Question

Define ERCP and indication for it based on this patient’s status. Which results are abnormal, and what do they reflect? The patient then undergoes ERCP and the stones and bile are released, but imaging indicates a stone is still within the cystic duct and gallbladder. A surgeon was consulted and a laparoscopic cholecystectomy was ordered. List four to five preoperative orders that will likely need to be done before the patient goes to surgery. If he had a laparoscopic cholecystectomy, which discharge instruction would the nurse advise the patient: (explain the rational for the correct choice). Keep the incision areas clean and dry for at least a week Report he need to take pain medication for shoulder pain Report any bile-colored or purulent drainage from the incisions Expect some postoperative nausea and vomiting for a few days

Answer 1

1. ERCP and its indication:-
- Endoscopic retrograde cholangiopancreatography (ERCP) is used both in the diagnosis and the treatment of many pancreatic and biliary diseases.
- ERCP provides information of the pancreaticobiliary system which we can not find by endoscopic ultrasound.
- It is a less invasive than open surgery for the management of several pancreatic diseases.

INDICATION:-
- Choledocholithiasis (gallstones in the common bile duct (CBD) and cystic duct.)
-Acute pancreatitis due to biliary obstruction, sphincter of Oddi dysfunction.
-pancreatic and biliary malignancy.
-Palliative therapy for inoperable.
-pancreaticobiliary malignancies.
-Chronic pancreatitis

2. Peri operative precautions:-
- General anesthesia
- Stomach must be completely empty to avoid vomiting during and after surgery.
- Nothing may be taken by mouth after midnight, and smoking is prohibited.
- Blood "thinning" medication must be discontinued several days before the operation to avoid excessive bleeding during the procedure.
- Preoperative tests include blood tests, a chest x-ray, an EKG, and a urine examination.

3. Correct answer:- (c) report any bile-colored or purulent drainage from the incision.