44 Management of Patients with Biliary Disorders ‘on completon otis chapter, ne leamer wi be able a 4 Init te sructre and funtion of heb ary tract an pancreas. © Deseba the pathoprysclogy cial manfestatons and medal management of choles + Derenate between acute ad chon pancreas. «ply the ring press as a fameuerk for care ofthe patent helen, sarang wswrszaio open (Slecysactomy, or win acute parce «. Epler re nator end metal elect of ural veeent tumors ofthe pancreas. omit Fary Irtcton Iethrmaton| Nationamylase: paneeae enzyme adenine gestion of aroha {holecytactomy: remot of Be gable ‘foley nena te glass wh canbe ctor ‘holeeystoljunostomy: anastomosis fhe jeunam oh glade “cholecystokinin (CCK): harmone: major stimu for gece enzyme ‘cretion, sonaats convacton of re gatas? _evolecystostomy:sugeal opening and rine ol he galtader ‘choledosholniasi: tonaein the common ie at ‘coledochostomy: opening into te commen be dit ‘olla: eealin he glee “lsotution therapy: he use of medoatons 0 breakupisssoWe ‘alors ledocrine tcreling ema Normand seteton of @ utes gn “ndescople retrograde chlanglopancreatography (ERCP): rocadre using Roop ecology to wsuatze he bly ysl ersotope vou (CUS) ree pore tg an aoe abe athe end ofan endoscope ete clean scomoreas ie gltlagoer ine eng of ae cclesyee ‘xocrine: scratng extemal, Pomeral seston rom excretory dts lipase: panefeate ray, ads inte esto os litotpey: drtsgaten of gatones by shockwaves pancreatitis othe pancreas, may ae arte ever “Tcrstin:homone respon er tubing nearoorate sectetan rom tha pansies ab ised as an as daprasngpancreste vce dioase ‘sttorhea: thy fubeeling took wh high fat cone ress rom maces dgurtan ol slees ends de aa loko pantease Juco inthe wets ‘eypain:panereate enzyme at inte digestion of otis Zolinger-Elison syndrome: hypereeeton of gatic wo tat, ‘duces pepe Uke asa esu of nor-Setsel una’ he Porcente sie Dison f he iin at nl pancreas ae common ad ine galblaer ony and pencec fact, An aang of the soctre and mcm of the ils” ct and paerene it sea slog wth mans cored magento ding ape) repre 4 Maia aque try sake nd ois ode at ene GI 1. Rep dered o hen antes, omiing, dames sens atone tn mpen) > (ater cater psa niece cig an ‘© por ren of pete a oo even of Yeni bomin 4. Lt symptoms at aul be repre 6 arson romp ane rooms aetnding ela lag Mean ee DISORDERS OF THE PANCREAS Pancreatitis efmmation ofthe pances)i seious corer, The wos ese sastficaion sys used to eee or caters the various stags fd Sms of pence de he dre ne eae and crn fans cae pce mes ol ery soc wi He a lenges detected tease dase lia ana agostienigs ae mot Sinays ofc! in the ay sags of the dace (Feldman ety 201 Papua A MacPhee, 202 Staveun & etan 2018) By te ne Eel fit (eats ent athena Flom a, 2016 Golman | 1 Sia 701 Papas & MoPhe, 209; Sntsan & Fda, 208 Act prt es 26 ya Cee ei at ‘Altovgh be mechaisns casing puncte iaamaation a wow, oocteis i commonly cessed 6 agolgeston o he panes It Feed wat the puree det seeomes impor ese‘a paris scared fom th spl wi a daoage tbe il in Sf reoning prompt any change in the aunt or shaterte of Sirage Asizance In scp the aporopriae ees reese sate acy ing me te in el ee ‘ung ar Tetons se Wy cet spp ams, most ems econ gal om a cholesetoy Hajeee Soe foes ‘Sty require evel fir tao! oboe ee. Ths bop rs a Feip ce te uopedicubny of te ponoprdve end Postage ‘kperonce or patos by proving lev pase ceson romp ah ‘els ané an aomv aprosh tothe sng eae otek 2019) Dasing hice vists the ous aves the pate’ piyseal san, (ion fo uietacy of pin fled pony Coe ie [pointe patent ar anne rye n place, she mae asses Tar pateney and apopae managenent ye pets Ta. ‘Asin orga leon and sdneag te ales thee ons anentaning a the Grapes open (ccs rand eum te nomal acieies) be esc, and previor aacaton ‘eine The age emphases te inprance’ of Kesping fallow Sepoinins an remieds he patent sn fay of te portance of uvcpsing eth proton ati and secummened hah 1 Reps rein la Split abomination to crete pin © Uns pps magna pected aUTKoleves sa rpy excaion wi dep pin and 4 rarer ar pecrbe ans, bulie) 4 stim kt urd ly dang te pp) ndersaing of how ty tet sone ae lst ke wih ee Process ieee ta are inte management 9 alba I purest dons ANATOMIC AND PHYSIOLOGIC OVERVIEW The Gallbladder “Te galt, petsbapd, lo, stk organ tat 7.4 103 42 ‘laches le, ie sallow depen as ie insta fe et, buble ie 20 20 ml of ee wall composed ly ef smoweh truce The glade e connate the comma ile et (€30) By the ‘ate dt eee, 4). The ular tons aa strge depot ie Between els whee the spine of Ol lon le posal By the Reparcs emashe balbiner During orgs,» lage