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HCC Hepato Biliary

Pancreas Function Secrete Insulin, glucagon, Amylase, and Lipase
Pancreatitis Autodigestion of the pancreas from premature activation of digestive enzymes(amylase and lipase)
Pancreatitis S/sx severe, constant, knife-like pain RUQ gastric and or radiating to the back and is unrelieved by N&V, jaundice, hyperglycemia. Worse when lying down or eating. Some relief in fetal position.
Primary Causes of Pancreatitis Alcoholism, ERCP, and biliary tract disease (gallstones can cause blockage where the common bile duct and pancreatic duct meet).
Pancreatitis Triggers Intake of large amounts of fat and/or alcohol.
Serum Amylase 25-125. Rises within 12hrs and lasts 4 days, urine amylase also remains elevated for up to 2 weeks
Serum Lipase 10-140. Rises slow and lasts up to 2 weeks
Positive Pancreatitis Amylase 2-3 times the normal value and Lipase 3-5 times the normal value
Other Lab Values Assoc. c Pancreatitis Serum Ca and Mg levels decreased due to fat necrosis. Serum liver enzymes and bilirubin levels elevated, WBC elevated due to infection and inflammation. CT scan with contrast.
Pancreatitis Assessment/Monitor Pain level, nutritional status, bowel function, blood glucose levels, diet and alcohol intake Hx, F&E status.
Nursing Interventions of Pancreatitis NPO until pain free! nasogastric tube(gas decompression), TPN, no alcohol, no smoking, limit stress.
Post pancreatitis diet Bland, low-fat with no stimulation. SMALL FREQUENT meals rather than large.
Pain management with Pancreatitis DEMEROL, know this medication. Position client side lying fetal c HOB elevated or sitting up/leaning forward.
Donnazyme(pancreatin) and Viokase(pancrelipase) Pancreatic enzymes, take with meals and snacks to aid in digestion of fats and proteins.
Pancreatitis Monitoring Hydration. Monitor for orthostatic BP, intake and output, lab values, hypocalcemia, tetany, Trousseau's sign, Chvostek's sign.
Trousseau's Sign Hand spasm when blood pressure cuff is inflated on that arm
Chvostek's Sign Facial twitching when facial nerve is tapped.
Pancreatitis Hypovolemia Up to 6L can be third-spaced, retroperitoneal loss of protein-rich fluid from proteolytic digestion.
Pancreatic Cancer Vague symptoms and usually diagnosed in late stages after liver or gallbladder involvement. High mortality rate, less than 20% live longer than 1 year
Pancreatic Cancer Risk Factors Age 60-80, smoker.
Wipple Removal of the head of the pancreas, duodenum, parts of the jejunum and stomach, gallbladder, and possibly the spleen. The pancreatic duct is connected to the common bile duct and the stomach to the jejunum.
Pancreatic Cancer Tx MORPHINE. Post-op care, monitor glucose levels, nutritional support
Complications of Pancreatic Cancer Most common is venous thromboembolism. Fistulas, peritonitis
Demerol (meperidine) Opioid analgesic, binds to receptors in CNS, produces CNS depression. SE's: SEIZURES, CONFUSION, SEDATION, HYPOTENSION, CONSTIPATION, N&v, respiratory depression.
Morphine (Astramorph) Opioid analgesic. Binds to opiate receptors in CNS, causes CNS depression. SE's: RESPIRATORY DEPRESSION, CONFUSION, SEDATION, HYPOTENSION, CONSTIPATION
Hepatitis Inflammation of the liver. A, B, C, D, and E. Carriers can spread the disease without showing any symptoms of the disease.
Hepatitis A(HAV) Oral-fecal route, ingestion of contaminated water/food.
Hepatitis B(HBV) Blood, drug abuse, sexual contact, healthcare work.
Hepatitis C(HBV) Blood, drug abuse, sexual contact.
Hepatitis D(HDV) Co-infection with HBV, drug abuse.
