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Page 1
Accessory Organs of
Digestive System
By: Mr. Ranie M. Esponilla
Page 2
REVIEW OF ANATOMY AND
PHYSIOLOGY
ACCESSORY ORGANS OF THE
DIGESTIVE SYSTEM:
Liver
Gall bladder and ductal system
...
Page 3
This is an in-situ
photograph of the
chest and abdominal
contents. As can be
seen, the liver is the
largest parench...
Page 4
REVIEW OF ANATOMY AND
PHYSIOLOGY
LIVER
Liver lobules
Hepatic sinusoids (capillaries) lined with
Kupffer cells
Po...
Page 5
REVIEW OF ANATOMY AND
PHYSIOLOGY
FUNCTIONS OF THE
LIVER:
Carbohydrate
metabolism
Glycogenesis
Glycogenolysis
Gl...
Page 6
REVIEW OF ANATOMY AND
PHYSIOLOGY
FUNCTIONS OF THE BILIARY SYSTEM:
1. Gallbladder – concentrate & store bile
2. Duct...
Page 7
REVIEW OF ANATOMY AND
PHYSIOLOGYPACREAS:
Head,
Body
Tail
Pancreatic duct
FUNCTIONS OF THE PANCREAS:
Exocrine :...
Page 8
CASE STUDY
• Sirius, 54 y.o., was brought by his family
because of vomiting of blood.
• He’s drowsy, with VS of : 3...
Page 9
CASE STUDY
• What other assessment findings would
you expect?
• What are your plans?
Page 10
NURSING ASSESSMENT
MANIFESTATIONS OF LIVER
DISORDERS
Jaundice
Hemorrhage / bleeding problems
Pruritus and itchi...
Page 11
MANIFESTATIONS OF LIVER
DISORDERS
JAUNDICE
CAUSES:
Prehepatic – hemolysis
Intrahepatic – liver parenchymal dse
...
Page 12
MANIFESTATIONS OF LIVER
DISORDERS
HEMORRHAGE
Due to inadequate prothrombin & other
clotting factors
Management :...
Page 13
MANIFESTATIONS OF LIVER
DISORDERS
PRURITUS & ITCHING
Caused by bile pigment deposited to
skin
Management:
bathi...
Page 14
MANIFESTATIONS OF LIVER
DISORDERSASCITES
Causes :
portal hypertension
decreased plasma colloid osmotic
pressure...
Page 15
MANIFESTATIONS OF LIVER
DISORDERS
ASCITES
Management :
daily weight & abdominal girth
low Na diet, fluid restri...
Page 16
MANIFESTATIONS OF LIVER
DISORDERS
GENERALIZED EDEMA
Insufficient albumin
INTOLERANCE OF SEDATION
Most sedatives ...
Page 17
DISEASES OF THE
LIVER
• HEPATITIS
• CIRRHOSIS
• CANCER OF THE LIVER
Page 18
HEPATITIS
TYPES:
• Viral Hepatitis
• Toxic Hepatitis – exposure to
hepatotoxin : carbon tetrachloride.
Morphine, b...
Page 19
HEPATITIS
Hepatitis A
• Infectious
• Fecal-oral route
Hepatitis B
• Serum hepatitis
• Blood & body fluid transmiss...
Page 20
HEPATITIS
DIAGNOSIS:
Screening test for Hepatitis
Liver function tests:
• SGOT
• Alkaline Phosphatase
• SGPT
Imagi...
Page 21
Grossly, there are areas of necrosis and collapse of liver lobules seen
here as ill-defined areas that are pale ye...
Page 22
HEPATITIS
PLANNING & IMPLEMENTATION
1. Prevent spread of the disease.
Hepatitis A
• Transmission : fecal-oral rout...
Page 23
HEPATITIS
PLANNING & IMPLEMENTATION
1. Prevent spread of the disease.
Hepatitis B
• Transmission : Blood & body fl...
Page 24
HEPATITIS
PLANNING & IMPLEMENTATION
3. Nutrition : Well- balanced, high P,
high C
4. Providing comfort measures
5....
Page 25
CIRRHOSIS
END RESULT OF HEPATO-CELLULAR INJURY
• Parenchymal cell death
• Regeneration & scarring
• Diminished blo...
