Please enable JavaScript.

Coggle requires JavaScript to display documents.

Biliary Disorder (management (supportive (emergence of supreimposed…

- - - - gallstone dissolution
        
        oral therapy: Ursodeoxycholic acid (UDCA) *not common
        
        local infusion of cholelitholytic agent via PTBD
  - - - initial antibiotics treatment:
        - Cephalosporin: Cefuroxime(Zinacef)
        - Metronidazole (Flagyl)
      - broadening antibiotics: ampicillin, gentamycin, clindamycin
  - - - symptomatic cholelithiasis
      - asymptomatic cholelithiasis with increased risk for carcinoma/ complication
      - acalculous cholecytitis
      - gallbladder polyps >0.5 cm
    - - ERCP with endoscopic papillotomy & stone extraction followed by laparoscopic cholecystectomy
      - LC & laparoscopic common bile duct exploration with laparoscopic cholangiogram (IOC) / LUS with high success rate
      - CBD followed by OPEN cholecystectomy
      - PTBD
- - - - types
        
        cholesterol stone (increase synthesis of cholesterol)
        
        pigment stones (excess unconjugated pigment of the bile)
      - female have higher chance
      - higher than 40 ages
      - obesity/DM
  - - - calculous cholecystitis/ acalculous cholecystitis (no stone)
      - untreated --> lethal
    - - thickened & fibrotic gallbladder
      - causes
        
        repeated cholecystits
        
        calculi
        
        chronic irriation
      - poor contractility & dysfunction
- - - - detect INTRAhepatic biliary obstruction - caculi, tumours, strictures, injuries
      - detect EXTRAhepatic biliary obstruction - caculi, tumours, pancreatitis, pancreatic duct abnormalities
    - - lithotripsy
      - stent placement for strictures
      - ST
      - Choledochostomy
        
        placement of ND
        
        indication
        
        acute cholecyctitis
        
        evacuation of stone s & drainage of bile till oedema subsides
- - - - maintain NG decompression
      - connect to drainage bag + hourly aspiration
    - - remains approximately 10 days
      - risks
        
        incidence of stricture in biliary tract
        
        bile peritonitis: bile leaks at anastomosis, tube dislodgement
      - exit site: observe for S/S of bleeding, haematoma, infection
      - avoid exertion & traction
      - maintain patency of T-Tube
      - note amount, colour, odour first dew hr
      - removal of T-Tube
        
        slowly withdraw
        
        may creates an orifice which leads to bile extravasation
        
        bile may leak till complete closure of the former t-tube insertion site
  - - - RUQ pain
      - abdominal distension
      - fever & chills
      - jaundice
      - nausea & vomiting
      - unusual characteristics of drainga