Care of Patients with Problems of the Biliary System and Pancreas

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.

Repeated episodes of cystic duct obstruction result in chronic inflammation

Pancreatitis, cholangitis Jaundice IcterusObstructive jaundicePruritus

Flatulence, dyspepsia, eructation, anorexia, nausea and vomiting, abdominal pain

Biliary colicMurphy’s signBlumberg’s signRebound tendernessSteatorrhea

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

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

Standard preoperative careOperative procedurePostoperative care:

Opioids via patient-controlled analgesia pump

T-tube Antiemetics Wound care

Care of the T-tube NPO Nutrition therapy

Serious and possibly life-threatening inflammatory process of the pancreas

Necrotizing hemorrhagic pancreatitis

Lipolysis Proteolysis Necrosis of blood vessels Inflammation Theories of enzyme activation

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

Generalized jaundiceCullen’s signTurner’s signBowel soundsAbdominal tenderness, rigidity,

guardingPancreatic ascitesSignificant changes in vital

signs

LipaseTrypsinAlkaline phosphataseAlanine aminotransferaseWBCGlucoseCalcium

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

Fasting and restDrug therapyComfort measuresEndoscopic retrograde

cholangiopancreatography (ERCP)

Preoperative care—NG tube may be inserted

Operative proceduresPostoperative care:

Monitor drainage tubes and record output from drain.

Provide meticulous skin care and dressing changes.

Maintain skin integrity.

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

Progressive destructive disease of the pancreas, characterized by remissions and exacerbations

Nonsurgical management includes: Drug therapy Analgesic administration Enzyme replacement Insulin therapy Nutrition therapy

Most serious complication of pancreatitis; always fatal if untreated

High feverBlood culturesDrainage via the percutaneous

method or laparoscopyAntibiotic treatment alone does

not resolve abscess

Complications: hemorrhage, infection, bowel obstruction, abscess, fistula formation, pancreatic ascites

May spontaneously resolveSurgical intervention after 6

weeks