Page 26
CIRRHOSIS
ASSESSMENT:
Gastrointestinal System
• DUE TO METABOLIC CHANGES IN THE LIVER
(P,C,F)
– Anorexia
– Nausea ...
Page 27
Ongoing liver damage with liver cell necrosis
followed by fibrosis and hepatocyte
regeneration results in cirrhosi...
Page 28
Mallory's hyaline is seen here, but there are also neutrophils, necrosis
of hepatocytes, collagen deposition, and ...
Page 29
CIRRHOSIS
ASSESSMENT:
Endocrine System
THE LIVER IS UNABLE TO METABOLIZE HORMONES
OF THE ADRENAL CORTEX, OVARIES, ...
Page 30
CIRRHOSIS
ASSESSMENT:
Other:
• JAUNDICE
• ICTERIC SCLERAE
• PRURITUS
• SPIDER ANGIOMA
• PALMAR ERYTHEMA
• MUSCLE A...
Page 31
CIRRHOSIS - management
• Sufficient rest & comfort
• Measures to relieve pruritus
• Nutrition: high calorie, low t...
Page 32
CIRRHOSIS
COMPLICATONS:
1. HEPATIC COMA
2. PORTAL HPN
ESOPHAGEAL VARICES
Page 33
Submucosal veins in the esophagus become dilated.
These are known as esophageal varices. Varices
are seen here in ...
Page 34
One of the most common
findings with portal
hypertension is
splenomegaly, as seen here.
The spleen is enlarged fro...
Page 35
HEPATIC COMA
DEGENERATIVE DISEASE OF THE BRAIN FROM LIVER FAILURE
DUE TO INABILITY OF THE LIVER TO CONVERT AMMONIA...
Page 36
HEPATIC COMA
MANAGEMENT:
1. Neuro monitoring
2. Diet : Restrict P, high C, with Vit K
3. Administer:
– enema,
– ca...
Page 37
ESOPHAGEAL VARICES
DILATION OF THE VEINS OF THE ESOPHAGUS FROM PORTAL
HYPERTENSION
PORTAL HYPERTENSION – resistanc...
Page 38
CANCER OF THE LIVER
• Primary
• Secondary – liver is the most
common site of CA mets
Page 39
Here is an
hepatocellular
carcinoma. Such liver
cancers arise in the
setting of cirrhosis.
Worldwide, viral
hepati...
Page 40
CANCER OF THE LIVER
• S/SX :
– Anorexia
– Weight loss
– Weakness
– abdominal fullness and bloating
– Abdominal pai...
Page 41
Page 42
DISEASES OF THE
GALLBLADDER
• CHOLELITHIASIS
• CHOLECYSTITIS
Page 43
CHOLELITHIASIS
FORMATION OF GALLSTONES
RISK FACTORS : 4 F’s : female, fat, forty,
fertile
Multiparous
Oral cont...
Page 44
CHOLELITHIASIS
PRECIPITANTS:
1. Alteration in the concentration of lecithin,
cholesterol, and bile salts
2. Metabo...
Page 45
PATHOPHYSIOLOGY
Bile acids and lecithin decrease in bile
The capacity to dissolve cholesterol is reduced
Excess ch...
Page 46
CHOLELITHIASIS
ASSESSMENT:
1. Biliary colic:
– RUQ pain, usually postprandially
– Referred pain: R subscapular
(BO...
Page 47
CHOLELITHIASIS
PLANNING & IMPLEMENTATION:
MEDICAL INTERVENTION
1. Low fat diet
2. Prevent dehydration
3. Medicatio...
Page 48
CHOLELITHIASIS
SURGICAL INTERVENTION
1. Cholecystostomy – draining of the
gallbladder
2. Cholecystectomy – removal...
Page 49
GALLBLADDER SURGERY
PRE-OP NURSING CARE:
• Assure optimal health
• Instruct client over pre-operative plan
Page 50
GALLBLADDER SURGERY
POST-OP NURSING CARE:
• Prevent complications
• Providing biliary drainage
• Preventing disten...
Page 51
GALLBLADDER SURGERY
COMPLICATIONS:
1. Bleeding
2. Cardiorespiratory
3. Thrombophlebitis
4. Wound Evisceration and ...
Page 52
GALLBLADDER SURGERY
POST-OP NURSING CARE:
• Prevent complications
• Providing biliary drainage
• Preventing disten...
