Assessment and Management of Patients

With Biliary/Pancreas Disorders

Shu-Yi (Emily) Wang, PhD, RN, CNS

Denver School of Nursing

Liver, Biliary System, and Pancreas

Figure 39-4, pp. 931

Gall bladder (GB) stoneIntrahepatic duct (IHD) stoneCommon bile duct (CBD) stone

Gastro-colic reflexDuodenal-colic reflex

Belching: expulsion of gas from the stomach through the monthFlatulence: expulsion of gas from the rectum

ERCP

NPO 8 hrsLocal anesthetic gargle or spray---gag reflex returnedAtropine given: ↓secretion; Glucagon given: relax smooth muscleObserve S/S perforation: pain, bleeding, unusual difficult swallowing, rapidly elevate temp

Nonsurgical Techniques for Removing Gallstones

Common Hepatic DuctCommon Bile Duct

Traditional Cholecystectomy

Care of the T-tubeKeep below GBAssess drainage & outputAssess odor & inspect skinNever irrigate or aspirateWhen allowed to eat

Care of wound

Laparoscopic Cholecystectomy

Pathogenic Process of Acute Pancreatitis

Pain: LLQPost-hepatic jaundice

Multiple Sumps after Pancreatic Surgery

Triple-lumen tubes consist of ports that provide tubing for irrigation, air venting and drainage

Pancreatoduodenectomy (Whipple’s Procedure)

End result of resection of carcinoma of the head of the pancreas or the ampulla of VaterThe common duct is sutured to the end of the jejunum, and the remaining portion of the pancreas and the end of the stomach are sutured to the side of the jejunum

Figure 44-16, pp. 1126