Chapter 0621

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  • Organs of the biliary system and the pancreatic ducts.
  • Anatomic relationships of the large intestine.
  • Gallstones within the gallbladder and obstructing the common bile and cystic ducts.
  • 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.
  • The process of autodigestion in acute pancreatitis.
  • 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.
  • Chapter 0621

    1. 1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Chapter 62Care of Patients with Problems of theBiliary System and Pancreas
    2. 2. 2Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.GI Tract
    3. 3. 3Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Gallstones
    4. 4. 4Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Gallstones (cont’d)
    5. 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. 6. 6Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Cholecystectomy Laparoscopic vs. traditional Preoperative, intraoperative, postoperativesimilarities and differences
    7. 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. 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. 9. 9Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Acute Pancreatitis (cont’d)
    10. 10. 10Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Autodigestion
    11. 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. 12. 12Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Complications of Acute Pancreatitis(cont’d) Pleural effusion, respiratory distresssyndrome, pneumonia Multisystem organ failure Disseminated intravascular coagulation Diabetes mellitus
    13. 13. 13Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Chronic Pancreatitis Progressive destructive disease of pancreascharacterized by remissions andexacerbations Nonsurgical management: Drug therapy Analgesic administration Enzyme replacement Insulin therapy Nutrition therapy
    14. 14. 14Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Chronic Pancreatitis (cont’d)
    15. 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 orlaparoscopy Antibiotic treatment alone does not resolveabscess

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