Page 53
GALLBLADDER SURGERY
BILIARY DRAINAGE:
• Bloody drainage – normal during 1st
2 hrs
• Greenish brown drainage - afte...
Page 54
GALLBLADDER SURGERY
BILIARY DRAINAGE:
• T tube stays for 6 wks to 6 mos before it is
removed
• Color to urine & st...
Page 55
GALLBLADDER SURGERY
POST-OP NURSING CARE:
• Prevent complications
• Providing biliary drainage
• Preventing disten...
Page 56
GALLBLADDER SURGERY
PREVENTING DISTENTION:
• NGT until peristalsis returns
• Rectal tube – expulsion of flatus
• E...
Page 57
GALLBLADDER SURGERY
POST-OP NURSING CARE:
• Prevent complications
• Providing biliary drainage
• Preventing disten...
Page 58
CHOLECYSTITIS
CAUSES:
• Infection: Strep, Staph, E. coli, Typhoid
• Gall stones
• Sludge
• Biliary stasis
S/SX:
• ...
Page 59
CHOLECYSTITIS
LABS:
1. Increased WBC
2. Increased serum amylase
DIAGNOSIS:
Utltrasound
COMPLICATIONS:
1. Abscess
2...
Page 60
CHOLECYSTITIS
MANAGEMENT
• IVF
• Antibiotic
• NG tube decompression
• Cholecystectomy
Page 61
Page 62
DISEASES OF THE
PANCREAS
• PANCREATITIS
– ACUTE
– CHRONIC
• CANCER OF THE PANCREAS
Page 63
INFLAMMATION
EDEMA
OBSTRUCTION OF PANCREATIC DUCT
RUPTURE & RELEASE OF DIGESTIVE ENZYMES
AUTOLYSIS OF PANCREATIC T...
Page 64
ACUTE PANCREATITIS
PREDISPOSING FACTORS:
• Binge alcohol drinking
• Biliary tract disease
• Duodenal obstruction
•...
Page 65
CHRONIC PANCREATITIS
PREDISPOSING FACTORS:
• Alcohol ingestion
• Gallbladder disease
• Autoimmune factors
Page 66
PANCREATITIS
• RELIEF OF PAIN:
– Demerol
– NO MORPHINE!
• DIET
– Avoid caffeine and alcohol
– Small frequent feedi...
Page 67
CANCER OF THE PANCREAS
S/SX:
• Anorexia
• Weight loss
• Weakness
• Nausea
• Late signs: pain, jaundice ascites, pa...
Page 68
• Which laboratory value would the
nurse expect to find in a client as a
result of liver failure?
a. Decreased ser...
Page 69
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  1. 1. Page 1 Accessory Organs of Digestive System By: Mr. Ranie M. Esponilla
  2. 2. Page 2 REVIEW OF ANATOMY AND PHYSIOLOGY ACCESSORY ORGANS OF THE DIGESTIVE SYSTEM: Liver Gall bladder and ductal system Pancreas
  3. 3. Page 3 This is an in-situ photograph of the chest and abdominal contents. As can be seen, the liver is the largest parenchymal organ, lying just below the diaphragm. The right lobe (at the left in the photograph) is larger than the left lobe. The falciform ligament is the rough dividing line between the two lobes.
  4. 4. Page 4 REVIEW OF ANATOMY AND PHYSIOLOGY LIVER Liver lobules Hepatic sinusoids (capillaries) lined with Kupffer cells Portal circulation – brings blood to the liver from : stomach, spleen, pancreas & intestines
  5. 5. Page 5 REVIEW OF ANATOMY AND PHYSIOLOGY FUNCTIONS OF THE LIVER: Carbohydrate metabolism Glycogenesis Glycogenolysis Gluconeogenesis Fat metabolism - ketogenesis Protein metabolism anabolism deamination urea formation Secretion of bile Detoxification Metabolism of vitamins A,D,K,B & Clotting factors, esp prothrombin
  6. 6. Page 6 REVIEW OF ANATOMY AND PHYSIOLOGY FUNCTIONS OF THE BILIARY SYSTEM: 1. Gallbladder – concentrate & store bile 2. Ductal system – route for bile to reach the intestines 1. Bile is formed in the liver & excreted into the hepatic duct 2. Cystic duct drains the gallbladder 3. Hepatic duct joins he cystic duct to form common bile duct. 4. Sphincter of Oddi : relaxed, bile enters duodenum; contracted, bile stored in the gall bladder; controlled by cholecystokinin from duodenal mucosa
  7. 7. Page 7 REVIEW OF ANATOMY AND PHYSIOLOGYPACREAS: Head, Body Tail Pancreatic duct FUNCTIONS OF THE PANCREAS: Exocrine : trypsinogen, chymotrypsin, amylase, lipase Endocrine : islets of Langerhans: insulin and glucagon
  8. 8. Page 8 CASE STUDY • Sirius, 54 y.o., was brought by his family because of vomiting of blood. • He’s drowsy, with VS of : 36o , 80/60. • He’s a chronic alcoholic; jaundiced & with big abdomen
  9. 9. Page 9 CASE STUDY • What other assessment findings would you expect? • What are your plans?