pron of he water ble aoe rough the wal othe alia us le inh galltiad fs 010 lines move cence tas hat ogy sted by the vr Wes food fst ke duoenum, the gullner coma andthe spine of Oa Usenet he untn of be CBD wh he Seder) reac Relation of Dir spnincrllows the eter the neine This response ft medaed ty seein of he hrmoneehleystaknin (CCK om he esta Wal nt 21) Cx te gr or ge ne etn a ‘ie i sampored of water ane cares (am, potas, calcio, ‘horde apd erbont) along wh sna amour of fc at) fei cole, lube ait he sas The be shy teeth Cholera ate a elie of othe lew, Ty ae Un Fes in th prea fr rm oe ver, rw hy ae Se aun ect nthe le. The phy fom eptoye o le | interne and ack tothe payer cle the rtrd setion Bosse of hs cuiton oly a sal con of thee sake sat ater te Intec av eee eh fet This deren the eed fo atv pte eas ter als “Aprsimatsy ha of he lian a pigment ere om thereon frond els) component oe Hi cnvera by he esi os leo wrobnggc, wich wa highly sll substance. Urbinoger iether cote nh io ed er ri, wee Km Etclton and then ste bythe Kidney (Goleman & Schafer 2015, ow 205, sat0"We No of is impeded (ee by gals in chile eu, ili oe at etre tne Ae, Mec level of iin nee Tit oneron of taba in he tall ine andeseaed exten the Stool These changes rode many ofthe sans and symptoms Se i fled dre Diphagn Seat igre 4-1» Theta iay ese, a paras ‘The Pancreas ‘The pace scaled in the upper abdomen Gee Fig 1 as bah rorine ering sta armor senon fm sett 8) nd fndoerioe(sccing neal, Rormoal secon of ete ghnd) ‘cows. Te exotn unig nade sce of psn eyes ito ‘he gst (GD tae tough the pancreas doc. Te ence ‘he bloode ‘The Exoctine Pancreas erate dt ch job the CBD and eater Sonu a he ap [Face Sonounding fe ampulla ete spn of O88, which partly ait ‘Te murs ists te gant abou pan maragonor. acy and crercae wound cretion, ad elowup ca ay Eosabed bal, + Youmay exetence pa dca tar Me ae used ie you's ea dur suger Sieg orght bed er ‘hae wing o-snganesng fod may ene aaron + Tae aaiene medesone at rondo ae os rescrted, Report {Dyer sujeor pene uveleved ten wh eae, Resuming Act + Seah tntotrose wating) mines, + Tata tower sro ater 62 ap Dive acre 3 4aay erent up sty or ook act nen cone. + Ces pect ly forage a fect, © van puree sown cand wt + “Atow spec aches sips ove pune leo al oD at pulmo Rast your nr et 5 tryocmadfainsleance str surge, radu anak lo yaurdit nama nomen + Mean apie we or son 7 10 ee ate + Gaon soon #you nares any geo sytons a tcton erouretne peta ne woneat, toasre ewan ea deaae + Gatouraugeon you epaerce a foe of 3.7 (10 mare Per ihe aahy + ‘Catyoarsogeon # yu dovtpnaute,vortng, or atone saeBicdig my ecu a sf inaderes puncse aay ta mje Sood vee Postapesvey the mse closely snes vi na and Inspects the supe nisms sd any dis fr lain, The nase a sees he pi ese ees so ig of he ae. thse sigs tod mpc oc, they ae repre he surgeon. The te’ a frye nsec ep ay ange ie clor0 st, Eisai ony te somes yap tough "Ae laconic shale the re cette pn 0 orci, outing uit abdomina dsteasne, an empeae evan These my inet neon o druton of tel tan Soul be “pice sgn ry, Rea he ue Sage ne ‘in writing about the importance of reporting these symptoms promptly Dues iinuld consider inplecing th eee mend hes ‘oaig pes ud ie to carte a ny reo dterb wa (Gey bt mtg tao wa cr pra a td (Gee Cher fr dco fhe unk eh. dng Patents Abs SSCA The mise te the tet dou the meetions ht re esrb (vitamins, aichoee {arpa aor) and ee atom. The ras ao infurms te ent sn arly aot spon ht olde repr oe primy Dovier isting judi atin, pleted tl prs and Sle int ammaton a infton sich ine ve, ‘Semple font ate othe wel movements day, which is 2 sll ofa cman tiie of Ale troyph th ebledcboduodl action af cnenytecoey Usa, sch fegiry dies ovr 8 Did ae mek to ever moh. erred De as ovr the rts t which scons om the pants athe alder rota coe sod an eectole-ch Ti, Tae setae, which ae vey rane becuse te hgh consraon of sum ctor, re capa St newraang he heh sede este je bat ene the doou=u ‘Selide amape which sdb in th digeion of ‘ich Sin the igetion of prin an pase tbl ads nie pein of faster enzymes hat promote een ‘aoe comples fois ae alo suc eomene origin inthe Of et slate the secretin of thse Sipesve erm scan the hommone CCK The agus nee eo inlcaes exert pncteteSeon ‘The Endocrine Pancreas “Theiss of Lanes, the eaoorie pa ofthe pancreas, cllestions of Celene nh utes. They ae compose aia ed eta call The boone proaced yt ets els cle ina he dk ‘A jr action of ain lover Mac shcose by pemitag ey of acon ino he elf he er sel an ihe nc, here ether Sore ar liogen or ed fener lin sia pam the ree in atpse tue and the syste