Choledocholithiasis Patient Applied to Endoscopic Retrograde Cholangio Pancreatography (ERCP) and Nursing Care: A Case Report
Abstract
Choledocholithiasis refers to the presence of gallstones in the common bile duct. Choledocholithiasis is more common in the elderly due to physiological dilatation of the common bile duct with age. Choledocholithiasis usually causes abdominal pain defined as biliary colic. It is accompanied by nausea and vomiting. Many complications such as acute cholangitis and acute biliary pancreatitis may develop in patients with choledocholithiasis. The aims of nursing care in patients with choledocholithiasis with complications are to detect signs and symptoms early, to provide self-care, to improve quality of life and well-being, to plan appropriate nursing interventions before, during and after the Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure, to follow the complications that may develop during and after the ERCP procedure and to implement the necessary nursing interventions, and to educate the patient and his family. A 56-year-old patient with a known diagnosis of ulcerative colitis (27 years), arrhythmia and DM presented to the emergency department because of fullness and pain in the epigastric region for 12 days and was admitted to the ward with a diagnosis of choledocholithiasis. The case was evaluated with Marjory Gordon's Functional Health Patterns Nursing Care Model and nursing care was provided. The necessary permission was obtained from the patient and her family for the study and publication. The nursing diagnoses of acute pain, nausea, hyperthermia, nutrition less than the body requirement due to anorexia, activity intolerance due to fatigue, deterioration in skin integrity due to jaundice and itching, fluid electrolyte imbalance, inadequacy in individual coping, and lack of information were determined.
Keywords
References
- Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: Natural history of choledocholithiasis revisited. Annals of surgery. 2004;239(1):28. http://doi:10.1097/01.sla.0000103069.00170.9c.
- Figueiredo JC, Haiman C, Porcel J, Buxbaum J, Stram D, Tambe N. Sex and ethnic/racial-specific risk factors for gallbladder disease. BMC gastroenterology. 2017;17(1):1-12. https://doi.org/10.1186/s12876-017-0678-6.
- O’Neill CJ, Gillies DM, Gani JS. Choledocholithiasis: Overdiagnosed endoscopically and undertreated laparoscopically. ANZ journal of surgery. 2008;78(6):487-91. http://doi:10.1111/j.1445-2197.2008.04540.x.
- Park CH. The management of common bile duct stones. Korean J Gastroenterol. 2018;71(5):260-3. http://doi:10.4166/kjg.2018.71.5.260.
- van Dijk AH, de Reuver PR, Besselink MG, van Laarhoven KJ, Harrison EM, Wigmore SJ. Assessment of available evidence in the management of gallbladder and bile duct stones: A systematic review of international guidelines. Hpb. 2017;19(4):297-309. http://dx.doi.org/10.1016/j.hpb.2016.12.011.
- Jinfeng Z, Yin Y, Chi Z, Junye G. Management of impacted common bile duct stones during a laparoscopic procedure: A Retrospective Cohort Study of 377 Consecutive Patients. Int J Surg. 2016;32:1-5. http://dx.doi.org/10.1016/j.ijsu.2016.06.006.
- Viriyaroj V, Rookkachart T. Predictive factors for choledocholithiasis in symptomatic gallstone patients. J Med Assoc Thai. 2016;99(8):112-7.
- Copelan A, Kapoor BS. Choledocholithiasis: Diagnosis and management. Tech Vasc Interv Radiol. 2015;18(4):244-55. http://doi:10.1053/j.tvir.2015.07.008.
- Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic accuracy of MRCP as compared to Ultrasound/CT in patients with obstructive jaundice. J Clin Diagn Res 2014;8:103. http://doi:10.7860/JCDR/2014/8149.4120.
- Yang M-H, Chen T-H, Wang S-E, Tsai Y-F, Su C-H, Wu C-W. Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surgical endoscopy. 2008;22(7):1620-4. http://doi:10.1007/s00464-007-9665-2.
- Masri KR, Salyers WJ. Pentad’s triad: Revisiting reynold’s pentad. Kansas Journal of Medicine. 2012;5(3):94-6.
- Buxbaum JL, Fehmi SMA, Sultan S, Fishman DS, Qumseya BJ, Cortessis VK. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointestinal endoscopy. 2019;89(6):1075-105. http://doi:10.1016/j.gie.2018.10.001.