  10. 10. Page 10 NURSING ASSESSMENT MANIFESTATIONS OF LIVER DISORDERS Jaundice Hemorrhage / bleeding problems Pruritus and itching Ascites Generalized Edema Intolerance of Sedation
  11. 11. Page 11 MANIFESTATIONS OF LIVER DISORDERS JAUNDICE CAUSES: Prehepatic – hemolysis Intrahepatic – liver parenchymal dse Poshepatic – obstruction of bile ducts
  12. 12. Page 12 MANIFESTATIONS OF LIVER DISORDERS HEMORRHAGE Due to inadequate prothrombin & other clotting factors Management : Bile salts p.o., Vit K, p.o. & parenteral, use of small needle with injection, use of soft toothbrush, check urine and stool for blood.
  13. 13. Page 13 MANIFESTATIONS OF LIVER DISORDERS PRURITUS & ITCHING Caused by bile pigment deposited to skin Management: bathing with tepid water & use of oil-based lotion cholestyramine – binds with bile salts and facilitates excretion withfeces Use soft linen Short fingernails
  14. 14. Page 14 MANIFESTATIONS OF LIVER DISORDERSASCITES Causes : portal hypertension decreased plasma colloid osmotic pressure  hyperaldosteronism
  15. 15. Page 15 MANIFESTATIONS OF LIVER DISORDERS ASCITES Management : daily weight & abdominal girth low Na diet, fluid restriction, diuretics relieve symptoms from pressure of ascites :  high fowler’s  turning & positioning IV albumin, Paracentesis Peritoneovenous Shunt
  16. 16. Page 16 MANIFESTATIONS OF LIVER DISORDERS GENERALIZED EDEMA Insufficient albumin INTOLERANCE OF SEDATION Most sedatives are metabolized in the liver except phenobarbital
  17. 17. Page 17 DISEASES OF THE LIVER • HEPATITIS • CIRRHOSIS • CANCER OF THE LIVER
  18. 18. Page 18 HEPATITIS TYPES: • Viral Hepatitis • Toxic Hepatitis – exposure to hepatotoxin : carbon tetrachloride. Morphine, barbiturates
  19. 19. Page 19 HEPATITIS Hepatitis A • Infectious • Fecal-oral route Hepatitis B • Serum hepatitis • Blood & body fluid transmission
  20. 20. Page 20 HEPATITIS DIAGNOSIS: Screening test for Hepatitis Liver function tests: • SGOT • Alkaline Phosphatase • SGPT Imaging: Ultrasound
  21. 21. Page 21 Grossly, there are areas of necrosis and collapse of liver lobules seen here as ill-defined areas that are pale yellow. Such necrosis occurs with hepatitis.