of pte in varus boy tte In he aoe of sli lsss cae tte el and exceed he we “This conion, clatter be dugnosed by hig eves f coe st The bod. see, oad ft and pete ae ed or cee) ited of coe, eng oe hoy mae Distr fede nS in Char {The eel of glucose the Ded normaly regulars ete af nih ‘eect om he pares (oldman Seater, 218. Nos 209) Glucagon “The elect f ocagon oposite tha of sini rae he lod _Bucae ty converting sycogen to laos inthe ee Glragn seca) Tbe paces in epeme accra ine velo bod lace. saSoman ences typolycemic ect by inering with release of Endocrine Control of Carbohydrate Metabolism cebobyaer and ao foe asins 3p the proces of paoneogmeis ‘locos can be stared temporary nthe for of glcogen i te Toe ‘uc, ad ober sues, The eos syste cons the level of Hood cose by mang the rate a wach glue saben sled, {Bocas ‘srl inne es nan 10 gl. (4 mal) ory Spi Papas € Mees 200). Ici ithe rary hirmone tat ower ‘te blood giao vel Ttemones ta ase the Blood glee level ae Els, sit, ater owt mor. ed Syd rr store fuente ison tough ert of eyes {no he eal dundee. Seeteta abd CCX ae horses fo he Gt Sn nt so ol nan by snling te eons ‘Considerable dysfunction af the pancreas must occur before enzyme secretion ‘ress and poten an ft igesionDesomes Inpaed. Pant cnyme ‘cect eo 80 800 ky 0, Pp ®p. Gerontologie Considerations ‘reese res nel and ome fay ep in he normal ances {rere ede han 70 yee Some lsd ele cange sir ih age, Thee eso decease rate of pancreate enyme treo sls lps, an ypu and dese caer ourpata lder as Some impunnen of momal ft absrpon soca wis snr age sty feces of delyed pute enping aol panei houlieey (Ghopuis, 2018) Nor 209, Payucs & MePhe. 2020) Deceased Salen aceon ay also osu These ges equ cae ee lapse tot susie the mrad pata ae roving etry DISORDERS OF THE GALLBLADDER a3 Alte thse sua procedures, the att is served fir ines of Snr age of He the pon cy an acon of le bc toe fred hak ms he eran Hones, Reese nice mas esl he moe should ase fe clo ofthe sles The mre shod ti npr ah pe a il a a ing ie may cominae to Sain fom the drainage wt in comiele uals for sme ine, ascesining eur changes of tbe tet ‘Sesngs and prec ofthe shin Go ia he ese ote Si. tue) ar collesion receptacle elevated above the level ofthe adomen so thn We ile die exer only If pesire devon nthe dct em, sinc hrc a ings Ne co age We tthe doen oad In digestion (runic, 201; Cancon & Cameron. 2020; Toweseed eal, 2015) Wait dis to 3 werk. the ‘eunage be removed (Draica, 201; Cameron & Caron, 2020 $end ta 2070) The pant no pes tome wi snags ie Pace raquie strton desea eae stn and ae "rube React 2019) nal pairs wih iia dria, he us (othe pats it ame) to éeiermine wither te ile pigment i esappearng irom the Blood and is hinng agin into he duodous, Manag crcl rood af ud ine od outs inp. Carbohydrates and prs imesily ser sngey Atte tie oF Hosp discharge, thew ae usally to special sltaryststons oer anc mattaie 4 Desh i and ld excess Ta Fat rescen Impaln of ter apn fnstonrsfcive Aer he tne, when the ast ae a at i wl be lesen fe ret malts Phe fats and lo the igen. This i ena oh onion ere blow nnamal saePanning and Goats ‘The gon for tepid kof pal, deg vot, tas shin improved ary deeage, opti azlenal ake tsace ok ‘Aer ecvery om ashes, the pat is placed inthe low Foe olen Fide my be aumintee IV, and asogsticsucton (a Hovpuri ibe war pcshy intend nme Bee sey fr Ielipsoscopie precede) may be ised to Yleve aban ‘Usein, Wate ander Das we given whe burs ae opresope procures Aso its sete al Dovel sound rae le saul {honest a heparan spree asd ‘The Toston ofthe seo incon ip nonaparscoic slider tego fen cts the pti oo ing a movi spi he ‘Mfce se, and to ke sho cts to preven pal Bectse fl ‘pansion ofthe lrgs and gral ieee sty ae neces 0 reve! pstapertive complcon, he ue ante sage ape SS prsbed ove the um ano ape patent op, ete ‘opal amb neat The ee of plow smile ‘veri non may die pals daring thse mune Patents nceping lary tact gery acpi roe pulmonary Complete areal paen with per abdominal inion, ‘heel the mse emi he pt o tke deep beats a ough ery hour to expand he lang fly and prevent tet The ey and ele fe pty an ps ee ep ‘her emplizaions ich at venossfremboembolam (VTE) fermion Falmenary corpse are moreikey os npn who area, ‘hase thot. aa ose wh reusing pulonay dase {he tunage te mute conned mmissf ramag espe ‘Themese shel ase he bingo the dessins wtf ples gown, yh cngh ena fr te oe win dang king ‘bulsing. th crunage bap may be paca fa Sabo pocket feene so hat Blow the aio Smmon ist eve I ae ee ‘sd te as charges te desis a eu Several dures atthe ily stem and iter With normal