Chapter 62
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
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
T-tube priority of care
Keep drainage system below site of insertion to prevent backup of bile into surgical area (infection)
Complications of Acute Pancreatitis
infection, hemorrhage, acute kidney failure, paralytic ileus, shock, ARDS, atelectasis, pneumonia, DIC, pleural effusion
Reliable indicator of peristalsis return post-op
passing of flatus or stool
Managing Chronic Pancreatitis
avoid caffeine, alcohol, & nicotine, eat bland, low-fat, high-protein, minimally spicey, & small meals, take prescribed pancreatic enzymes, & rest frequently
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
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
Major concern with Acute Pancreatitis
Respiratory failure; assess status q8h
Pancreatic Abscess
potentially fatal abscesses formed by collections of purulent liquid of netrotic pancreas