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PANCREATITIS

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REVIEW: ANATOMYAND PHYSIOLOGY

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GALLBLADDER

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PANCREAS

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PANCREAS

http://hepatobiliary/pancreas.mp4

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LABORATORY/ DIAGNOSTICPROCEDURES

1. ORALCHOLECYSTOGRAPHY

Gallbladder series

An accurate identificationof gallstones

Asess the ability of thegallbladder to function

USED in dissolutiontherapy

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ORAL CHOLECYSTOGRAPHY

Pre procedure Care Ingestion of radiopaque dye

ipodate sodium- low fat dinner

iponoic acid- high fat dinner

Watch for sensitivity to the dye

Remember: CONJUGATION is inthe LIVER

Contraindicated: JAUNDICE

Post procedure care

no special postprocedural care

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2. CHOLANGIOGRAPHY

IntravenousCholangiography

-common bile ductvisualization

Percutaneoustranshepaticcholangiography

- Injecting the dye directly

into the ductal systemthrough the skin via along, slender needle

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2. CHOLANGIOGRAPHY

Endoscopic retrogade

cholangiopancreatography

- -Direct visualization with

radiographic material with theuse of contrast medium

- - injected in the Upper GI

- - both therapeutic and diagnostic

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2. CHOLANGIOGRAPHY

Endoscopic retrogadecholangiopancreatography

BEFORE CARE:

1. Consent2. NPO 10-12 hrs

3. Allergy to seafoods

4. Initial V/S

5. At So4 as ordered

6. Local anesthetic spray in the throat

7. LEFT SIDE

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2. CHOLANGIOGRAPHY

Endoscopic retrogadecholangiopancreatography

AFTER CARE:

1. NPO until gag reflex

2. Turn to side to avoid aspiration

3. Monitor V/S

4. Monitor for complications:1. SEPSIS

2. PERFORATION

3. PANCREATITIS

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CHOLECYSTITIS-INFLAMMATIONOFTHEGALLBLADDER

Acute Cholecystitis

-in 90% of cases, acutecholecystitis is causedby gallstones

Symptoms:

1. Be sharp, cramping,or dull

2. Come and go

3. Spread to the back or

below the rightshoulder blade

4. Occur within minutesof a meal

Chronic Cholecystitis

-long-standing swelling andirritation

-usually caused by repeatedattacks of acute

cholecystitisSymptoms:

1. . abdominal pain, oftenwith nausea or vomiting

http://www.nlm.nih.gov/medlineplus/ency/article/000273.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003120.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003117.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003117.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003120.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003120.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000273.htm

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CHOLELITHIASIS

Risk Factors:

( 5 Fs)

Four theories of

Gallstone formation1. Change in

composition of Bile

2. Gallbladder stasis

3. Infection4. Genetics and

demography

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SIGNS AND SYMPTOMS

Decreased fatemulsification

1. Fat intolerance

2. Anorexia

3. Nausea and vomiting

4. Wt loss

5. Belching

6. Flatulence and

bloating7. steatorrhea

Inflammation of theGallbladder

1. Pain

2. Fever

3. Leukocytosis

4. MURPHYs Sign

Biliary obstruction

1. Alcoholic stool

2. dec vitamin K

3. Inc.serum bilirubin

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MANAGEMENT: PHARMACOLOGIC

Relief of pain

1. Demerol (MeperidineHCL)

GallstoneDissolution

1. Chenix (Chenodiol/Chenodeoxycholicacid)

2. Actigall (Ursodiol)

3. Moctatin(Monoctanoid)

MTBE THERAPY

antiemetics

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MANAGEMENT: SURGICAL

Cholecystectomy Choledochotomy

NON SURGICAL Extracorporeal

shockwave lithotripsy

Intracorporeal

shockwave lithotripsy

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NURSINGCARE

Before

1. Consent

2. NPO status

3. Preop medications4. Liver functions

5. Fluid status

After

1. Position: SEMIFOWLERS

2.

NGT insertion3. DBCT exercises

4. Diet: Low fat diet thengradually introduce

fats5. Early ambualation

6. T-Tube insertion

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T-TUBE

Purposes:

1. Drain bile from the commonbile duct

2. Maintain patency

3. Prevent leakage of bile

Normal color:

reddish brown (1st 24 hrs)

Green-brown (after 24 hrs)

Normal amout of drainage 300-500 mls (1st 24 hrs)

500-1,000 mls per day after24 hrs)

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NURSING DIAGNOSIS

Pain and discomfort

Impaired Gas exchange

Impaired Skin Integrity

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PANCREATITIS