2. Care of Patients with Problems of the Biliary System and Pancreas

4.  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.

6.  Repeated episodes of cystic duct obstruction result in chronic inflammation  Pancreatitis, cholangitis  Jaundice  Icterus  Obstructive jaundice  Pruritus

7.  Flatulence, dyspepsia, eructation, anorexia, nausea and vomiting, abdominal pain  Biliary colic  Murphy’s sign  Blumberg’s sign  Rebound tenderness  Steatorrhea

8.  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

9.  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

11.  Standard preoperative care  Operative procedure  Postoperative care:  Opioids via patient-controlled analgesia pump  T-tube  Antiemetics  Wound care

12.  Care of the T-tube  NPO  Nutrition therapy

13.  Serious and possibly life-threatening inflammatory process of the pancreas  Necrotizing hemorrhagic pancreatitis  Lipolysis  Proteolysis  Necrosis of blood vessels  Inflammation  Theories of enzyme activation

15.  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

16.  Generalized jaundice  Cullen’s sign  Turner’s sign  Bowel sounds  Abdominal tenderness, rigidity, guarding  Pancreatic ascites  Significant changes in vital signs

17.  Lipase  Trypsin  Alkaline phosphatase  Alanine aminotransferase  WBC  Glucose  Calcium

18.  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

19.  Fasting and rest  Drug therapy  Comfort measures  Endoscopic retrograde cholangiopancreatography (ERCP)

20.  Preoperative care—NG tube may be inserted  Operative procedures  Postoperative care:  Monitor drainage tubes and record output from drain.  Provide meticulous skin care and dressing changes.  Maintain skin integrity.

21.  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

22.  Progressive destructive disease of the pancreas, characterized by remissions and exacerbations  Nonsurgical management includes:  Drug therapy  Analgesic administration  Enzyme replacement  Insulin therapy  Nutrition therapy

23.  Most serious complication of pancreatitis; always fatal if untreated  High fever  Blood cultures  Drainage via the percutaneous method or laparoscopy  Antibiotic treatment alone does not resolve abscess

24.  Complications: hemorrhage, infection, bowel obstruction, abscess, fistula formation, pancreatic ascites  May spontaneously resolve  Surgical intervention after 6 weeks