dings one the most eonmn sar othe tay stem, Not al ecaence ff bles ae eae sons cel) in egal (choles) estos be CHD (choledoeholbiasis). Hower os of he 1 ian ‘eros wih gallons he o poi nd fe whan af th secs of ‘ener Camaro & Camera, 2 Kellerman & Rake 2018). Cholecystitis Coe onion of hell which cn Be at sis) Seip pi ode andre a he upper He sen hat ay rai i ia ch ll ih aa ‘sitar dlp i he galley bees el ws plo Red ts. “als cyt he eof math 9 of te of sete cic (Bem 201%; Canton Cama, 22) koe pallens «cena acon: aan ad edema esr a he Biol ees gle re compe conprsing hr ast spp aces of he gla ts prion uy ea Bac ply Stimerlnme diet herer senny nae tsamaty enh Gta) and cde Ehrohacal Reb pss, Std Sepaccar Bast comand ile he Stal sc of tte slain, Peon Brn 016 Sosa cles dese Wien be sive of oberon by plsine. Ace choles nt i at pochen ic ps sv r sc oheration, ray hte ton of i abla, and le ‘ood wasitne rissa hat seals cysts ened 6y Sons ina nd Cee an sto in rein! ld aw the vara chelate, Bic cs act of gM ccacon) ad Sl fie i wesc rh ero Sgr iach by Caner Canc yc Sic). sataCholelithiasis Cala, oF galitnes, ely form in the galltager fom the si enstteats of leh vary el In se, stage and compose (2 Fl {WD} They are cctnen i clos and Jousp as ba bee mare ‘Bho for 3% 102 in women fees te ape of 20 and 38 Soars nd ‘om 25% to 3 in ween older than 0 sears, Choshin eos pron 0% of women by he age of 70 ys Lilt & Lemar gure .2 zal of lca galtonee ft) macau of ' coanecone s¢ mug srnl ones spat anloras fitcoraced sitet epee ren Sop Shaye, OS Rube, G15) ses pt Enciprhcioge tata f mean in 9), Padlpna Pathophysiology the puboysiolog gallons developnat ula Tete revo slertyp of gullence: one composed predomi of mer nd he onmpestd primal of chose, Pighent sacs potaby form whea| “conse pigments inte ble precip fo fy slons hese Sones sour ar abt 10% t 25% of exer fa be Und Snes (ae ‘MePhos 2019, The sk of developing sch sons i ined in patel sais NURSING PROCESS “Tho Pationt Undergoing Surgery for Gallbladder Disease ‘he patent ndezing sual wean of glider Saas 6 olen cited tothe tool er mime-eaysupey unt onthe momng ‘Srey Preamion fering olen completes wes or longer Ble ‘nso Atte he ace dicate the ptt aoe he ne 0 ‘old skin, to enbunce pumonay recovery pooper nd ot enn cmp Tec ol an, esa emetic aie contin al te semi processes ‘Sao ommtaes are nes isto oF woking, preies resp probiens, sal ‘spinon, poset ar icfoeve cough and the preter. of ‘vats bets oud, Neal us eal trough 9 etry testing. The nurse as reviews previulyshispd abort reste 9 ‘tit ifomaton abou th pales una Sats Bosed othe eset da, malo posepertivewasng dagoss ay inca te lowing * Tepe ens ec ih ek sri ave + Imps kin imeriy ascii ard ly ina ae Si ervenan (ie ube was nso because af tale Sones inte common Be Ot ov anaer ranage device wt trplyed 1 (tk ofinawieige abou citar seer nid wih non ‘ire, Sean’ modifesons ined}, mieten, an eps Sins or symptoms eg fv, lewd. Yomi) Pct! eplcalns ny sade he ling: 1 Gtapmptoms (ay be eed to ila sk rin othe Bowel) 3the pda of uasound oe computed umephy (C1). Ble saps w see spon of he mee ce 9 ta nt be nd resoleon af sine and pte of sp nd eyes have Noon ‘pot wit hs prsedure Anite agers we wen before, ding er he proctiee Endoscopic Ulresound Endoscopic lrasound (EUS) guided altar eatage rss that Sing (Coin Sy 019), FUN deed ore a crn thechane, Bp rong con Sara renin for Giese of the bili tet she mest comm pratve rvelize rome i thal aal Chest stration of be “foes wth age Decne of nce heat season of elec nd ‘ough ie inedene ogame nreates wih ape, he eer patient may ot exhib the spel poms of fever fan, il and asd Symptom of bly ont dtc in he cdr ail ey be accompa or peceel by Lose of si shock. which Toco ligt, bypaesion, Changer neni satay an aches ‘hou srs in he ser ad pres» rik cs of resting assole ens, he morally fat tm seus completions of Bay fret dee ill (alo high. ‘The nk of deat and compiaion ‘Steeel ithe elder pte ebo unengoes emergency sey fr le {freueing des ofthe Mi act espe be presence of Sees ‘trmany alder pte seve chlecscosemy fealy wel ters nd a be cai out wow tk irexpe asasmes aod ae ae provid Seid, a alee uel pocle(Rabock 2019), he Higher compan xl te gh of pl say mak it sonal at eer patens ander fly tebow recive, seni |nfomsion abot signs and Symptons of compliatons and teases to prover thes ith ens, Nemo, and into ofthe lary uel Plgmet snes paller dare inthe Unice Ses Cholrel which 4 noma onetae of il, eins in wae cli depends on eae Sd etn (poapolpas in ile Haan de MePhee 2019) aston ‘eciptates out ofthe bile to form siones (Hammer & McPhee, 2019), The oleertsataed ie predispose ton of alse ata 5 Sinus Ut prods alnmatory canes ia the moa of the Se ans Me ee palbiasier sae women ae esol ser than 40 yas, Toligros, sad have abesty (edn ea, 2016, Gola & Seba, 29 mac Pee 2019), Stone aroalin re que a pop owt norte ry sles sssraion lamer & MPa, 2019), ‘he ieee of one formation ease with gear. est need heat sereon of testa aed dered ie sid chess (ame MePiee 2019). In aden, he iv at incewel. tak. teense of Those who have underpne eal resin ot apa. Te incidence lo beter people wih cakes (se Chat $81). The role of et i te fusion of eholtrel snes hw ot been confined butt unde ty ‘Towel ih rk may be encamped ota an opti body wel nd onder resicng mnie rk ctr yee snmp of ps {nd ea fod ower ods, ad st Fn Di Chul, Gara, Freck, frat, 2019, a61 gtittene 1 Freuenchangesin weight 1 enreasion sr sseae 1 Camcdoe coven arapy—oares # ara nrease Inte ok of balance + Soest Rapid wight ne (eae api developer of alltanat and gh facet ynplomse dats). + Tremont win ngh-oseerogon {Woman paca those hav had mute pregnancies or who (Bot ticre Anetian er. eadhweses ape oe tp om om fle, & Pty, 8. 8, he “foragenen of guise deuce” A pct! and sense band ‘encesh Cham Snarare Serge Pulao Clinical Manifestations Catan may be sie, prodcing no pin nd aly mild Gl spams Sich ‘ones may e eed icin ing gry evlatin fr uel robs Uaniner & McPhee, 201, Sain & Pengo, 2018, The pln wth gallslader uct eating Cam alone may develop two pes ofsyeptmethone doe ods fe altar oa ed ee {ist osnrcton ofthe ile passe by plone, The mpm 3) e tate o cons pigs des, sacha ules, abomia deat, fn wage pai he Ht upper stata of the bomen, ty occu Tas ‘davet ey fall tel chi Hod fy fonds (Onan 2019, Pain ana Bilary Cole If gas obras the eae at the glbaer heirs dnd ‘plone nd vetlel arte eyo) The pet develops ‘ver and may sve a ple anemia ma The pst may fae itary ole with exciting upe gt abominal pin ha raises othe ack of bt soul Bil coie i aly associ with mse ad emia {dics ntrable over otra ue heny mel The patent ve bo ‘ety nib oid a cmfrbe poston some pene ne pas | msn rahr tu cle (Brn, 309; Camera & Came 2020) ‘Sicha out of Slay cob Is eased by cembaton ofthe gallo, whch cane: elee cba fasten he sue, When tend ‘heads fhe alle comes ico thao wa i a7 Bile act nary ia serious compiaion of celeste, but ous Shalinciion Cholecystectomy Palblaier i enoved trough a all sbi cso. athe name Ips. I noted te suet nisin It etended to Tomove. ge table stones Dean ay oe} ot be se. The stat eth os Sy his tuonsdnties at a mor alvaage of ls pe af poste (Drascrs 201% Cameron & Cameron, 220 Goldman Scat, 201) “heprocoie fe conrverea ect imi expe al vse ly Coledochostomy ‘Chotedcrostomy is reseed fr the si wih ce cea who may Sette une sal rsd. Ts prev a a cui der sides Ths ake cnet to py riage big: ‘he petssmonined cs, andaaprscpi chlo secon pane {orate ae ete ialaaton seve ‘Surpcal Colecyststony leroy pened whe te pal’ en es ce Palle ir upicly open, noes an the Ble ore parle nage Ee rove and dsinae foe ie secre wth pusesang str. The thinage sae comnecte toa tage sytem oper le Hor Teng found te eo seapng no the porte evi. Aller reco ore Sele Sle heat ne begat ape morality rae (reported to bea high as 10% to 30%) because of the oer inetous dsease ross (Brut, 2019 Caen & Cane 2, Flan cal 2016, Colones Seba, 3019, Pereuanaous Crolaystostomy erates destin as ed ec ai of {er penetra Th sss youn ay nla pase wth epi severe cargo, plonaryo Ive Tale (Goran & She, 209; Kober Pk Chick, ta 2019) Under cal wes, 8 Hie sede Introd trough th abla wal and ve dg no the gall ander 30onthe sane dy of ugg or within 1 or 2 ays dese fl sty ond acer in he Unied Sct and 3404 ty RD of ener nemo Canton oan pen procedure eae teres ifammaton a ard the alice mate. stedasaton of the. porta hepa dieu (Grane 209; Feldman, 2016: Goldman Shue, 2019, The port eat the fsa of he fer re he pol ina he hea ey tern te hate Sct et the net “he mos ews eompcatn afer loscopeeholastomyis e uct injury, wc yb ented and cometh ie the procedure ‘nur wo the bled comes apptet (Brania, 201, Caneon (Cree, 2020 A tl leak my es in Dl ealcons, ed a usally Smad by dope se ene Ble pois» re Tecnu of he shor nal of hosp ay_wih uncomplicated lupreseoic cholestasis Inport we provide pet eeeaion| ‘Reg oe pin an pring yp fi ff ie abcamen and lemperuie elevation Alioughrcaver or Japaescoic sleet epi paet ae owns fewer. The pen ms: have asstace a hae ding the fst 24 to 48 hors If pa fcc tte ah shoul e seal ae (Ho mrt the eaten dowde ted to ifile te sana cvty dsng te poco) the ‘use may recommends