Nursing care for biliary obstruction in the context of regional and health disparities in Bulgaria

Abstract

Biliary obstruction is a complex medical problem characterized by mechanical obstruction of the outflow of bile from the hepatic system to the duodenum, which leads to the development of cholestasis syndrome and mechanical jaundice. The management of this disease requires coordinated efforts of a multidisciplinary team in which the nurse occupies a central place. Aim: By analyzing the epidemiology of the diseases and regional health disparities related to the treatment of diseases of the hepatobiliary system, the study aims to model nursing care as a continuous risk management process, which is of key importance for patient safety. Materials and methods: Data from the Global Cancer Observatory and the National Statistical Institute for the period 2010-2024 were used to analyze morbidity and mortality. A statistical database of the Interventional Gastroenterology Department (University Multi-profile Hospital for Active Treatment "Acibadem City Clinic Tokuda Hospital" − Sofia) for the period 2023-2025 was studied, including 12,823 individual records. Clinical protocols for diagnosis and nursing care during ERCP procedures were also analyzed. Statistical, documentary and observational methods were used. Results: Against the background of the alarming growth of malignant diseases of the pancreas and biliary system, challenges facing Bulgarian healthcare in the treatment of biliary obstructions have been outlined. The study reveals significant regional disparities and deep inequalities in access to treatment of biliary obstructions, expressed in a concentration of specialized care in large cities and a shortage of resources in peripheral areas. The critical role of the nurse in the diagnostic and treatment process is highlighted, especially when conducting high-tech procedures such as ERCP.