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    Assessment and Management of Patients With Biliary Disorders

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    Bav VAansoqnuaetz
    Endocrine disorders

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    Assessment and Management of Patients With Biliary Disorders

    Uploaded by

    Bav VAansoqnuaetz
    181 views26 pages
    Endocrine disorders

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    15765215

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    Endocrine disorders

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    181 views26 pages

    Assessment and Management of Patients With Biliary Disorders

    Uploaded by

    Bav VAansoqnuaetz
    Endocrine disorders

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 26

    Chapter 50

    Assessment and Management


    of Patients With Biliary
    Disorders

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Review of Anatomy and Physiology
    • Gallbladder
    – Bile
    • Pancreas
    – Insulin
    – Glucagon
    – Somatostatin

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Liver, Biliary System, and Pancreas

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Question
    Is the following statement true or false?

    Bile is stored in the gallbladder.

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Answer
    True

    Bile is stored in the gallbladder.

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Cholelithiasis
    • Pathophysiology
    – Pigment stones (formed from unconjugated pigments
    in the bile)
    – Cholesterol stones (Account for most cases of
    gallbladder disease)
    – Refer to Figure 50-2
    • Risk factors: refer to Chart 50-1

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Clinical Manifestations of Cholelithiasis
    • None or minimal symptoms, acute or chronic
    • Pain
    • Biliary colic (Excruciating upper right abdominal pain that
    radiates to the back or right shoulder)
    • Jaundice
    • Changes in urine or stool color
    • Vitamin deficiency, fat soluble (vitamins A, D, E, and K)
    • Diagnostic tests: refer to Table 50-1

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Cholesterol Gallstones and Pigment
    Gallstones

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Question
    Is the following statement true or false?

    Cholecystitis is when a patient has calculi in the


    gallbladder.

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Answer
    False

    Cholecystitis is inflammation of the gallbladder.


    Cholelithiasis is when a patient has calculi in the
    gallbladder.

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Medical Management of Cholelithiasis
    • ERCP (Endoscopic Retrograde Cholangiopancreatography)
    • Dietary management
    • Medications: ursodeoxycholic acid and chenodeoxycholic
    acid
    • Laparoscopic cholecystectomy (“Lap chole”)
    • Nonsurgical removal
    – By instrumentation
    – Intracorporeal or extracorporeal lithotripsy (Stones
    are fragmented by laser)

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Nonsurgical Removal of Gallstones

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Laparoscopic Cholecystectomy

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Nursing Process: The Care of the Patient
    With Cholelithiasis—Assessment
    • Patient history
    • Knowledge and education needs
    • Respiratory status and risk factors for respiratory
    complications postoperative
    • Nutritional status
    • Monitor for potential bleeding
    • GI symptoms: after laparoscopic surgery, assess for loss
    of appetite, vomiting, pain, distention, fever—potential
    infection or disruption of GI tract

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Nursing Process: The Care of the Patient
    With Cholelithiasis—Diagnosis
    • Acute pain
    • Impaired gas exchange
    • Impaired skin integrity
    • Imbalanced nutrition
    • Deficient knowledge

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Collaborative Problems and Potential
    Complications
    • Bleeding
    • GI symptoms
    • Complications related to surgery in general: atelectasis,
    thrombophlebitis

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Nursing Process: The Care of the Patient
    With Cholelithiasis—Planning
    • Goals may include relief of pain, adequate ventilation,
    intact skin, improved biliary drainage
    • Optimal nutritional intake
    • Absence of complications
    • Understands self-care routines

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Nursing Process: The Care of the Patient
    With Cholelithiasis—Interventions
    • Low Fowler’s position
    • NG or NPO until bowel sounds return; then a soft, low-
    fat, high-carbohydrate diet
    • Care of biliary drainage system
    • Analgesics, pain management
    • Turn, cough, and deep breathing; splinting to reduce
    pain
    • Ambulation
    • Self-care education: refer to Chart 50-2

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Pancreatitis
    • Acute: pancreatic duct becomes obstructed, and
    enzymes back up, causing autodigestion and
    inflammation of the pancreas
    • Chronic: progressive inflammatory disorder with
    destruction of the pancreas; cells are replaced by fibrous
    tissue; pressure within the pancreas increases,
    obstructing the pancreatic and common bile ducts
    • Refer to Chart 50-3

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Question
    What is a major symptom of chronic pancreatitis?
    A. Recurrent attacks of severe upper abdominal and back
    pain accompanied by vomiting
    B. Fever, jaundice, confusion, and agitation
    C. Ecchymosis in the flank or umbilical area
    D. Abdominal guarding

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Answer
    A. Recurrent attacks of severe upper abdominal and back
    pain accompanied by vomiting

    Chronic pancreatitis has recurrent attacks of severe upper


    abdominal and back pain accompanied by vomiting. Acute
    pancreatitis presents with fever, jaundice, confusion,
    agitation, ecchymosis in the flank or umbilical area, and
    abdominal guarding.

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Nursing Process: The Care of the Patient
    With Acute Pancreatitis—Diagnosis
    • Acute pain
    • Ineffective breathing pattern
    • Imbalanced nutrition
    • Impaired skin integrity
    • Refer to Chart 50-4

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Collaborative Problems and Potential
    Complications
    • Fluid and electrolyte disturbances
    • Necrosis of the pancreas
    • Shock
    • Multiple organ dysfunction syndrome
    • DIC

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Tumors of the Pancreas
    • Pancreatic cysts
    • Pancreatic cancer
    – Risk factors (Smoking, exposure to chemicals or
    toxins, diets high in fats or meats)
    – Sites of lesions (May develop in the head, body, or
    tail of pancreas)
    – Treatment may be palliative
    • Chemotherapy
    • Radiation (limited)
    • Surgery

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Pancreatoduodenectomy
    (Whipple’s Procedure)

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


    Multiple Sumps After Pancreatic Surgery

    Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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