Chapter 59 care of patients with biliary system and pancreas problems
Cholecystitis inflammation of the gallbladder that affects many adults very commonly is in other countries.
• Acute cholecystitis
o Calculous cholecystitis chemical irritation that results from gallstones that obstruct the cystic
duct, gallbladder neck, or common bile duct. The gallbladder is inflamed is reabsorbed and
acts as a chemical irritant to the gallbladder wall. Reabsorbed bile in combination with
impaired circulation edema and distention of the gallbladder causes ischemia and infection.
Results in necrosis and gangrene of the gallbladder
o Peritonitis section of the peritoneum may result in perforation if too large
o bacteria can form a round gull stones causing infection in the biliary system
o Acalculous cholecystitis is inflammation occurring without the gallstones. Typically
associated with biliary stasis caused by any condition that affects the regular filling or
emptying of the gallbladder
▪ Common causes
• Sepsis, severe trauma or burns, long-term parental nutrition, multiple
organ dysfunction syndrome, major surgery, hypovolemia
• Chronic cholecystitis
o repeated episodes of cystic duct obstruction cause chronic inflammation calculi almost
always present. And chronically cholecystitis the gallbladder becomes fibrotic in contracted
which results in decreased mobility and absorption
o jaundice and icterus (yellow discoloration of the sclera) can occur
• Risk factors
o women, gaining, Asian, American Indian Mexican American or conclusion, obesity, rapidly
weight loss or prolonged fasting, increased serum cholesterol, women on hormone replacement
therapy, cholesterol lowering drugs, family history of gallstones, prolong total parenteral
nutrition, Crohn’s disease, gastric bypass, sickle cell disease, glucose intolerance, pregnancy
genetic factors
o forty, female, fat, fertile
• Assessment
o Key features
▪ Abdominal pain or discomfort that can radiate to the right shoulder, pain triggered by
a high fat or high-volume meal, anorexia, nausea or vomiting, dyspepsia (indigestion),
eructation (burping), flatulence, fullness in the abdomen, rebound tenderness,
fever, jaundice, clay colored stools, dark urine, steatorrhea
▪ Biliary colic is severe pain by the obstruction of the duct of the gallbladder or movement
of one or more stones
o Diagnostic assessment
▪ An increase in white blood cell count indicates inflammation, serum levels of alkaline
phosphate, AST and LDH may be elevated indicating abnormalities and liver function
in patients with severe biliary obstruction
• Interpreting
o Priority collaborative problems for patients with this include weight loss due to decreased
intake because of pain nausea and inflammation and acute pain
• Planning/responding
o Nutrition
▪ May decline food because of abdominal discomfort, nausea, and anorexia
▪ Since diet should be high fiber and low in fat
▪ gas producing foods should be avoided.
▪ Small frequent meals are often preferable to three standard meals daily
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, ▪ weigh the patient daily
▪ Monitor for laboratory results such as BUN, pre-albumin, and total protein
o acute pain
▪ priority care to address pain include providing support of care by relieving symptoms and
decreasing inflammation
▪ Acute pain is present when the common bile duct is obstructed most patients find that
they need to avoid fatty foods to prevent further episodes
o drug therapy
▪ requires opioids such as morphine or Hydromorphone. All opioids may cause
some degree of sphincter of the oddi spasm
▪ NSAID maybe used for mild to moderate alterations in comfort
▪ Ursodiol and chenodoil may be given as a long-term therapy to dissolve or stabilize
gallstones. A gallbladder ultrasound is required every six months for the first year of
therapy to determine the effectiveness of the drug
• Patients to report any of the following diarrhea, vomiting, severe abdominal pain
• remind them to take this medication with food and milk
o non-surgical
▪ For some patients with small stones or for those who are not good surgical candidate a
treatment that is commonly used for kidney stones can be used to break up gallstones
also
—extracorporeal shock wave lithotripsy (ESWL)
• can only be used for patients with a normal weight, cholesterol best stones, and
good gallbladder function
▪ a percutaneous transhepatic biliary catheter (a drain) it’s the blocked duct so the bile can
flow
• usually divert the bile from the liver into the duodenum to bypass a stricture
o surgical management
▪ laparoscopic
• Minimally invasive
• Performed far more than the traditional open approach
• Complications are not common.
• Patient recovery is quicker.
• Postoperative pain is less severe.
• Assess the patient’s oxygen level frequently until the effects of the
anesthesia have passed. Remind the patient to perform deep breathing every
hour
▪ post cholecystectomy syndrome (PCS)
• Report any changes that may indicate infection. Reminded patient to report any
epigastric pain with vomiting or diarrhea that may occur several weeks to
months after surgery
• common causes
o biliary-- Pseudo cyst, common bile duct leak, CBD or pancreatic duct
structure or obstruction, retained or new CB do you call stone, pancreatic
for a liver mass, primary sclerosing cholangitis, diverticular compression
o nonbiliary—coronary artery disease, intercostal neuritis, unexplained
pain syndrome, psychiatric or neurologic disorder
Acute pancreatitis it’s a serious and it times life threatening inflammation of the pancreas. This process,
which affects the body’s immunity is caused by premature activation of excessive pancreatic enzymes to destroy
ductal tissue and pancreatic cells resulting in auto digestion and fibrosis of the pancreas
• necrotizing hemorrhagic pancreatitis is bleeding pancreatic tissue fibrosis in tissue death
o Toxic injury to the pancreas cells in the production and release a pancreatic enzyme
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Cholecystitis inflammation of the gallbladder that affects many adults very commonly is in other countries.