- Lee SY, Goh BKP, Chan CY. Chapter 55 - Etiology, pathogenesis, and diagnostic assessment of acute pancreatitis. Sixth Edit. Vols 1–2, Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas: Sixth Edition. Elsevier Inc.; 2017. 883-896.e3 p. http://10.1016/B978-0-323-34062-5.00055-8.
- Correa CSM, Bagatini A, Prates CG, Sander GB. Patient safety in an endoscopy unit: An observational retrospective analysis of reported incidents. Brazilian Journal of Anesthesiology, 2021;71(2):137-141. https://doi.org/10.1016/j.bjane.2021.02.023.
- Hasalla E, Taka I, Hasalla B, Baha S, Dybeli E. Nursing care during ERCP. International Journal of Medicine & Healthcare. 2018;3(1):17-21.
- Chen C, Sun B, Wang S, Wang S, Wang K, Hu B, Ye Z. Nursing care of patients undergoing endoscopic ultrasonography guided biliary drainage in the treatment of malignant obstructive jaundice. Chinese Journal of Nursing. 2018;53(3):310-313.
- Burtea E, Dimitriu A, Maloş A, Saftoıu A. Periprocedural role of nurses during ınterventional endoscopic procedures under deep sedation. Current Health Sciences Journal. 2018;44(1):14-18. https://doi.org/10.12865/CHSJ.44.01.02.
- Kızılcık Özkan Z. Hemşirelik sınıflama sistemlerine göre ağız ve diş sağlığı hizmetlerinde hemşirelik süreci. Balıkesir Sağ Bil Derg. 2021;10(2):194-198. https://doi.org/10.53424/balikesirsbd.775483.
- Okana N, Ito K, Takuma K, Hara S, Igarashi Y. Prevention and management of ERCP-related complications. Mini-invas Surg 2021;5(29): 1-9. https://doi.org/10.20517/2574-1225.2021.15.
- Frossard JL, Morel PM. Detection and management of bile duct stones. Gastroint Endos. 2010;72(4):808-16. https://doi:10.1016/j.gie.2010.06.033.
- Fitzgerald JEF, White MJ, Lobo DN. Courvoisier’s gallbladder: law or sign? World journal of surgery. 2009;33(4):886-91. https://doi:10.1007/s00268-008-9908-y.
- Abboud P-AC, Malet PF, Berlin JA, Staroscik R, Cabana MD, Clarke JR. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastroint Endos. 1996;44(4):450-7. http://doi:10.1016/s0016-5107(96)70098-6.
- Tse F, Barkun JS, Barkun AN. The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy. Gastroint Endos. 2004;60(3):437-48. http://doi:10.1016/s0016-5107(04)01457-9.
- Talukdar R. Complications of ERCP. Best Pract Res Clin Gastroenterol. 2016;30(5):793-805. http://dx.doi.org/10.1016/j.bpg.2016.10.007.
- Petelin JB. Laparoscopic common bile duct exploration. Surgical Endoscopy And Other Interventional Techniques. 2003;17(11):1705-15. https://10.1007/s00464-002-8917-4.
- Manoharan D, Srivastava DN, Gupta AK, Madhusudhan KS. Complications of endoscopic retrograde cholangiopancreatography: an imaging review. Abdom Radiol. 2019;44(6):2205-16. https://doi.org/10.1007/s00261-019-01953-0.
- Freeman ML. Preventing Post-ERCP Pancreatitis: Update 2016. Curr Treat Options Gastroenterol. 2016;14(3):340-7. http://dx.doi.org/10.1007/s11938-016-0097-8.
