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Recognizing Biliary Obstruction - Article Example

Also, numerous treatment choices with possible outcomes and suggested nursing interventions based on research evidence are described. Thus, this article also satisfies the PICO model for evidence based nursing which represents the problem identification of the patient, interventions suggested, contrasting treatment options and possible outcomes. This essay presents the summary of chosen paper, consideration of research findings of authors, its relevance to clinical practice and the possible benefits of their application. This article focuses on a frequently occurring disorder biliary obstruction; which affects significant number of people in a population with an estimated rate of 5 per 1000 people. Biliary obstruction or cholestasis is caused by disruption in the flow of bile from liver (where it is synthesized as exocrine secretion) to duodenum (where it assimilates fats and bilirubin). Bilirubin is formed as a by-product of hemoglobin breakdown in spleen and its metabolism is dependent upon uptake, storage, conjugation and secretion. The conversion of un-conjugated bilirubin to water soluble conjugated bilirubin is carried out by hepatocytes in liver and thus secreted into bile. From where it travels in intestine and is finally eliminated in feces in the form of urobilinogens. Excessive amounts of conjugated bilirubin in urine and blood causes hyperbilirubinemia which is characterized by icterus or jaundice. Clinical detection of jaundice occurs at serum bilirubin levels of least 3mg/dL.3

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while normal levels range below 1mg/dL. The basic etiologies for cholestasis may occur due to factors like biliary strictures or by metabolic causes like hepatotoxicity. Also, it can occur due to intra-hepatic or extra-hepatic reasons. Interruption in bile flow at hepatocyte or biliary canal membrane level is known as intrahepatic cholestasis and generally caused by hepatitis, cirrhosis or primary biliary cirrhosis. Restricted bile flow at biliary ducts system results in extra-hepatic cholestasis and can either be intra-ductal or extra-ductal. Generally, gallstones are the major cause of intra-ductal obstruction along with biliary strictures, dyskinesia, primary sclerosing cholangitis and neoplasms. Reasons for extra-ductal obstruction include malignant or benign neoplasms, tumors or pancreatitis (Habib and Saunders, 2011). Physical signs for this disease may include pain, weight loss, pruritus, anemia, malignancy, diarrhea, fever, GI bleeding, darker colored urine, pale stools, jaundice, diabetes, excoriations etc. The diagnosis must be based upon blood liver function test and imaging studies including trans-abdominal ultrasonography, endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound is most accurate in diagnosis however; trans-abdominal ultrasonography is considered the initial evaluation choice due to its sensitivity and inexpensiveness. CT is used to assess the specific cause and degree of obstruction. MRCP accurately measures the level of obstruction in bile and pancreatic ducts. ERCP combines endoscopic and radiographic technologies and is considered a standard in diagnosis and therapeutic treatment (Habib and Saunders, 2011). Nursing interventions for patients with biliary obstruction include assessment of physical signs and symptoms, recommending lab screening test and imaging diagnosis and most importantly
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The article “Yellow Bird of Jaundice: Recognizing Biliary Obstruction” discusses a commonly occurring disorder biliary obstruction, its underlying etiology, basic patho-physiology, diagnostic tests and available treatment options. There are several reasons for which I chose this article…
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