  22. 22. Page 22 HEPATITIS PLANNING & IMPLEMENTATION 1. Prevent spread of the disease. Hepatitis A • Transmission : fecal-oral route • Incubation period : 2-7 wks (virus in the blood & feces) • Most infective 2 wks before onset of s/sx • Enteric precautions • Gloves when handling stools • Handwashing
  23. 23. Page 23 HEPATITIS PLANNING & IMPLEMENTATION 1. Prevent spread of the disease. Hepatitis B • Transmission : Blood & body fluid • Exposed individuals : Hep B immunoglobulin, provides passive immunity • High Risk Individuals : Hep B vaccine – Those who handle blood – Homosexual males – IV drug users – Hemodialysis patients 2. Obtain rest to promote liver regeneration
  24. 24. Page 24 HEPATITIS PLANNING & IMPLEMENTATION 3. Nutrition : Well- balanced, high P, high C 4. Providing comfort measures 5. Administer medications : – Antivirals – Liver supplements
  25. 25. Page 25 CIRRHOSIS END RESULT OF HEPATO-CELLULAR INJURY • Parenchymal cell death • Regeneration & scarring • Diminished blood flow fibrosis • Fatty degeneration • Portal vein obstruction TYPES: 1. Postnecrotic – post Hep B; macronodular 2. Portal (Laenec’s) – alcoholism; micronodular 3. Biliary – obstruction 4. Cardiac – from portal hypertension
  26. 26. Page 26 CIRRHOSIS ASSESSMENT: Gastrointestinal System • DUE TO METABOLIC CHANGES IN THE LIVER (P,C,F) – Anorexia – Nausea & vomiting – Weight loss – Flatulence – Fatigue • ABDOMINAL PAIN • HEPATOMEGALY • ASCITES
  27. 27. Page 27 Ongoing liver damage with liver cell necrosis followed by fibrosis and hepatocyte regeneration results in cirrhosis. This produces a nodular, firm liver. The nodules seen here are larger than 3 mm and, hence, this is an example of "macronodular" cirrhosis.
  28. 28. Page 28 Mallory's hyaline is seen here, but there are also neutrophils, necrosis of hepatocytes, collagen deposition, and fatty change. These findings are typical for acute alcoholic hepatitis. Such inflammation can occur in a person with a history of alcoholism who goes on a drinking "binge" and consumes large quantities of alcohol over a short time.
  29. 29. Page 29 CIRRHOSIS ASSESSMENT: Endocrine System THE LIVER IS UNABLE TO METABOLIZE HORMONES OF THE ADRENAL CORTEX, OVARIES, ESTROGEN AND TESTES • AMENORRHEA • GYNECOMASTIA • LOSS OF PUBIC HAIR • IMPOTENCE Hepato-Renal Syndrome RENAL FAILURE WITHOUT DISEASE
  30. 30. Page 30 CIRRHOSIS ASSESSMENT: Other: • JAUNDICE • ICTERIC SCLERAE • PRURITUS • SPIDER ANGIOMA • PALMAR ERYTHEMA • MUSCLE ATROPHY • PROLONGED • EASY BRUISING LABS: • LIVER FXN TESTS • S. BILIRUBIN • PROLONGED Prothrombin time • DECREASED Serum Albumin • DECREASED Hgb & Hct
  31. 31. Page 31 CIRRHOSIS - management • Sufficient rest & comfort • Measures to relieve pruritus • Nutrition: high calorie, low to moderate P, high C, low fat,Vit A, B comp, C, D and K • Monitor, prevent bleeding. • Diuretics if with ascites • Client teaching : avoid hepatotoxic drugs : opiates & sedatives, avoid alcohol
  32. 32. Page 32 CIRRHOSIS COMPLICATONS: 1. HEPATIC COMA 2. PORTAL HPN ESOPHAGEAL VARICES
  33. 33. Page 33 Submucosal veins in the esophagus become dilated. These are known as esophageal varices. Varices are seen here in the lower esophagus as linear blue dilated veins. There is hemorrhage around one of them. Such varices are easily eroded, leading to massive gastrointestinal hemorrhage.
  34. 34. Page 34 One of the most common findings with portal hypertension is splenomegaly, as seen here. The spleen is enlarged from the normal 300 grams or less to between 500 and 1000 gm. Another finding here is the irregular pale tan plaques of collagen over the purple capsule known as "sugar icing" or "hyaline perisplenitis" which follows the splenomegaly and/or multiple episodes of peritonitis that are a common accompaniment to cirrhosis of the liver.