Endoskopik Retrograd Kolanjiyo Pankreatografi (ERCP) Uygulanan Koledokolitiazis Hastası ve Hemşirelik Bakımı: Olgu Sunumu
Abstract
Koledokolitiazis, ortak safra kanalı içinde safra taşı varlığını ifade etmektedir. Yaşla birlikte fizyolojik olarak ortak safra kanalının genişlemesi nedeniyle koledokolitiazis, yaşlılarda daha sık görülmektedir. Koledokolitiazis genellikle biliyer kolik olarak tanımlanan karın ağrısına neden olmaktadır. Beraberinde bulantı ve kusma eşlik etmektedir. Koledokolitiazisli hastalarda Akut kolanjit, Akut Bilier Pankreatit gibi pek çok komplikasyon gelişebilmektedir. Komplikasyon gelişmiş koledokolitiazisli hastada hemşirelik bakımının amaçları; belirti ve bulguları erken tespit etmek, bireylerin öz bakımlarını sağlamak, yaşam kalitelerini yükseltmek ve iyilik hali kazandırmak, Endoskopik Retrograd Kolanjiyo Pankreatografi (ERCP) işlemi öncesinde, esnasında, sonrasında uygun hemşirelik girişimlerini planlamak, ERCP işlemi sırasında ve sonrasında gelişebilecek komplikasyonları takip etmek ve gerekli hemşirelik girişimlerini uygulamak, hasta ve ailesini eğitmektir. 56 yaşında olduğu bilinen ülseratif kolit (27 yıldır), ritim bozukluğu, DM tanıları olan hastanın 12 gündür epigastrik bölgede dolgunluk ve ağrısı nedeniyle acile başvurmuştur ve koledokolitiazis tanısı ile servise kabul edilmiştir. Olgu Marjory Gordon’un Fonksiyonel Sağlık Örüntüleri Hemşirelik Bakım Modeli ile değerlendirilerek, hemşirelik bakımı verilmiştir. Hastadan ve ailesinden çalışmanın yapılması ve yayınlanması için gerekli izin alınmıştır. Olguda akut ağrı, bulantı, hipertermi, iştahsızlığa bağlı vücut gereksiniminden az beslenme, yorgunluğa bağlı aktivite intoleransı, sarılık ve kaşıntıya bağlı cilt bütünlüğünde bozulma, sıvı elektrolit dengesizliği, bireysel başetmede yetersizlik, bilgi eksikliği hemşirelik tanıları belirlenmiştir.
Keywords
References
- Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: Natural history of choledocholithiasis revisited. Annals of surgery. 2004;239(1):28. http://doi:10.1097/01.sla.0000103069.00170.9c.
- Figueiredo JC, Haiman C, Porcel J, Buxbaum J, Stram D, Tambe N. Sex and ethnic/racial-specific risk factors for gallbladder disease. BMC gastroenterology. 2017;17(1):1-12. https://doi.org/10.1186/s12876-017-0678-6.
- O’Neill CJ, Gillies DM, Gani JS. Choledocholithiasis: Overdiagnosed endoscopically and undertreated laparoscopically. ANZ journal of surgery. 2008;78(6):487-91. http://doi:10.1111/j.1445-2197.2008.04540.x.
- Park CH. The management of common bile duct stones. Korean J Gastroenterol. 2018;71(5):260-3. http://doi:10.4166/kjg.2018.71.5.260.
- van Dijk AH, de Reuver PR, Besselink MG, van Laarhoven KJ, Harrison EM, Wigmore SJ. Assessment of available evidence in the management of gallbladder and bile duct stones: A systematic review of international guidelines. Hpb. 2017;19(4):297-309. http://dx.doi.org/10.1016/j.hpb.2016.12.011.
- Jinfeng Z, Yin Y, Chi Z, Junye G. Management of impacted common bile duct stones during a laparoscopic procedure: A Retrospective Cohort Study of 377 Consecutive Patients. Int J Surg. 2016;32:1-5. http://dx.doi.org/10.1016/j.ijsu.2016.06.006.
- Viriyaroj V, Rookkachart T. Predictive factors for choledocholithiasis in symptomatic gallstone patients. J Med Assoc Thai. 2016;99(8):112-7.
- Copelan A, Kapoor BS. Choledocholithiasis: Diagnosis and management. Tech Vasc Interv Radiol. 2015;18(4):244-55. http://doi:10.1053/j.tvir.2015.07.008.
- Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic accuracy of MRCP as compared to Ultrasound/CT in patients with obstructive jaundice. J Clin Diagn Res 2014;8:103. http://doi:10.7860/JCDR/2014/8149.4120.
- Yang M-H, Chen T-H, Wang S-E, Tsai Y-F, Su C-H, Wu C-W. Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surgical endoscopy. 2008;22(7):1620-4. http://doi:10.1007/s00464-007-9665-2.
