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PANCREATITIS
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REVIEW: ANATOMYAND PHYSIOLOGY
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GALLBLADDER
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PANCREAS
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PANCREAS
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LABORATORY/ DIAGNOSTICPROCEDURES
1. ORALCHOLECYSTOGRAPHY
Gallbladder series
An accurate identificationof gallstones
Asess the ability of thegallbladder to function
USED in dissolutiontherapy
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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
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2. CHOLANGIOGRAPHY
IntravenousCholangiography
-common bile ductvisualization
Percutaneoustranshepaticcholangiography
- Injecting the dye directly
into the ductal systemthrough the skin via along, slender needle
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2. CHOLANGIOGRAPHY
Endoscopic retrogade
cholangiopancreatography
- -Direct visualization with
radiographic material with theuse of contrast medium
- - injected in the Upper GI
- - both therapeutic and diagnostic
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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
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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
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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
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CHOLELITHIASIS
Risk Factors:
( 5 Fs)
Four theories of
Gallstone formation1. Change in
composition of Bile
2. Gallbladder stasis
3. Infection4. Genetics and
demography
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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
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MANAGEMENT: PHARMACOLOGIC
Relief of pain
1. Demerol (MeperidineHCL)
GallstoneDissolution
1. Chenix (Chenodiol/Chenodeoxycholicacid)
2. Actigall (Ursodiol)
3. Moctatin(Monoctanoid)
MTBE THERAPY
antiemetics
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MANAGEMENT: SURGICAL
Cholecystectomy Choledochotomy
NON SURGICAL Extracorporeal
shockwave lithotripsy
Intracorporeal
shockwave lithotripsy
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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
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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)
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NURSING DIAGNOSIS
Pain and discomfort
Impaired Gas exchange
Impaired Skin Integrity
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PANCREATITIS