Hepatitis E(HEV) Oral-fecal route, ingestion of contaminated water.
High Risk Behaviors to Hepatitis Failure to use universal precautions, percutaneous exposure(puncture-needle/tattoo), unprotected sex, unscreened blood, hemodialysis, food prepped by infected person, tap water in underdeveloped country.
Hepatitis Labs ALT elevated(most definitive for liver tissue damage), AST elevated, ALP elevated, Bilirubin elevated, albumin decreased.
Hepatitis X-ray Abdominal films are used to visualize possible hepatomegaly, ascites, or spleen enlargement.
Liver Biopsy Most definitive. Identifies intensity of infection and degree of tissue damage. CLIENT WILL LIE ON SURGICAL SITE SIDE FOR A SHORT TIME AFTER THE BIOPSY.
Hepatitis S/sx Influenza sx: HA, fatigue, low grade fever, RUQ pain, N&V. HBV presents with additional: hepatomegaly, sx of obstruction(light colored stools, dark urine, jaundice, elevated bilirubin and liver enzymes.
Hepatitis Diet High-carb, high-kcal, low-mod fat, and low-mod protein diet. And small, frequent meals to promote nutrition and healing.
Interferon Med given to treat HBV and HCV. SE's: FLU-LIKE Sx, ALOPECIA, AND BONE MARROW SUPPRESSION. Monitor CBC
Chronic Hepatitis Results from HBV, HCV, or HDV. Increases the client's risk for liver cancer.
Fulminating Hepatitis Fatal form of hepatitis is due to inability of liver cells to regenerate with increased progression of the necrotic process. Results in encephalopathy and death.
Cirrhosis Extensive scarring of the liver. Can be life-threatening.
Causes of Cirrhosis Chronic biliary cirrhosis, Steatohepatitis(fatty liver), autoimmune hepatitis, chronic HBV HCV or HDV, alcohol abuse, drug abuse.
Cardiac Cirrhosis A result of sever right heart failure indicating necrosis and fibrosis due to lack of blood flow.
Cirrhosis Labs 1 ALT, AST, and ALP initially elevated then normal when liver cells no longer able to create an inflammatory response. Bilirubin elevated. Protein and albumin low due to lack of hepatic synthesis.
Cirrhosis Labs 2 CBC, WBC, and platelets decreased 2ndary to anemia, PT/INR prolonged due to decreased synthesis of prothrombin. AMMONIA INCREASED.
Cirrhosis S/sx FATIGUE, wt loss, abd pain & distention, PRURITUS(itching), confusion, GI bleeding, ASCITES, JAUNDICE, PETECHIAE, palmar erythema, ASTERIXIS(liver flapping tremor).
Cirrhosis Assessment/Monitoring Resp status, skin integrity, VS's, neuro status, nutritional status. MONITOR FOR BLEEDING COMPLICATIONS.
Lactulose (constilac) Laxative/osmotic. Increases water content and softens stool. Lowers pH of colon which inhibits diffusion of ammonia from colon to blood, reducing blood ammonia levels. SE's: BELCHING, CRAMPS, DISTENTION, FLATULENCE.
Flagyl (metronidazole) Anti-infectives. Removes intestinal bacteria which produces ammonia. Disrupts DNA and protein synthesis in susceptible organisms. SE's: SEIZURES, DIZZINESS, HA, ABD PAIN, ANOREXIA, NAUSEA.
Portal Systemic Encephalopathy (PSE) Clients who have a poorly functioning liver are unable to convert ammonia and other waste products to a less toxic form. These products are carried to the brain and cause neurological symptoms.
Esophageal Varicies Swollen, fragile blood vessels in the esophagus. Blood flow through the liver is restricted and diverted to other vessels such as the vessels of the esophagus due to liver damage.
Complications of Esophageal Varicies Medical emergency. Hemorrhage, hypovolemic shock, and complications of anemia.
Portal Hypertension Primary risk factor for development of esophageal varicies. Conditions include: alcoholic cirrhosis and viral hepatitis.