heating od for 1 to 20 tes. (Chotcytectomy Inches, he pbs remaved though an aban! acon (Gesly ren sbcosal) ater te eye cut and aren ae ted. The rece prod fr ace an shone elses se pet SES dd ey bel hn oh ane Snip preseting acumen of Bie Usa, ly 0 mall amotet of ‘ronnie th i 24 hours ae suger srwar the la emoved The din pil ate I tees xcs org oF Silage serra Tbe (nme fr tae) no he COD Sai ‘he per procter mow commons i ad ty i he Sting omplctn fe, ened CRD soe) Tee seed rth CBD ot ‘He tine of sui eplraon. alms exeral Cunage of le Lo sm repos ofthe igh th and 10h cosa cartilages This podose mae Ueber inthe ight upper unde! oe exp spa tpt fl "Te pn of sot soley may hes severe that ase meisons amc reget Te te of morphine has taorly heen svoded beau of foooern Batt could case spasm of the apbincer of Oud Ths ‘anagem face pun Futuro al ops ste te pine ‘ai some degre Lilteld & Lanaan, 209; Papas & Mth, 2a, I th gallstone is dodged and no lager obs te eye dat the spl ese aay pon rw = iy tn pefrsn with eee eons may rsh Jaunice ‘hettin ofthe ssmon Bie sk. The ie wick smo ones card fo the duodenum, is abubed by the Mood and her thin and uct rmemiras yellow cole. Tie gue aecpuned by mac pris Ticking athe kn [Changes in Urine and Stool Colo The exertion af the ile pment bythe Mines ie th i ey dak tole: Th ey no nage Colonel Wi ile gmc, rr Cr tS) Vitamin Deficiency arta of ile ow neice wt bert af the Esai vamis| ‘haraction has heen prolonged For example, a patient way have bleeding aus by amin K efiseny (ar Ki necessary fr oma Bond states, Assessment and Diagnostic Findings ‘A wie age of dag sues may’ be peinmol in ets wit lly Soren use tt ieries vous pocltec and her agnostic tse ‘eran ha ab a pn at pe arse sos note tends rete bene hey provide norinon abot ‘seas popeson swe ase peas espns eta. ainGalera ‘Vessel Cece ene) Viner pc singe Some ahi mal est ms smn née "ns pn on “Tadocopcremgnde Visas Sc dc iy ‘Sanat wish ‘eve nee step sme Ima rare “Seesailae pings ine sbine of ber Seve bv men=rBN ‘i inept Ctcsrsinck Fowl hac ea en ‘aap om sie acta fa) Fares anal ot ‘Shera secs a (oan) Pras, i te re Abdominal XRay the pin resents with sympa of galt ete, a sion! ‘yma bound cxloe her enero spams lee ony 10% {0°15 of plone secede wobe vile on such xy Sis (aa 2019; Goldman & Slr 2009) Utasonogeaphy Uitasonograny isthe dase poet of eae Ksase pi and cure al ate sede pats ih Lver dances ad june It hc et ape pens a fnsng ration Tne proces most accra Fike potent sats ovrighe ap tat te. pulinder tien sai9 {rout ne umole cin (8 Tha conor sprrahe dps thgndn gh ancn min ar en soy he fore the proces, he pat ie sic that a9 ope abdoniaa ‘rocefire may be neces, and geeral aes Bie. Laparoscopic foley sctony is performed tough a all incon or puncte male Trough the sional walla be une. The thea cavly i inutied wit bon dene (meenoparitnes) to ei i iseing te IGprncape ard st in ining the domi! stares. The erope scope Is ised trough the sal umbiclinlon. Seve aol Pacts esol sons ae made he abil walt together Segal isteancnl ino te operate Eel. A camera ached to te ‘prem ona evion mantor Afterthe ce dcr deed. the CBD cat Te visulzed by whasound or cholagogaphy to tla the alomy aod ey snes. the yt ary i dase os a ped. The alae sepa ba ted rove om be seni yer cut ge So ‘Wit the lprescopl procedure, ths pate does eat capsene he orate ew ht occu pet abdominal ser and fa es toperave sheila. The patel sen Sched to he Rosira ble cdc solvents. Bocas the rocedine rau no nis ad | opinion, penta ae uae as onoaden ut oul Sever Sos are necviany Tat pssst lage Doon repced by Japacoic cielecietm. PSWI rated in some comer or = all porecnage of sabe pens (has wh CRD stones who may. note Sri! candidates) sometimes conbrion wih tsar therapy (Getdmun eta 2015 Kerman kel 2018) ‘Surgical Management ‘Suri ween of alba scan elites aid onto relieve holes Strpey maybe desyed an the pen’ symp have fncdeeoritmay be poomed a an emergeney posed, nce Uy the pavers endsion Preoperative Measures Ces sty, econ, and ive uncon ess may be perfor a ‘dione inaging st foe ella Vitamin Kay be give i he ror evel stove Nuon! rgurenent ae coeed i he Suna a opal maybe ecevay to pode 1V lao wh Dron spent oa wound Rings lp pct Iver camaze ate edt fo aller suger ssa ott fe ae) ope voi! lpr or psc nsracons and exlanions a gen Sears a! turing sd deep healing Postoperative por nd lea can Be aed by deepening cernr, nae aig nd fy ambulon, The patie shoul! fe ifrmed tht nage tes sod 3 fuogistic tute aad suclon mga ke syed dng the immed stoperaing prods anapen lesen is efored Laparoscopic Chelecstetony