JC

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.