Chapter 0621
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This document discusses various topics related to the biliary system and pancreas, including gallstones, cholecystitis, cholecystectomy, acute pancreatitis, chronic pancreatitis, and pancreatic abscess. It covers underlying causes, signs and symptoms, surgical and nonsurgical treatment options, postoperative care, complications, and the roles of the healthcare team in management of these conditions.
Chapter 0621
- 1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 62 Care of Patients with Problems of the Biliary System and Pancreas
- 2. 2Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. GI Tract
- 3. 3Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Gallstones
- 4. 4Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Gallstones (cont’d)
- 5. 5Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Acute vs. Chronic Cholecystitis  Underlying cause  Signs/symptoms  Risk factors  Role of diet
- 6. 6Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Cholecystectomy  Laparoscopic vs. traditional  Preoperative, intraoperative, postoperative similarities and differences
- 7. 7Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Traditional Cholecystectomy  Standard preoperative care  Operative procedure  Postoperative care  Opioids via PCA pump  T-tube (and care of)  Antiemetics  Wound care  NPO  Nutrition therapy
- 8. 8Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Acute Pancreatitis  Laboratory and diagnostic tests  Clinical manifestations  Contributing factors  Roles of collaborative health care team  Priority of care  Priority nursing interventions  Patient and family teaching  Resources
- 9. 9Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Acute Pancreatitis (cont’d)
- 10. 10Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Autodigestion
- 11. 11Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Complications of Acute Pancreatitis  Hypovolemia  Hemorrhage  Acute kidney failure  Paralytic ileus  Hypovolemic or septic shock
- 12. 12Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Complications of Acute Pancreatitis (cont’d)  Pleural effusion, respiratory distress syndrome, pneumonia  Multisystem organ failure  Disseminated intravascular coagulation  Diabetes mellitus
- 13. 13Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chronic Pancreatitis  Progressive destructive disease of pancreas characterized by remissions and exacerbations  Nonsurgical management:  Drug therapy  Analgesic administration  Enzyme replacement  Insulin therapy  Nutrition therapy
- 14. 14Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chronic Pancreatitis (cont’d)
- 15. 15Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Pancreatic Abscess  Most serious complication of pancreatitis; always fatal if untreated  High fever  Blood cultures  Drainage via percutaneous method or laparoscopy  Antibiotic treatment alone does not resolve abscess
Editor's Notes
- #2: Organs of the biliary system and the pancreatic ducts.
- #3: Anatomic relationships of the large intestine.
- #4: Gallstones within the gallbladder and obstructing the common bile and cystic ducts.
- #10: Acute pancreatitis. Axial CT image demonstrates peripancreatic stranding (arrow), a finding of pancreatitis. There are multiple gallstones in the gallbladder, which were the cause of this patient's pancreatitis.
- #11: The process of autodigestion in acute pancreatitis.
- #15: Chronic calcific pancreatitis. Axial unenhanced CT image demonstrates multiple pancreatic calcifications, which are a common finding in chronic pancreatitis. The pancreatic duct is also dilated, although that is generally better delineated on postcontrast images.