Transcript Alterations in Metabolism

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
Icterus
Obstructive jaundice
Pruritus






Flatulence, dyspepsia, eructation,
anorexia, nausea and vomiting,
abdominal pain
Biliary colic
Murphy’s sign
Blumberg’s sign
Rebound tenderness
Steatorrhea




Nutrition therapy—low-fat diet, fatsoluble 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 care
Operative procedure
Postoperative 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 jaundice
Cullen’s sign
Turner’s sign
Bowel sounds
Abdominal tenderness, rigidity,
guarding
Pancreatic ascites
Significant changes in vital signs







Lipase
Trypsin
Alkaline phosphatase
Alanine aminotransferase
WBC
Glucose
Calcium

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 rest
Drug therapy
Comfort measures
Endoscopic retrograde
cholangiopancreatography (ERCP)



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.

Interventions include:




NPO in early stages
Antiemetics for nausea and vomiting
Total parenteral nutrition
Small, frequent, moderate- to highcarbohydrate, 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 fever
Blood cultures
Drainage via the percutaneous method
or laparoscopy
Antibiotic treatment alone does not
resolve abscess



Complications: hemorrhage, infection,
bowel obstruction, abscess, fistula
formation, pancreatic ascites
May spontaneously resolve
Surgical intervention after 6 weeks