PANCREATITIS

REVIEW: ANATOMY AND PHYSIOLOGY

GALLBLADDER

PANCREAS

PANCREAS

LABORATORY/ DIAGNOSTIC PROCEDURES

1. ORAL CHOLECYSTOGRAPHY Gallbladder series An accurate identification of gallstones Asess the ability of the gallbladder to function USED in dissolution therapy

ORAL CHOLECYSTOGRAPHY
Pre procedure Care Ingestion of radiopaque dye ipodate sodium- low fat dinner iponoic acid- high fat dinner Post procedure care Watch for sensitivity to the dye no special post procedural care Remember: CONJUGATION is in the LIVER Contraindicated: JAUNDICE

2. CHOLANGIOGRAPHY
Intravenous Cholangiography -common bile duct visualization Percutaneous transhepatic cholangiography - Injecting the dye directly into the ductal system through the skin via a long, slender needle

2. CHOLANGIOGRAPHY

Endoscopic retrogade cholangiopancreatography -Direct visualization with radiographic material with the use of contrast medium - injected in the Upper GI - both therapeutic and diagnostic

2. CHOLANGIOGRAPHY
Endoscopic

retrogade cholangiopancreatography

BEFORE CARE: 1. Consent 2. 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

2. CHOLANGIOGRAPHY
Endoscopic

retrogade cholangiopancreatography NPO until gag reflex Turn to side to avoid aspiration Monitor V/S Monitor for complications:
1. 2. 3.

AFTER CARE:
1.

2.
3. 4.

SEPSIS PERFORATION PANCREATITIS

CHOLECYSTITIS -INFLAMMATION OF THE GALLBLADDER

Acute Cholecystitis -in 90% of cases, acute cholecystitis is caused by gallstones Symptoms: 1. Be sharp, cramping, or dull 2. Come and go 3. Spread to the back or below the right shoulder blade 4. Occur within minutes of a meal

Chronic Cholecystitis -long-standing swelling and irritation -usually caused by repeated attacks of acute cholecystitis Symptoms: 1. . abdominal pain, often with nausea or vomiting

CHOLELITHIASIS
THE PRESENCE OF GALLSTONES
Gallstones - Crystalline structures formed by hardening or adherence of particles of bile constituents 3 types of Gallstones 1. Cholesterol 2. Pigment 3. mixed

CHOLELITHIASIS
Risk Factors: ( 5 Fs) Four theories of Gallstone formation 1. Change in composition of Bile 2. Gallbladder stasis 3. Infection 4. Genetics and demography

SIGNS AND SYMPTOMS

1. 2. 3.

4.
5. 6.

7.

Decreased fat emulsification Fat intolerance Anorexia Nausea and vomiting Wt loss Belching Flatulence and bloating steatorrhea

Inflammation of the Gallbladder 1. Pain 2. Fever 3. Leukocytosis 4. MURPHYs Sign Biliary obstruction 1. Alcoholic stool 2. dec vitamin K 3. Inc.serum bilirubin

MANAGEMENT: PHARMACOLOGIC
Relief of pain 1. Demerol (Meperidine HCL) Gallstone Dissolution 1. Chenix (Chenodiol/ Chenodeoxycholic acid) 2. Actigall (Ursodiol) 3. Moctatin (Monoctanoid)

MTBE THERAPY antiemetics

MANAGEMENT: SURGICAL

Cholecystectomy

Choledochotomy

NON SURGICAL Extracorporeal shockwave lithotripsy Intracorporeal shockwave lithotripsy

NURSING CARE

1.
2. 3. 4. 5.

Before Consent NPO status Preop medications Liver functions Fluid status

1.

2. 3. 4.

5.
6.

After Position: SEMI FOWLERS NGT insertion DBCT exercises Diet: Low fat diet then gradually introduce fats Early ambualation T-Tube insertion

T-TUBE
Purposes: 1. Drain bile from the common bile 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 after 24 hrs)

NURSING DIAGNOSIS
Pain

and discomfort Impaired Gas exchange Impaired Skin Integrity

PANCREATITIS