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RUBBER BAND LIGATION OF HEMORRHOIDS ASSESSMENT FINDINGS:

 To remove a hemorrhoid using rubber band  Pain in the RUQ or epigastric that last for 12 –
ligation, your surgeon inserts a small tool called 18 hours
a ligator through a lighted tube (scope) in the  Low grade fever
anal canal and grasps the hemorrhoid with  Nausea & vomiting after a High Fat Diet
forceps. Sliding the lIgator’s cylinder upward  Flatulence
releases rubber bands around the base of the  Indigestion
hemorrhoid. Rubber bands cut off the  Abdominal tenderness
hemorrhoid's blood supply, causing it to wither  Palpable gallbladder (Murphy’s sign)
and drop off.  Clay-colored, steatorrhea stools
 Bile colored urine
NURSING MANAGEMENT (POST –OP)
 Promote healing; Prevent complications; Relieve COMPLICATIONS:
pain.
 Perforation, peritonitis, infection of biliary
system, pancreatitis, intestinal obstruction,
DISTURBANCES IN ACCESSORY ORGANS: fistula formation.

GALLBLADDER, LIVER AND EXOCRINE MEDICAL MANAGEMENT:


PANCREATIC DISORDERS 
Bed rest
Fluid and electrolyte replacement
 Drug therapy – Analgesics/antibiotic
 Dietary Management – Low Fat diet
A. DISORDERS OF THE BILIARY TRACT:  Surgery – Cholecystostomy/Cholecystectomy

2. Chronic Cholecystitis
1. CHOLECYSTITIS ❒ is a long-standing swelling and irritation of the
❒ is an acute inflammation of the gallbladder, which gallbladder  thickening of the walls  shrink.
is the storage site for bile production from the ❒ long term intolerance to fatty foods
liver.
SYMPTOMS are vague, such as:
CAUSES: 1. Chronic indigestion
 Gallstones / Surgical trauma or injury to the 2. Vague abdominal pain
gallbladder / Anatomical abnormalities 4. Nausea
5. Belching
PATHOPHYSIOLOGY:
 Originate from an obstruction of the cystic duct TREATMENT:
either by a stone or by a bacterial invasion. As a 1. Surgery – Cholecystectomy
result of the inflammation, the gallbladder wall 2. Diet – Low Fat
becomes thickened & edematous & the diameter 3. Weight reduction
of the cystic duct lumen increases in size. 4. Drug therapy – Acid-suppressing and
 If the inflammation and edema spread to the Anticholenergic; Antacids.
common duct, the temporary obstruction of bile
elimination will result in jaundice. COMPLICATIONS:
 If the cystic duct is completely occluded, the  Pancreatitis or Cancer of the gallbladder (rarely).
gallbladder will become distended with
inflammatory exudate and bile. Following the DIAGNOSTIC TEST:
acute attack, the surface mucosa heals, scarring  CBC – WBC is elevated
the gallbladder wall, affecting future gallbladder  Serum alkaline phophatase, AST
functioning.  S. Bilirubin
 S. Amylase and Lipase
TYPES:  UTZ of abdomen – diagnostic test of choice
1. Acute cholecystitis
a) Calculous Cholecystitis – is the cause of 90%
of cases of acute cholecystitis. Gallbladder
stones obstruct s bile flow  gangrene &
perforation.
b) Acalculous Cholecystitis – is the absence of
obstruction by a gallstone.

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2. GALL BLADDER STONE OR  Improve respiratory status – deep breathing; use

(CHOLELITHIASIS) of incentive spirometer, early ambulation.
 Promote skin care/biliary drainage – signs of
❒ presence of gall stones. infection, protect from irritation of bile, measure
collected bile, never clamp T-tube, if clamped–
CAUSES: note for color of stools.
 Change in bile composition, Stasis, Infection,  Improve nutritional status – low fat, high
Genetic carbohydrate and protein.

ETIOLOGY AND RISK FACTORS : C ARE OF T-TUBE:

 5F’s, age, obesity, familial tendency, rapid  Normal drain – post – op: 500 ml 1st 24 hours
weight loss post-op – decreased to 200 in 2-3 days.
 INITIALLY – GREEN
GROUP OF GALLSTONE INCLUDES :  Report excessive drainage – may indicate
 Cholesterol stones obstruction.
 Pigment stones  Place in fowler’s position.
 Mixed stones  Assess skin for bile leakage during change of
dressing.
Gallbladder with numerous stones. Their brownish and  Ensure that T-tube is properly connected to
greenish colors suggest a cholesterol calculi. drainage (JP drain); keep it below level of
surgical wound.
ASSESSMENT FINDINGS:
 Asymptomatic for a majority of persons; Biliary NURSING DIAGNOSES:
colic; Jaundice in CBD obstruction; Nausea and  Alteration in Comfort R/T Biliary Spasms
vomiting; Intolerance to fatty foods; vague upper  NGT insertion relieves biliary spasms
abdominal discomfort. (contractions)
 Positive results of diagnostic studies such as  Analgesics, except MS (causes
Ultrasonography; CT scan; Oral contraction of the sphincter of Oddi);
Cholecystography; Cholangiography; ERCP. NTG – relaxes smooth muscles thus
decrease colic
MEDICAL MANAGEMENT:  Relaxation technics, diversional
 Nutritional and Supportive Therapy activities
 Complete bedrest  Fluid Volume Deficit R/T Vomiting and NGT
 NPO and NGT; Fluid and electrolyte suctioning
replacement; Medications such as  Potential for Injury R/T Endoscopic Procedure
Demerol, Anti-emetics, Antispasmodics, for stone removal
Anticholinergics, Antibiotics.  Observe for S/S of bleeding &
 Pharmacologic Therapy hemorrhage due to procedure.
 Ursodeoxycholic acid (UDCA/URSO,  Knowledge deficit
Actigall) and Chenodeoxycholic Acid
(Chenodiol).
 Nonsurgical Removal of Stones
 Dissolving of stones – infusion of a
solvent (Mono-octanoin or methyl
tertiary butyl ether [MTBE]) into the
gallbladder.
 Stone Removal by Instrumentation
a. ERCP
b. Intracorporeal Lithotripsy
c. Extracorporeal Shock Wave Lithotripsy
(ESWL)
 Surgical Management
a. Laparoscopic Cholecystectomy
b. Cholecystectomy
c. Choledochostomy
d. Surgical Cholecystostomy
e. Percutaneous Cholecystostomy

POST-OPERATIVE CARE:
 Relieve pain – analgesic

Abigail marie