Chapter 50 Assessment and Management of Patients With Biliary Disorders

Review of Anatomy and Physiology Gallbladder Bile Pancreas Insulin Glucagon Somatostatin

Liver, Biliary System, and Pancreas

Question Is the following statement true or false? Bile is stored in the gallbladder.

True Bile is stored in the gallbladder. Answer True Bile is stored in the gallbladder.

Cholelithiasis Pathophysiology Pigment stones Cholesterol stones Refer to Figure 50-2 Risk factors: refer to Chart 50-1

Clinical Manifestations of Cholelithiasis None or minimal symptoms, acute or chronic Pain Biliary colic Jaundice Changes in urine or stool color Vitamin deficiency, fat soluble (vitamins A, D, E, and K) Diagnostic tests: refer to Table 50-1

Cholesterol Gallstones and Pigment Gallstones

Question Is the following statement true or false? Cholecystitis is when a patient has calculi in the gallbladder.

Answer False Cholecystitis is inflammation of the gallbladder. Cholelithiasis is when a patient has calculi in the gallbladder.

Medical Management of Cholelithiasis ERCP Dietary management Medications: ursodeoxycholic acid and chenodeoxycholic acid Laparoscopic cholecystectomy Nonsurgical removal By instrumentation Intracorporeal or extracorporeal lithotripsy

Nonsurgical Removal of Gallstones

Laparoscopic Cholecystectomy

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

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

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

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

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

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

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

Answer 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.

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

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

Tumors of the Pancreas Pancreatic cysts Pancreatic cancer Risk factors Sites of lesions Treatment may be palliative Chemotherapy Radiation (limited) Surgery

Pancreatoduodenectomy (Whipple’s Procedure)

Multiple Sumps After Pancreatic Surgery