Lapuoscope clei (ee Fp 45) te stand of therapy for ‘papa ln Aprninay 7000 path ie ier them oe cannes for laparoscopic chosen (Braco, 201 {Cres & Carta, 200 Feldman eta, 2016, Goldman & Stale 201, ite CAD i thou io be obstuse by '2 allen, an ERCP with (Groncards 2019; Cameron & Cameron 200; Goldman & Se 2008 Littlefield & Lenhan, 2019; Mow ea 2019), " a7 Luana can dts cll inthe galtiader or died CBD with Sore aecaacy (Srecur, 201% Goldman & Soler, 2019; Lileld & [paar 201; Mo tsa Hal 2019 Radionuclide inaging of Cholscinigraphy Choline sos in the dag of acute cea or Roskaee of Sle dct Gmc, ms Gnan & See, 2 radoetve agents administered intravenously (IV), which i taken up by the heats and excreted rapidly trough he ily act The lay tas Sense lie ft ular i td. ht ‘pose te pet raion Ion ad when ssnepany Sot fone sac snacks esis (Brae, 2019: Goan & Scat 2519 Lite @ Lena 201% Mou eal 2013 Oral Chelecystography ‘rl eokestopaphy used lsc exupment i pat avai ri he Usd resus ae neondasive. Tis stay may be performed to Gee falstnes a6 ase the aby of the gallate il conenate 13 ctr enact and ey If the pt a6 ale snes sean fn inddecoiaming.contas. agers that iv exerted by she Tver and Soocented nthe glare pve 1 9 12 hue foe the xy say (Bruin, 201%, Goldman & Scale 209; Lill © Lend, 2019 ‘ral teeny maybe ied as pa ofthe evauaton of pens wba oon teed ih gallon soltinn therapy (he ass of Idiom to trak ypsove glstns) or Mbotepy (sagan of palmer sy sock wate) [Endoscopic Retrograde Cholanglopancrestography Endo erie chungipancrateraphy ERCP) pss eet Ip This posed carne he hpaory pie wa 9 he \ewing eile feo endoscope insted though He esp hag Yo the Sescedig ode ee Fe 3). Mule Psion canes ate Taubes 1s paste endoscope daring th proslue Bepag oC sempre 20outa sh Enon tape chobrgparcealeay. A inure ncorum: he snpuiacar hese aro "Syma to tneeta feted The recaure f apo pretence and Iuaton of ctl arse. Celeron fs eater toa {he endeerpe into te CHD bth mot npn epi since {Given ofthe msc of ela phate for galizone exci 98 slain of suypcted CBD sone: Sut can be used teat confmed| Sholedcholthiadr tere or Sang lapaesopiccholspesomy ‘Branca, 2019; Cameron & Cameron, 3120, Nursing notions 21 Several nde ate we oreo acest were not removed a the ine Sf eleytectcy erate Becume loge fhe CBD oe Fig 424A.) A hoe inter ths bet ach oe tended tag the Eb tractor Fla frmed ake time of ee nero the Bt ee Teove andro fe sone aged in he common ile at "hwnd procedure wave th in fhe ERCP dope ae Fig sc) Ath endoscope ines eating instruments ped ough he {sit te samc Fier, ppl fhe spine of O48} erin the poring, which aay alow ihe lodged stn to fss spotty i the ‘Soon Ano set witha sal se or loos ip ey be Inert trough te endoscope to reseve estan (ase Tip 4-aDe!) The Fete saver closely leding person andthe development oF Tancredo) or ses “The ERCP pocoe i prulay seul a gress and weet of| ates ho ave sympa Way tac sugey alent st Dlblaer nd pases orem gery parc had Irvacorpoveat ioupay ‘sf devist tat cn dsingssh betwen snc and te The Taser ple Produce pi expuson sn dsnegrton of plc onthe soe uf, fei it mca ink weve nce yes re premre waves tht ste ns to rape Thi tose sth be Sed Ferencnsly wih eee or balloon cate apa or by ect sting te can be ised to alg for biiary Secampesan and pret tone inycto lathe common ile dst. Tl apposch lls ne Fee erovemct pe cal contin ul alioes a lee ‘sacl, psu ors eracorprea Shock Wave Linotipy asa neve ay (ESL) a el soa Tepes ick wats edt he alone nthe ane of CBD 0 {immer the sons The waves ae amid To the body though ls fied tag ar by nese the palin water bu. Aer the nese yl oy sone faeces psd 5igre 444+ A, roots fo eovg gatetoes. Nonsurgical Ramoval of Gallstont Dissohing Galstones Several method avs bon wed oso ality inion of ter (oneocanon or met erary bu ee [MBE] othe gar The solvent cas be inaed tough the falsing ross! Hough ade o htc nt octal ey te eb gh ae ‘aren: endomapialy wih FRCP; ois a ancl lary ether ‘acy bed goose dc YK lace of siete, pore ieee and ‘eeurence tues of upto SM (Gotinan A Shafer, 201% Townend Beauchamp ver ea 2010, Spun tsuneo ithe sandr for management. Dison sherapies esa for tse pets who may no fe cance or the power duct say comers reztig geal asia (Gada & Sout 200: Towable al 2008, ‘Stone Removal y Instrumentation sms Bete ERCE, the pt i test sbout he proce andl io “This regu analy suey sn ate he ero of teense Toten: taker stingy moth fr sever os before he proces, The FPosedue rote rmenos (IV) sedan ane monitored rests care It Some cases general neta regi, nd he edt ptt smeared sly den an arth cs