I. Disease knowledge
1.What is acute pancreatitis?
Acute pancreatitis is an acute chemical inflammation caused by the digestive enzymes of the pancreas digesting itself.
2.Etiology and causative factors
Biliary tract disease is the main cause, alcoholism, overeating, mood swings, trauma, etc. are often its triggers.
3.Symptoms
The symptoms are persistent right upper abdominal pain, accompanied by nausea and vomiting. Simple edema type pancreatitis can be cured by non-surgical treatment: hemorrhagic necrotizing pancreatitis and rare, the condition is dangerous, the course of the disease is long, once diagnosed, easy to operate as soon as possible.
Second, preoperative guidance
1. Diet: fasting. Because after eating, food into the duodenum, prompting the pancreatic fluid secretion, aggravate the duodenal papilla edema, biliary sphincter spasm and increased pressure in the duodenum, duodenal fluid backflow into the pancreatic duct, aggravate the condition. If the condition is stable and allowed to eat, a small amount of fluid diet with little oil can be used as appropriate, and then increase the diet part by part, but fatty foods should be restricted, because fat can prompt bile secretion, bile activates the pancreatic secretion of various digestive enzymes, aggravating the condition.
2, position: absolute bed rest, including urination and defecation in bed. Take a semi-recumbent position to loosely hold the abdominal muscles, reduce pain, and facilitate drainage of the gastric tube and the flow of abdominal exudate to the pelvis to prevent subdiaphragmatic abscesses.
3, gastrointestinal decompression: suck out acidic gastric juice so that it does not stimulate pancreatic secretion, and also has a therapeutic effect on the intestinal paralysis caused by the disease. Gastrointestinal decompression can be stopped when abdominal pain and vomiting basically disappear.
III. Postoperative guidance
1, diet: fasting, and long time. Because the postoperative gastrointestinal tract has many fistulas, in order to reduce pancreatic secretion, the fistula should be maintained for a longer period of time, so you can not eat, fasting can also avoid acidic chyme leading to increased pancreatic secretion.
2, position: after the blood pressure is stable, take a semi-recumbent position, in order to facilitate adequate drainage of the abdominal cavity, and facilitate breathing.
3, drainage tube care instructions.
(1) abdominal drainage tube: its purpose is to exclude toxic exudate and exclude secondary necrotic tissue in and around the pancreas, because residual necrotic tissue can lead to abdominal abscess if not drained in time. Do not remove the drainage tube at will and prevent distortion and pressure.
(2) Pancreatic bed flushing tube: it can flush out various enzymes, necrotic tissues, pus and toxins contained in the abdominal cavity, and the prognosis of the disease is directly affected by the good or bad flushing. When flushing, the patient should be instructed not to turn off the flushing device at will to ensure the flushing effect, and to tell the medical staff if abdominal pain and distension appear during flushing so that the flushing speed can be adjusted.
(3) Gastrostomy tube: It can reduce gastric acid stimulating pancreatic secretion through body fluid factor and decompress the gastrointestinal paralysis at the same time. Attention should be paid to the color of gastric fluid drainage, which should generally be dark green, and should be promptly reflected if there is sudden drainage of hemorrhagic fluid.
(4) Cholecystostomy port: drainage of juice, reduce the pressure of the pancreaticobiliary duct, and prevent infected bile from refluxing into the pancreatic duct and aggravating the disease.
(5) jejunostomy tube: to reduce gastrointestinal secretion and allow the pancreas to rest adequately. Generally, about 1 week after surgery, fluid diet can also be dripped through this tube, such as elemental diet, vegetable soup, etc., to supplement part of the body’s nutritional consumption. It should be noted that during the drip process, the patient should not drop the drip rate at will, and pay attention to any abdominal pain, bloating and other reactions, and adjust the drip rate and diet concentration in time to adapt to the intestinal function.
4. In case of complications of extra-pancreatic fistula and intestinal fistula, explain to the patient and family the reason for continuous negative pressure to attract the leaking fluid and protect the skin around the fistula with zinc oxide ointment to prevent the occurrence of dermatitis.
5. Complication prevention.
(1) Keep the mouth clean and insist on gargling with a mouthwash such as Mouth Tai or Dopey’s solution to prevent bad breath, mouth ulcers and infection. Because the patient fasted for a long time, the secretion and accumulation of saliva not only cause bad odor in the mouth, but also promote the growth of bacteria causing the above symptoms.
(2) Patients spend a long time in bed, so they should be turned regularly, once every 2 hours, to reduce local ischemia due to long-term pressure, and to move both lower limbs to prevent decubitus ulcers and venous embolism of the lower limbs.
(3) Encourage the patient to insist on effective coughing and deep breathing, and use ultrasonic nebulized inhalation to assist in sputum excretion to prevent pulmonary infection and pulmonary atelectasis. Because of the patient’s heavy condition and long-term bed rest, sputum is easy to deposit at the bottom of the lung and accumulate to cause infection.
IV. Discharge guidance
1.No alcohol, no large amount of fatty food, especially in the near future should eat low-fat food, avoid overeating to avoid relapse.
2, pay attention to rest, avoid exertion, emotional pulsation and tension, according to the recovery of the disease, generally six months later can be engaged in light work.
3.When there is abdominal pain and abdominal distension, you should consult a doctor in time.