Chapter44 2

Chapter Overview

• Management of patients with biliary disorders.

• Focus on biliary disorders, gallbladder function, and pancreatitis management.

Anatomy and Physiology Overview

Gallbladder

• Stores bile produced by the liver.

Bile

• Aids in digestion and absorption of fats.

Pancreas

• Exocrine Function: Secretes amylase, trypsin, lipase, and secretin to aid digestion.

• Endocrine Function: Produces insulin, glucagon, and somatostatin to regulate blood glucose levels.

Liver and Biliary System

• Key organs involved:

  • Liver: Produces bile.

  • Gallbladder: Stores bile.

  • Pancreas: Digestion and regulation of glucose.

• Ducts involved:

  • Common hepatic duct

  • Pancreatic duct

  • Cystic duct

  • Common bile duct

Cholelithiasis (Gallstones)

Pathophysiology

• Types of stones:

  • Pigment stones: Formed from bilirubin.

  • Cholesterol stones: Most common, associated with high cholesterol levels.

• Risk factors: Include obesity, high-fat diet, certain medications.

Clinical Manifestations

• Symptoms:

  • None or minimal symptoms initially, can be acute or chronic.

  • Pain, biliary colic, jaundice, changes in urine/stool color, vitamin deficiencies (A, D, E, K).

  • Refer to diagnostic tests for identification.

Cholecystitis vs Cholelithiasis

Definitions

• Cholecystitis: Inflammation of the gallbladder.

• Cholelithiasis: Presence of stones in the gallbladder.

Medical Management of Cholelithiasis

• Diagnostic approaches include:

  • ERCP (Endoscopic retrograde cholangiopancreatography)

• Dietary management adjustments recommended.

• Medications: Ursodeoxycholic acid and chenodeoxycholic acid to dissolve stones.

• Surgical options:

  • Laparoscopic cholecystectomy.

  • Nonsurgical removal via instrumentation or lithotripsy.

Post-Operative Care for Gallbladder Disease

Assessment and Monitoring

• Monitor patient history, respiratory status,

  • Nutritional status and GI symptoms post-surgery.

Potential Complications

• Bleeding, GI symptoms, atelectasis, thrombophlebitis.

Goals for Patient Management

• Relief of pain and improved biliary drainage.

• Ensure optimal nutritional intake and education on self-care routines.

Interventions for Post-Surgical Care

• Position the patient in low Fowler's position.

• Nutritional guidelines: NG or NPO until bowel sounds return; then a soft, low-fat diet.

• Pain management, ambulation, and education on biliary drainage system care.

Pancreatitis Overview

Types of Pancreatitis

• Acute: Due to duct obstruction, leading to autodigestion.

• Chronic: Progressive disorder leading to fibrosis, pressure increase, and obstruction.

Risk Factors for Pancreatitis

• Biliary tract disease, alcohol use, viral infections.

Clinical Signs of Pancreatitis

• Severe abdominal pain, nausea, and vomiting.

• Lab Tests: Serum levels of “ASES” (lipase and amylase) increase in acute pancreatitis.

Major Symptoms of Chronic Pancreatitis

• Recurrent severe abdominal pain with vomiting is characteristic.

• Differentiate from acute presentations that may include severe abdominal guarding.

Complications from Acute Pancreatitis

• Potential for fluid disturbances, pancreatic necrosis, shock, and multiple organ dysfunction.

Tumors of the Pancreas

• Types: Pancreatic cysts and cancer.

• Treatment: May include chemotherapy, limited radiation, and potentially palliative surgery.

Diet Considerations for Acute Pancreatitis

• Patients require a high-carbohydrate, low-protein, and low-fat diet to prevent overstimulation of pancreatic secretions.