ra, 2019) ty beeen cannulation easer by decreasing duodenal persalsis, The nurse observes Stosey for signs of tester and CNS” depesion. Iypteston, Sresedsn, and vorticg i eluagoa I gen). Dutag BRC. the ase The paces he nr maior he pets condo, observing vil igs tnd sessing sigs of eorsin or neton There aso manors the Fol for side ete o ay motezins esd ding te oc Percutaneous Transhepatic Cholanglography Percutanesas trsoate colaegozahy (PTC) sey ese fe dagosic Parnes lone du fo sua ofr ss vas and eb trang Seis POC i rsved fr hose patel fn Wor a EEC Be esa dete previou sigan iverng ee ir tact ric 201; Caneron 1 Cameron, 2020 Feldman aly 2015) The ue f BTC ht any eer Tepiced by FRCP and’ tagoetc resonance colmpopencenogey IRIRCR). PTC inves te ieton of dhe dey no the bay tac, Becnse ofthe realy lage concern of dye i ode bay sen, ting the pate dacs win the er teenie eg of The cmman ie dhe se ct andthe elder oui lea “hs proce cat be cae et the presence of Tne yuncion and janice is uel for dsingustingjurdce cased 8) ver dase {heater ami) fm al cued by ny eben, ive She Gl symptoms fa pation woe gale hasbeen removed laine Sones win the ble-dics ant Sagroing cancer ivaving the bia ‘sem (Brin, 2019; Cameron & Cameron, 2020, Feloman ea 2016 Ths tae cedures pred ener Mere sean ot» pet wha bes fasting hepato wees lel anaes Caguaon| nme and pit cnt shld be normal minimize the sk of sing. Brasspscrim anise ar piven daring he procedure Psst the high preva of tata saonzton rm tseuce lay ‘sens (li eta 2016 Brae, 2019, Canoe & Caco, 2020, ited ah err the np dente miler ne mein'y oes erg costa azn Soest enty of dot sted whe le spate en tn of centage Uasund can be wed gue smpuncture of the dct. ile apes, and samples a set for batiogy End eying (Brncans 2019 Flan ea, 2016: Kellman & Rake 2508, Awatcslabe sonra agen etd il the iy ten Te ‘orosspy bled ad the ae epson alow ere {ake in multpe poets Dele wry views an hes abvormalies St more Wis dics and deerme the leg a a sete wr mull |notke peroneal cav, ths ian te isk ile eons, Nursing Inpistions owe the compiccon rte aor is poco is ow, she ur ms los sre th ptt Zoe symptoms of ekg, pets, an ep The muse ase he ae for pain nd esion 6fBese compinons| spleen em ye pian rie, kes ese ea ‘eonimiv tek of epi an i hock Medical Management ‘The major objets of mdi therapy are to redaethe insiene of wae ssisdes of zalblaer pr and colette by sopponive and isan ‘uragarent and, If posible wo vetoxe the cate of cleat ty harsuccige heap), wndoeoic procedure, of sti rence, [loupe procedure cin is sure wh ey es presser ae seneied ith pete rpioms oro Roe Trmaion Most of the norsuical aprons, cng Iihsps and issn of glstns, provide ely tmp) solulens to gallstone Poti aw eeucy ued pte Unie Stn se stn (her rearent sppanes mayb nid tena dene ae, ‘Gholeystetomy (emote gander) Ioush waar sui arostes has langly bec epied By lpaoscopic tole (Gamoval of te gala tough all son trough the uate) (stele ssn). Avareml supe kahve ceeaed seg wih \enph of Roel may andthe ong covery prod reed fer andi ‘peal chleeectom. In retely roe Insances» sandad sail ocecure tay be cs, [Nuttonal and Supportive Therapy Arprovimste'y 0% ofthe pans sith ss galanin ‘thle reson mith zo 1 de easgasie scion. stale, and fhe gona Unless the pues codon dees, sai ‘Stavrton eyed jst lr are eyupines ee (sly wl m5 {Bran 0; Cen Caen 30 aan Soe 208) inl pomeedsapemens heh i rots até carbo ne no ‘him mie Cooked fats ise otic, leo meats masked poss, om sting veel, ted calle, oa ay beaded a le The Fler sod nid eas sean pr, fed ody ches rch eng “eming veges, ab Senor npr so end he pes ay fede may face an eps cole Diesry mansemet may be aj ode of hrapy In poll wo he ad only ary lore fo {ty ods nl vague syngas & Rak, 2018), Pharmacologic Merapy Ussodeoncholic acd (UDCA) and chenodeoxychole acd endl ot {CbcA) have been wood to dase smal itce elses composed Femaiy of colt! (Gadean Shale 2019) UDCA hs lower sie "fe as y ining the nes and raeson of shlesrateeby ‘sae ie. Troumnt wie UDCA ca rouse so sisting ones, ‘sco sal stn, nd poset no Sones Lars So 12 nt fr hap reused in mary pens lo dane one and manag of the pater orrsunence ftps othe scree af ieee (ep Gi Smpioms, rch i oq rng he tne The efeine thse of medion dps en body weleM. TAS wetod of eatee fowtly lected for pails wh rls scpey ee fe hn gery i fSnminnes The sce rate of ths therny lw a te rears {swing i igh (Gama & Shae, 201) Potts wih een syepioms ei ct oseson,o pigment stones tae ot cant for phurmacloge Weep Lapscni oof hole tiny mor ampere er yom pes wah cepa Spersve ik Goluman Shae 2019),