Chapter 62

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Care of Patients with Problems of the Biliary System & Pancreas
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1

Risk factors for Cholecystitis

women, aging, obesity, prolonged fasting, birth control pills or HRT, crohn's disease, sickle cell disease, pregnancy, diabetes, increased serum cholesterol

2

Key features of Cholecystitis

episodic upper abdominal pain, pain caused by high fat meal, anorexia, n/v, dyspepsia, belching, gas, abdominal fullness feeling, Blumberg's sign (rebound tenderness), fever, jaundice

3

T-tube priority of care

Keep drainage system below site of insertion to prevent backup of bile into surgical area (infection)

4

Complications of Acute Pancreatitis

infection, hemorrhage, acute kidney failure, paralytic ileus, shock, ARDS, atelectasis, pneumonia, DIC, pleural effusion

5

Reliable indicator of peristalsis return post-op

passing of flatus or stool

6

Managing Chronic Pancreatitis

avoid caffeine, alcohol, & nicotine, eat bland, low-fat, high-protein, minimally spicey, & small meals, take prescribed pancreatic enzymes, & rest frequently

7

Pancreatic enzyme replacement therapy management

take drugs with meals and a glass of water (to ensure none remain in mouth & wipe mouth with towel to protect skin) and do not mix enzymes with foods containing proteins

8

Key features of Chronic Pancreatitis

intense, continuous abdominal pain and tenderness, ascites, respiratory complications, steatorrhea (clay-colored stools), weight loss, jaundice, dark urine, possible left upper quad mass

9

Major concern with Acute Pancreatitis

Respiratory failure; assess status q8h

10

Pancreatic Abscess

potentially fatal abscesses formed by collections of purulent liquid of netrotic pancreas