  35. 35. Page 35 HEPATIC COMA DEGENERATIVE DISEASE OF THE BRAIN FROM LIVER FAILURE DUE TO INABILITY OF THE LIVER TO CONVERT AMMONIA TO UREA • CHANGES IN PERSONALITY AND BEHAVIOR • LETHARGY • CONFUSION • TREMORS • STUPOR • DIZZINESS • COMA • FETOR HEPATICUS – FRUITY ODOR BREATH • SPIDER TELANGIECTASIA • ELEVATED SERUM AMMONIA LEVELS
  36. 36. Page 36 HEPATIC COMA MANAGEMENT: 1. Neuro monitoring 2. Diet : Restrict P, high C, with Vit K 3. Administer: – enema, – cathartics – LACTULOSE – conversion of ammonia to nonabsorbable ammonium – intestinal antibiotics – NEOMYCIN 1. Management for cirrhosis
  37. 37. Page 37 ESOPHAGEAL VARICES DILATION OF THE VEINS OF THE ESOPHAGUS FROM PORTAL HYPERTENSION PORTAL HYPERTENSION – resistance to normal venous drainage of the liver into the portal vein MANAGEMENT: 1. Iced normal saline lavage 2. Blood transfusions 3. Vitamin K 4. Sengstaken Blakemore - 3 lumen – Keep scissors at bedside – Label each lumen 1. IV vasopressin 2. Surgery – shunting of blood to decompress varices 3. Sclerotherapy 4. Percutaneous embolization
  38. 38. Page 38 CANCER OF THE LIVER • Primary • Secondary – liver is the most common site of CA mets
  39. 39. Page 39 Here is an hepatocellular carcinoma. Such liver cancers arise in the setting of cirrhosis. Worldwide, viral hepatitis is the most common cause, but in the U.S., chronic alcoholism is the most common cause. The neoplasm is large and bulky and has a greenish cast because it contains bile. To the right of the main mass are smaller satellite nodules.
  40. 40. Page 40 CANCER OF THE LIVER • S/SX : – Anorexia – Weight loss – Weakness – abdominal fullness and bloating – Abdominal pain • MANAGEMENT – Total Hepatic Lobectomy • RESECTION IS UP TO 90% OF THE ORGAN
  41. 41. Page 41
  42. 42. Page 42 DISEASES OF THE GALLBLADDER • CHOLELITHIASIS • CHOLECYSTITIS
  43. 43. Page 43 CHOLELITHIASIS FORMATION OF GALLSTONES RISK FACTORS : 4 F’s : female, fat, forty, fertile Multiparous Oral contraceptives Cirrhosis Obesity Hyperlipidemia Total parenteral nutrition Bile stasis
  44. 44. Page 44 CHOLELITHIASIS PRECIPITANTS: 1. Alteration in the concentration of lecithin, cholesterol, and bile salts 2. Metabolic changes 3. Cholecystitis 4. Biliary stasis
  45. 45. Page 45 PATHOPHYSIOLOGY Bile acids and lecithin decrease in bile The capacity to dissolve cholesterol is reduced Excess cholesterol precipitate as crystals GALLSTONES
  46. 46. Page 46 CHOLELITHIASIS ASSESSMENT: 1. Biliary colic: – RUQ pain, usually postprandially – Referred pain: R subscapular (BOA’S SIGN) – Epigastric pain – Nausea & vomiting 1. Evidence of choledocholithiasis: – Jaundice – Clay-colored stools – Hyperbilirubinemia – Elevated alkaline phosphatase DIAGNOSIS : Ultrasound
  47. 47. Page 47 CHOLELITHIASIS PLANNING & IMPLEMENTATION: MEDICAL INTERVENTION 1. Low fat diet 2. Prevent dehydration 3. Medications: 1. Smooth Muscle relaxants: reduce spasm of the duct & permit bile passage • Papaverine • Nitroglycerine • NO Morphine! 1. Bile acids – Chenodeoxycholic acid (CHENIX) and Ursodeoxycholic acid (ACTIGALL) :for clients who are poor risk for surgery; Toxic to the liver
  48. 48. Page 48 CHOLELITHIASIS SURGICAL INTERVENTION 1. Cholecystostomy – draining of the gallbladder 2. Cholecystectomy – removal of the gallbladder 3. Choledocholithotomy – removal of stones from the common bile duct 4. Intraoperative Cholangiogram – dye in the bile duct thru the cystic duct, if with choledocholithiasis
  49. 49. Page 49 GALLBLADDER SURGERY PRE-OP NURSING CARE: • Assure optimal health • Instruct client over pre-operative plan
  50. 50. Page 50 GALLBLADDER SURGERY POST-OP NURSING CARE: • Prevent complications • Providing biliary drainage • Preventing distention • Manage pain – Fowler’s position • Maintain nutrition • Discharge planning & homecare – d/c after 7-10 days
  51. 51. Page 51 GALLBLADDER SURGERY COMPLICATIONS: 1. Bleeding 2. Cardiorespiratory 3. Thrombophlebitis 4. Wound Evisceration and Dehiscence
  52. 52. Page 52 GALLBLADDER SURGERY POST-OP NURSING CARE: • Prevent complications • Providing biliary drainage • Preventing distention • Manage pain – Fowler’s position • Maintain nutrition • Discharge planning & homecare – d/c after 7-10 days
  53. 53. Page 53 GALLBLADDER SURGERY BILIARY DRAINAGE: • Bloody drainage – normal during 1st 2 hrs • Greenish brown drainage - after 2 hrs • 400 ml in 1st 24 hrs, 200 ml/24 hrs thereafter • Placed above the bile duct to collect overflow drainage
  54. 54. Page 54 GALLBLADDER SURGERY BILIARY DRAINAGE: • T tube stays for 6 wks to 6 mos before it is removed • Color to urine & stool should be observed after removal of the tube • Chills and fever is normal with clamping of T tube during healing period.
