Hepatobiliary Disorders 2

  • View
    220

  • Download
    1

Embed Size (px)

Text of Hepatobiliary Disorders 2

  • 8/2/2019 Hepatobiliary Disorders 2

    1/21

    PANCREATITIS

  • 8/2/2019 Hepatobiliary Disorders 2

    2/21

    REVIEW: ANATOMYAND PHYSIOLOGY

  • 8/2/2019 Hepatobiliary Disorders 2

    3/21

    GALLBLADDER

  • 8/2/2019 Hepatobiliary Disorders 2

    4/21

    PANCREAS

  • 8/2/2019 Hepatobiliary Disorders 2

    5/21

    PANCREAS

    http://hepatobiliary/pancreas.mp4
  • 8/2/2019 Hepatobiliary Disorders 2

    6/21

    LABORATORY/ DIAGNOSTICPROCEDURES

    1. ORALCHOLECYSTOGRAPHY

    Gallbladder series

    An accurate identificationof gallstones

    Asess the ability of thegallbladder to function

    USED in dissolutiontherapy

  • 8/2/2019 Hepatobiliary Disorders 2

    7/21

    ORAL CHOLECYSTOGRAPHY

    Pre procedure Care Ingestion of radiopaque dye

    ipodate sodium- low fat dinner

    iponoic acid- high fat dinner

    Watch for sensitivity to the dye

    Remember: CONJUGATION is inthe LIVER

    Contraindicated: JAUNDICE

    Post procedure care

    no special postprocedural care

  • 8/2/2019 Hepatobiliary Disorders 2

    8/21

    2. CHOLANGIOGRAPHY

    IntravenousCholangiography

    -common bile ductvisualization

    Percutaneoustranshepaticcholangiography

    - Injecting the dye directly

    into the ductal systemthrough the skin via along, slender needle

  • 8/2/2019 Hepatobiliary Disorders 2

    9/21

    2. CHOLANGIOGRAPHY

    Endoscopic retrogade

    cholangiopancreatography

    - -Direct visualization with

    radiographic material with theuse of contrast medium

    - - injected in the Upper GI

    - - both therapeutic and diagnostic

  • 8/2/2019 Hepatobiliary Disorders 2

    10/21

    2. CHOLANGIOGRAPHY

    Endoscopic retrogadecholangiopancreatography

    BEFORE CARE:

    1. Consent2. 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

  • 8/2/2019 Hepatobiliary Disorders 2

    11/21

    2. CHOLANGIOGRAPHY

    Endoscopic retrogadecholangiopancreatography

    AFTER CARE:

    1. NPO until gag reflex

    2. Turn to side to avoid aspiration

    3. Monitor V/S

    4. Monitor for complications:1. SEPSIS

    2. PERFORATION

    3. PANCREATITIS

  • 8/2/2019 Hepatobiliary Disorders 2

    12/21

    CHOLECYSTITIS-INFLAMMATIONOFTHEGALLBLADDER

    Acute Cholecystitis

    -in 90% of cases, acutecholecystitis is causedby gallstones

    Symptoms:

    1. Be sharp, cramping,or dull

    2. Come and go

    3. Spread to the back or

    below the rightshoulder blade

    4. Occur within minutesof a meal

    Chronic Cholecystitis

    -long-standing swelling andirritation

    -usually caused by repeatedattacks of acute

    cholecystitisSymptoms:

    1. . abdominal pain, oftenwith nausea or vomiting

    http://www.nlm.nih.gov/medlineplus/ency/article/000273.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003120.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003117.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003117.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003120.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003120.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000273.htm
  • 8/2/2019 Hepatobiliary Disorders 2

    13/21

  • 8/2/2019 Hepatobiliary Disorders 2

    14/21

    CHOLELITHIASIS

    Risk Factors:

    ( 5 Fs)

    Four theories of

    Gallstone formation1. Change in

    composition of Bile

    2. Gallbladder stasis

    3. Infection4. Genetics and

    demography

  • 8/2/2019 Hepatobiliary Disorders 2

    15/21

    SIGNS AND SYMPTOMS

    Decreased fatemulsification

    1. Fat intolerance

    2. Anorexia

    3. Nausea and vomiting

    4. Wt loss

    5. Belching

    6. Flatulence and

    bloating7. steatorrhea

    Inflammation of theGallbladder

    1. Pain

    2. Fever

    3. Leukocytosis

    4. MURPHYs Sign

    Biliary obstruction

    1. Alcoholic stool

    2. dec vitamin K

    3. Inc.serum bilirubin

  • 8/2/2019 Hepatobiliary Disorders 2

    16/21

    MANAGEMENT: PHARMACOLOGIC

    Relief of pain

    1. Demerol (MeperidineHCL)

    GallstoneDissolution

    1. Chenix (Chenodiol/Chenodeoxycholicacid)

    2. Actigall (Ursodiol)

    3. Moctatin(Monoctanoid)

    MTBE THERAPY

    antiemetics

  • 8/2/2019 Hepatobiliary Disorders 2

    17/21

    MANAGEMENT: SURGICAL

    Cholecystectomy Choledochotomy

    NON SURGICAL Extracorporeal

    shockwave lithotripsy

    Intracorporeal

    shockwave lithotripsy

  • 8/2/2019 Hepatobiliary Disorders 2

    18/21

    NURSINGCARE

    Before

    1. Consent

    2. NPO status

    3. Preop medications4. Liver functions

    5. Fluid status

    After

    1. Position: SEMIFOWLERS

    2.

    NGT insertion3. DBCT exercises

    4. Diet: Low fat diet thengradually introduce

    fats5. Early ambualation

    6. T-Tube insertion

  • 8/2/2019 Hepatobiliary Disorders 2

    19/21

    T-TUBE

    Purposes:

    1. Drain bile from the commonbile 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 after24 hrs)

  • 8/2/2019 Hepatobiliary Disorders 2

    20/21

    NURSING DIAGNOSIS

    Pain and discomfort

    Impaired Gas exchange

    Impaired Skin Integrity

  • 8/2/2019 Hepatobiliary Disorders 2

    21/21

    PANCREATITIS