications

    10. Pancreatitis-- Overview Acute Inflammatory process of the pancrease Premature activation of pancreatic enzymes Destruction of ductal tissue/pancreatic cells Autodigestion/fibrosis of pancreas Pathophysiologic processes Lipolysis Proteolysis Necrosis of blood vessels inflammation Theories of enzyme activation Chronic

    11. Acute Pancreatitis– Clinical Manifestations Abdominal pain Midepigastric/left upper quad Radiates, intense, continuous Affected by position Generalized jaundice Cullen’s sign: Gray-blue discoloration of abdomen/periumbilical area

    12. Acute Pancreatitis– Clinical Manifestations (continued) Turner’s sign: gray-blue discoloration of flanks Decreased bowel sounds/paralytic ileus Tenderness, rigidity/guarding Palpable mass Elevated temperature/tachycardia/? BP

    13. Pancreatitis: Assessment and Diagnostics Serum amylase and lipase elevated Abdominal x-ray Ultrasound CT H&H Peritoneal fluid analysis

    14. Acute Pancreatitis-- Interventions Nonsurgical Pain management and comfort measures Respiratory care Biliary drainage Surgical Diagnostic procedure Establish pancreatic drainage Resect or debride necrotic tissue

    15. Acute Pancreatitis: Nursing Management Improve breathing patterns Improve nutritional status Improve skin integrity Monitor for and manage potential complications

    16. Chronic Pancreatitis-- Overview Progressive, destructive Remissions/exacerbations Inflammation/fibrosis Repeated episodes of alcohol-induced acute pancreatitis Types of chronic: Calcyfying pancreatitis (alcohol induced) Obstructive pancreatitis

    17. Chronic Pancreatitis– Clinical Manifestations Intense abdominal pain and tenderness Ascites Possibly LUQ mass (pseudocyst) Respiratory compromise Steatorrhea, clay-colored stools Weight loss Jaundice Dark urine Polyuria, polydipsia, polyphagia

    18. Chronic Pancreatitis: Assessment and Diagnostics ERCP MRI CT Ultrasound Glucose Tolerance Test

    19. Chronic Pancreatitis-- Interventions Nonsurgical Drug therapy Enzyme replacement Insulin therapy Diet therapy Surgical Pancreaticojejunostomy (Roux-en-Y)

    20. Pancreatic Carcinoma-- Overview Originates from epithelial cells of pancreatic ductal system Most often discovered in late stages May be primary or metastatic Clinical manifestations depend upon site of origin or metastasis Spreads rapidly through lymphatic and venous systems Thrombophlebitis is a common complication

    21. Pancreatic Cancer– Clinical Manifestations Jaundice Clay-colored stools Dark urine Abdominal pain Anorexia and weight loss Nausea and vomiting Glucose intolerance Splenomegaly Flatulence GI bleed Ascites Leg or calf pain weakness

    22. Pancreatic Cancer: Assessment and Diagnostic Spiral CT ERCP Histologic studies Percutaneous biopsy

    23. Pancreatic Cancer-- Interventions Nonsurgical Management Drug therapy Pain management Chemotherapy Radiation therapy Surgical Management Total pancreatectomy Whipple (pancreaticoduodenectomy)

    24. Pancreatic Cancer: Nursing Management Pain management Provide nutritional support Skin care End-of-life issues

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