Transjugular Intrahepatic Portal-systemic Shunt(TIPS) The client is sedated and a balloon is used to enlarge the portal vein, and a metal stent is used to keep it open.
Esophagogastric Balloon Tamponade An esophagogastric tube with balloons is used to compress blood vessels. Traction is applied and then gradually released when bleeding has stopped. CHECK BALLOONS FOR LEAKS PRIOR TO INSERTION.
Gastric Lavage with Saline Performed through a large-bore NG tube. Position client in side-lying, up to 200 mL of NS is inserted then suctioned, causing vasoconstriction. Continued until return is clear.
Esophageal Varicies Assessments/Monitoring HEMATEMESIS, melena, HYPOTENSION, tachycardia
Inderal (propanolol) Antianginals, beta blockers. Blocks stimulation of beta1(myocardial) and beta2(pulmonary, vascular, and uterine)-adrenergic receptor sites. Decreased HR and BP. SE's: FATIGUE, WEAKNESS, ARRHYTHMIAS, BRADYCARDIA, CHF, PULMONARY EDEMA, ED.
Desmopressin (Vasopressin) Antidiuretic Hormones. Enhanced reabsorption of water in the kidneys. Control of bleeding. SE's: hypertension, hypotension, tachycardia, flushing.
Sandostatin (octreotide) Antidiarrheals, hormones. Increases absorption of F&E's from GI tract and increases transit time. SE's: edema, orthostatic hypotension, palpitations, flushing.
Liver Cancer (hepatocellular carcinoma HCC) Most frequent type of liver cancer. 5-year survival rate is less than 9%.
Liver Cancer Risk Factors Cirrhosis-chronic HBV and HCV infection and alcoholic liver disease. Metastasis from another site.
Alpha-fetoprotein (AFP) A tumor marker, elevated in liver cancer.
Liver Cancer Labs ALP elevated.
Liver Cancer Diagnosis Liver biopsy is the most definitive diagnostic procedure. CLIENT WILL LIE ON SURGICAL SITE SIDE FOR A SHORT TIME AFTER THE BIOPSY.
Chemotherapy Given through surgically implanted controlled infusion pumps to be infused directly into the liver tumor.
Liver Transplant Portions of healthy livers are used. Transplanted liver will regenerate and grow in size based on need. Takes 12hrs, Immunosuppressant therapy.
Chemoembolization A chemo drug like Rubex is delivered through a catheter, along with tiny particles. The particles block blood vessels leading to the tumor. keeps chemo drug in liver longer.
Rubex (doxorubicin) Antineoplastics. Inhibits DNA and RNA synthesis by forming a complex with DNA. Immunosuppressive properties. SE's: CARDIOMYOPATHY, DIARRHEA, ESOPHAGITIS, N&v, STOMATITIS, RED URINE, ALOPECIA, ANEMIA, LEUKOPENIA, PHLEBITIS, THROMBOCYTOPENIA.
Liver Cancer S/sx Abd discomfort, anorexia, wt loss, signs of biliary obstruction-jaundice, sx of cirrhosis.
Liver Cancer Assessments/Monitoring Pain, F&E's, hepatic function, nutritional status.
Liver Cancer Diet High-calorie mod fat, possibly low-sodium or low-protein. Small, frequent, well-balanced meals. Supplemental vitamin-enriched liquids. AVOID ALCOHOL.
Acute Graft Rejection Post Liver Transplantation Can occur between 4-10 days after surgery.
Liver Transplant Rejection Symptoms Tachycardia, upper right flank pain, jaundice, lab results indicative of liver failure.
Sandimmune (cyclosporine) Immunosuppressants, polypeptides. Inhibits normal immune responses. SE's: SEIZURES, TREMOR, HTN, DIARRHEA, HEPATOTOXICITY, NAUSEA, VOMITING, NEPHROTOXICITY, HIRSUTISM, INFECTIONS!!
Created by: mande747
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