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10 differentiate the risk factors pathophysiology

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10. Differentiate the risk factors, pathophysiology, clinical manifestations, and treatment ofpatients with biliary and pancreatic disorders.
bilirubin: 1.2Liver enzymes may be elevated.AST 5-40ALT 7-56Diagnostic tests: Ultrasound**, ERCPManagementRest, IV fluids, NG suction, analgesic, antibiotics. Delay surgery until acutesymptoms subside, then proceed with surgery.Diet after acute episode- liquids (low fat) progress slowly. Avoid fatty, fried, orgas-forming foods.Medications: ursodeoxycholic acid and chenodeoxycholic acid- may dissolvesmall gallstones.Nonsurgical removalBy instrumentationIntracorporeal or extracorporeal lithotripsyLaparoscopic cholecystectomy or Open cholecystectomyComplicationsBleeding, infectionGI symptomsComplications related to surgery in general:common bile duct injury,atelectasis, thrombophlebitis, infectionEducationCare of the patient after cholecystectomyNPO until fully awake, then liquids; progress to soft, low-fat, high-carbohydrate diet as tolerated.Care of biliary drainage system if the patient has a T-tube.Observe for blockage of drainage and accompanying symptomsRead care of T tube (ATI- page 344)Analgesics, pain management.Turn, cough, and deep breathing; splinting to reduce painLap Chole:EARLY Ambulation promotes absorption of CO2 gas used inprocedure.Report pain, vomiting abd. Distension (may be a leak)Discharge educationDischarge education- Frequently same day discharge.Diet- low-fat, avoid dairy and fried foods,avoid gas forming foods,chocolate, nuts, gravy). Small frequent mealsTake fat-soluble vitaminsInclude when to call, postop visit, activity.KNOW chart 50-2.(Will bequestions directly from this chart!!).heating pad sitting upright in bed or chair will help ease paincall for signs of infection redness swelling heat drainage paincall if fever >2 daysPain unrelieved by analgesics may be a common bile duct injury. Patient
needs to call the surgeon!PANCREATITISPathoAcute: pancreatic duct becomes obstructed, and enzymes back up, causingautodigestion and inflammation of the pancreas. Mild or severe80% of acute pancreatitis pts. have biliary dx. Other- trauma,metabolic, alcohol use.

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Term
Fall
Professor
NoProfessor
Tags
hemorrhage, Tachycardia

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