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Alterations in Metabolism

Care of Patients with Problems of the Biliary System and Pancreas. Alterations in Metabolism. Hepatobiliary Anatomy. Acute Cholecystitis. Acute cholecystitis is the inflammation of the gallbladder. Calculous cholecystitis. Cholelithiasis (gallstones) usually accompanies cholecystitis.

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Alterations in Metabolism

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  1. Care of Patients with Problems of the Biliary System and Pancreas Alterations in Metabolism

  2. Hepatobiliary Anatomy

  3. Acute Cholecystitis • Acute cholecystitis is the inflammation of the gallbladder. • Calculous cholecystitis. • Cholelithiasis (gallstones) usually accompanies cholecystitis. • Acalculous cholecystitis inflammation can occur in the absence of gallstones.

  4. Gallstones

  5. Chronic Cholecystitis • Repeated episodes of cystic duct obstruction result in chronic inflammation • Pancreatitis, cholangitis • Jaundice • Icterus • Obstructive jaundice • Pruritus

  6. Clinical Manifestations • Flatulence, dyspepsia, eructation, anorexia, nausea and vomiting, abdominal pain • Biliary colic • Murphy’s sign • Blumberg’s sign • Rebound tenderness • Steatorrhea

  7. Nonsurgical Management • Nutrition therapy—low-fat diet, fat-soluble vitamins, bile salts • Drug therapy—opioid analgesic such as morphine or hydromorphone, anticholinergic drugs, antiemetic • Extracorporeal shock wave lithotripsy • Percutaneous transhepatic biliary catheter insertion

  8. Surgical Management • Laparoscopic cholecystectomy • Standard preoperative care • Operative procedure • Postoperative care: • Free air pain result of carbon dioxide retention in the abdomen • Ambulation • Return to activities in 1 to 3 weeks

  9. Surgical Management

  10. Traditional Cholecystectomy • Standard preoperative care • Operative procedure • Postoperative care: • Opioids via patient-controlled analgesia pump • T-tube • Antiemetics • Wound care

  11. Traditional Cholecystectomy (Cont’d) • Care of the T-tube • NPO • Nutrition therapy

  12. Acute Pancreatitis • Serious and possibly life-threatening inflammatory process of the pancreas • Necrotizing hemorrhagic pancreatitis • Lipolysis • Proteolysis • Necrosis of blood vessels • Inflammation • Theories of enzyme activation

  13. Autodigestion

  14. Complications of Acute Pancreatitis • Hypovolemia • Hemorrhage • Acute renal failure • Paralytic ileus • Hypovolemic or septic shock • Pleural effusion, respiratory distress syndrome, pneumonia • Multisystem organ failure • Disseminated intravascular coagulation • Diabetes mellitus

  15. Clinical Manifestations • Generalized jaundice • Cullen’s sign • Turner’s sign • Bowel sounds • Abdominal tenderness, rigidity, guarding • Pancreatic ascites • Significant changes in vital signs

  16. Laboratory Assessment • Lipase • Trypsin • Alkaline phosphatase • Alanine aminotransferase • WBC • Glucose • Calcium

  17. Acute Pain • Interventions include: • The priority for patient care to provide supportive care by relieving symptoms, decrease inflammation, and anticipate and treat complications • Comfort measures to reduce pain including fasting and drug therapy • Endoscopic retrograde cholangiopancreatography

  18. Nonsurgical Management • Fasting and rest • Drug therapy • Comfort measures • Endoscopic retrograde cholangiopancreatography (ERCP)

  19. Surgical Management • Preoperative care—NG tube may be inserted • Operative procedures • Postoperative care: • Monitor drainage tubes and record output from drain. • Provide meticulous skin care and dressing changes. • Maintain skin integrity.

  20. Imbalanced Nutrition: Less Than Body Requirements • Interventions include: • NPO in early stages • Antiemetics for nausea and vomiting • Total parenteral nutrition • Small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals • Avoidance of foods that cause GI stimulation

  21. Chronic Pancreatitis • Progressive destructive disease of the pancreas, characterized by remissions and exacerbations • Nonsurgical management includes: • Drug therapy • Analgesic administration • Enzyme replacement • Insulin therapy • Nutrition therapy

  22. Pancreatic Abscess • Most serious complication of pancreatitis; always fatal if untreated • High fever • Blood cultures • Drainage via the percutaneous method or laparoscopy • Antibiotic treatmentalone does not resolve abscess

  23. Pancreatic Pseudocyst • Complications: hemorrhage, infection, bowel obstruction, abscess, fistula formation, pancreatic ascites • May spontaneously resolve • Surgical intervention after 6 weeks

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