• Acute cholecystitis
o Calculous cholecystitis chemical irritation that results from gallstones that obstruct the cystic
duct, gallbladder neck, or common bile duct. The gallbladder is inflamed is reabsorbed and
acts as a chemical irritant to the gallbladder wall. Reabsorbed bile in combination with
impaired circulation edema and distention of the gallbladder causes ischemia and infection.
Results in necrosis and gangrene of the gallbladder
o Peritonitis section of the peritoneum may result in perforation if too large
o bacteria can form a round gull stones causing infection in the biliary system
o Acalculous cholecystitis is inflammation occurring without the gallstones. Typically
associated with biliary stasis caused by any condition that affects the regular filling or
emptying of the gallbladder
▪ Common causes
• Sepsis, severe trauma or burns, long-term parental nutrition, multiple
organ dysfunction syndrome, major surgery, hypovolemia
• Chronic cholecystitis
o repeated episodes of cystic duct obstruction cause chronic inflammation calculi almost
always present. And chronically cholecystitis the gallbladder becomes fibrotic in contracted
which results in decreased mobility and absorption
o jaundice and icterus (yellow discoloration of the sclera) can occur
• Risk factors
o women, gaining, Asian, American Indian Mexican American or conclusion, obesity, rapidly
weight loss or prolonged fasting, increased serum cholesterol, women on hormone replacement
therapy, cholesterol lowering drugs, family history of gallstones, prolong total parenteral
nutrition, Crohn’s disease, gastric bypass, sickle cell disease, glucose intolerance, pregnancy
genetic factors
o forty, female, fat, fertile
• Assessment
o Key features
▪ Abdominal pain or discomfort that can radiate to the right shoulder, pain triggered by
a high fat or high-volume meal, anorexia, nausea or vomiting, dyspepsia (indigestion),
eructation (burping), flatulence, fullness in the abdomen, rebound tenderness,
fever, jaundice, clay colored stools, dark urine, steatorrhea
▪ Biliary colic is severe pain by the obstruction of the duct of the gallbladder or movement
of one or more stones
o Diagnostic assessment
▪ An increase in white blood cell count indicates inflammation, serum levels of alkaline
phosphate, AST and LDH may be elevated indicating abnormalities and liver function
in patients with severe biliary obstruction
• Interpreting
o Priority collaborative problems for patients with this include weight loss due to decreased
intake because of pain nausea and inflammation and acute pain
• Planning/responding
o Nutrition
▪ May decline food because of abdominal discomfort, nausea, and anorexia
▪ Since diet should be high fiber and low in fat
▪ gas producing foods should be avoided.
▪ Small frequent meals are often preferable to three standard meals daily
This study source was downloaded by 100000852681095 from CourseHero.com on 12-08-2022 01:49:49 GMT -06:00
https://www.coursehero.com/file/58669567/Chapter-59-care-of-patients-with-biliary-system-and-pancreas-problemsdocx/
, ▪ weigh the patient daily
▪ Monitor for laboratory results such as BUN, pre-albumin, and total protein
o acute pain
▪ priority care to address pain include providing support of care by relieving symptoms and
decreasing inflammation
▪ Acute pain is present when the common bile duct is obstructed most patients find that
they need to avoid fatty foods to prevent further episodes
o drug therapy
▪ requires opioids such as morphine or Hydromorphone. All opioids may cause
some degree of sphincter of the oddi spasm
▪ NSAID maybe used for mild to moderate alterations in comfort
▪ Ursodiol and chenodoil may be given as a long-term therapy to dissolve or stabilize
gallstones. A gallbladder ultrasound is required every six months for the first year of
therapy to determine the effectiveness of the drug
• Patients to report any of the following diarrhea, vomiting, severe abdominal pain
• remind them to take this medication with food and milk
o non-surgical
▪ For some patients with small stones or for those who are not good surgical candidate a
treatment that is commonly used for kidney stones can be used to break up gallstones
also
—extracorporeal shock wave lithotripsy (ESWL)
• can only be used for patients with a normal weight, cholesterol best stones, and
good gallbladder function
▪ a percutaneous transhepatic biliary catheter (a drain) it’s the blocked duct so the bile can
flow
• usually divert the bile from the liver into the duodenum to bypass a stricture
o surgical management
▪ laparoscopic
• Minimally invasive
• Performed far more than the traditional open approach
• Complications are not common.
• Patient recovery is quicker.
• Postoperative pain is less severe.
• Assess the patient’s oxygen level frequently until the effects of the
anesthesia have passed. Remind the patient to perform deep breathing every
hour
▪ post cholecystectomy syndrome (PCS)
• Report any changes that may indicate infection. Reminded patient to report any
epigastric pain with vomiting or diarrhea that may occur several weeks to
months after surgery
• common causes
o biliary-- Pseudo cyst, common bile duct leak, CBD or pancreatic duct
structure or obstruction, retained or new CB do you call stone, pancreatic
for a liver mass, primary sclerosing cholangitis, diverticular compression
o nonbiliary—coronary artery disease, intercostal neuritis, unexplained
pain syndrome, psychiatric or neurologic disorder
Acute pancreatitis it’s a serious and it times life threatening inflammation of the pancreas. This process,
which affects the body’s immunity is caused by premature activation of excessive pancreatic enzymes to destroy
ductal tissue and pancreatic cells resulting in auto digestion and fibrosis of the pancreas
• necrotizing hemorrhagic pancreatitis is bleeding pancreatic tissue fibrosis in tissue death
o Toxic injury to the pancreas cells in the production and release a pancreatic enzyme
This study source was downloaded by 100000852681095 from CourseHero.com on 12-08-2022 01:49:49 GMT -06:00
https://www.coursehero.com/file/58669567/Chapter-59-care-of-patients-with-biliary-system-and-pancreas-problemsdocx/