  55. 55. Page 55 GALLBLADDER SURGERY POST-OP NURSING CARE: • Prevent complications • Providing biliary drainage • Preventing distention • Manage pain – Fowler’s position • Nutrition - when biliary drainage is reestablished: – Fat –restricted diet • Discharge planning & homecare – d/c after 7-10 days
  56. 56. Page 56 GALLBLADDER SURGERY PREVENTING DISTENTION: • NGT until peristalsis returns • Rectal tube – expulsion of flatus • Enema – 3rd day – peristalsis and release of flatus
  57. 57. Page 57 GALLBLADDER SURGERY POST-OP NURSING CARE: • Prevent complications • Providing biliary drainage • Preventing distention • Manage pain – Fowler’s position • Nutrition - when biliary drainage is reestablished: – Fat –restricted diet • Discharge planning & homecare – d/c after 7-10 days
  58. 58. Page 58 CHOLECYSTITIS CAUSES: • Infection: Strep, Staph, E. coli, Typhoid • Gall stones • Sludge • Biliary stasis S/SX: • Intolerance to fatty foods • Unrelenting RUQ pain & tenderness • Referred pain : right subscapular, epigastric • Nausea & vomiting • MURPHY’S SIGN
  59. 59. Page 59 CHOLECYSTITIS LABS: 1. Increased WBC 2. Increased serum amylase DIAGNOSIS: Utltrasound COMPLICATIONS: 1. Abscess 2. Perforation 3. choledocholithiasis
  60. 60. Page 60 CHOLECYSTITIS MANAGEMENT • IVF • Antibiotic • NG tube decompression • Cholecystectomy
  61. 61. Page 61
  62. 62. Page 62 DISEASES OF THE PANCREAS • PANCREATITIS – ACUTE – CHRONIC • CANCER OF THE PANCREAS
  63. 63. Page 63 INFLAMMATION EDEMA OBSTRUCTION OF PANCREATIC DUCT RUPTURE & RELEASE OF DIGESTIVE ENZYMES AUTOLYSIS OF PANCREATIC TISSUE NECROSIS PANCREATITIS
  64. 64. Page 64 ACUTE PANCREATITIS PREDISPOSING FACTORS: • Binge alcohol drinking • Biliary tract disease • Duodenal obstruction • Infection • Trauma • Nutritional deficiency
  65. 65. Page 65 CHRONIC PANCREATITIS PREDISPOSING FACTORS: • Alcohol ingestion • Gallbladder disease • Autoimmune factors
  66. 66. Page 66 PANCREATITIS • RELIEF OF PAIN: – Demerol – NO MORPHINE! • DIET – Avoid caffeine and alcohol – Small frequent feeding of BLAND, easy digestable food • PANCREATIC EXTRACTS – Viokase/ Cotazym – facilitate digestion of fat-soluble vitamins
  67. 67. Page 67 CANCER OF THE PANCREAS S/SX: • Anorexia • Weight loss • Weakness • Nausea • Late signs: pain, jaundice ascites, palpable mass SURGERY: • Whipples Procedure: removal of the head of the pancreas, distal stomach, CBD & duodenum
  68. 68. Page 68 • Which laboratory value would the nurse expect to find in a client as a result of liver failure? a. Decreased serum creatinine b. Decreased sodium c. Increased ammonia d. Increased calcium
  69. 69. Page 69

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