- Masri KR, Salyers WJ. Pentad’s triad: Revisiting reynold’s pentad. Kansas Journal of Medicine. 2012;5(3):94-6.
- Buxbaum JL, Fehmi SMA, Sultan S, Fishman DS, Qumseya BJ, Cortessis VK. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointestinal endoscopy. 2019;89(6):1075-105. http://doi:10.1016/j.gie.2018.10.001.
- Lee SY, Goh BKP, Chan CY. Chapter 55 - Etiology, pathogenesis, and diagnostic assessment of acute pancreatitis. Sixth Edit. Vols 1–2, Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas: Sixth Edition. Elsevier Inc.; 2017. 883-896.e3 p. http://10.1016/B978-0-323-34062-5.00055-8.
- Correa CSM, Bagatini A, Prates CG, Sander GB. Patient safety in an endoscopy unit: An observational retrospective analysis of reported incidents. Brazilian Journal of Anesthesiology, 2021;71(2):137-141. https://doi.org/10.1016/j.bjane.2021.02.023.
- Hasalla E, Taka I, Hasalla B, Baha S, Dybeli E. Nursing care during ERCP. International Journal of Medicine & Healthcare. 2018;3(1):17-21.
- Chen C, Sun B, Wang S, Wang S, Wang K, Hu B, Ye Z. Nursing care of patients undergoing endoscopic ultrasonography guided biliary drainage in the treatment of malignant obstructive jaundice. Chinese Journal of Nursing. 2018;53(3):310-313.
- Burtea E, Dimitriu A, Maloş A, Saftoıu A. Periprocedural role of nurses during ınterventional endoscopic procedures under deep sedation. Current Health Sciences Journal. 2018;44(1):14-18. https://doi.org/10.12865/CHSJ.44.01.02.
- Kızılcık Özkan Z. Hemşirelik sınıflama sistemlerine göre ağız ve diş sağlığı hizmetlerinde hemşirelik süreci. Balıkesir Sağ Bil Derg. 2021;10(2):194-198. https://doi.org/10.53424/balikesirsbd.775483.
- Okana N, Ito K, Takuma K, Hara S, Igarashi Y. Prevention and management of ERCP-related complications. Mini-invas Surg 2021;5(29): 1-9. https://doi.org/10.20517/2574-1225.2021.15.
- Frossard JL, Morel PM. Detection and management of bile duct stones. Gastroint Endos. 2010;72(4):808-16. https://doi:10.1016/j.gie.2010.06.033.
- Fitzgerald JEF, White MJ, Lobo DN. Courvoisier’s gallbladder: law or sign? World journal of surgery. 2009;33(4):886-91. https://doi:10.1007/s00268-008-9908-y.
- Abboud P-AC, Malet PF, Berlin JA, Staroscik R, Cabana MD, Clarke JR. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastroint Endos. 1996;44(4):450-7. http://doi:10.1016/s0016-5107(96)70098-6.
- Tse F, Barkun JS, Barkun AN. The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy. Gastroint Endos. 2004;60(3):437-48. http://doi:10.1016/s0016-5107(04)01457-9.
- Talukdar R. Complications of ERCP. Best Pract Res Clin Gastroenterol. 2016;30(5):793-805. http://dx.doi.org/10.1016/j.bpg.2016.10.007.
- Petelin JB. Laparoscopic common bile duct exploration. Surgical Endoscopy And Other Interventional Techniques. 2003;17(11):1705-15. https://10.1007/s00464-002-8917-4.
- Manoharan D, Srivastava DN, Gupta AK, Madhusudhan KS. Complications of endoscopic retrograde cholangiopancreatography: an imaging review. Abdom Radiol. 2019;44(6):2205-16. https://doi.org/10.1007/s00261-019-01953-0.
- Freeman ML. Preventing Post-ERCP Pancreatitis: Update 2016. Curr Treat Options Gastroenterol. 2016;14(3):340-7. http://dx.doi.org/10.1007/s11938-016-0097-8.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Olgu Sunumları |
| Authors | |
| Early Pub Date | November 10, 2023 |
| Publication Date | November 20, 2023 |
| Submission Date | April 3, 2023 |
| Acceptance Date | August 4, 2023 |
| Published in Issue | Year 2023 Volume: 18 Issue: 3 |
