Gallbladder, Liver, and Pancreatic Disorders
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Cholelithiasis | Formation of stones in the gallbladder or biliary duct system
🗑
|
||||
| Cholelithiasis Risk Factors | Family history
American Indian, or Mexican
Rapid weight loss or yo-yo dieting
Biliary stasis (slowed emptying)
Increased estrogen, pregnancy or premenopause
Diabetes or cirrhosis
Obesity
Elevated cholesterol
Inflammation, or chronic inflammation
🗑
|
||||
| Cholelithiasis Symptoms | Vague pain in epigastric and RUQ often occur after meal but may begin only as a vague fullness
May be asymptomatic
Pain in epigastrium RUQ
Often radiates into the back, scapula, or shoulder
Nausea and vomiting
Hurts worse when the client moves
🗑
|
||||
| Cholelithiasis Complications | Cholecystitis
Obstruction of the common bile duct, causes bile reflux into the liver, leads to liver failure and pancreatitis, fatal if not corrected
Gallstones can migrate into the ducts
Cholangitis (Inflammation of the duct)
🗑
|
||||
| Cholecystitis | Bile-pouch-inflammation
Inflammation of the gallbladder may be acute or chronic
If ischemia (restriction of blood supply) occurs this can cause tissue death known as necrosis and perforation of the gall bladder wall
🗑
|
||||
| Acute Cholecystitis | Obstruction of duct, increased pressure
Retained bile causes inflammation and can lead to ischemia
Symptoms: (Biliary colic, RUQ pain and tenderness that is severe that may radiate, movement aggravates pain, Nausea/Vomiting, Possible fever and anorexia)
🗑
|
||||
| Chronic Cholecystitis | Often asymptomatic
Persistent irritation of the gallbladder by stones
Can result from repeated attack of acute cholecystitis
🗑
|
||||
| Complications of Cholecystitis | Empyema (collection of infected fluid in the gallbladder)
Gangrene, perforation, with peritonitis
Fistula (abnormal opening) to another organ
Obstruction of the small intestine by large stone (gallstone Illius - obstruction that stops flow)
🗑
|
||||
| Cholecystitis Diagnostic Tests | Serum (Total) bilirubin or (0.1-1.2)
Direct (conjugated) Bilirubin (0.1-0.3) Rise with liver obstruction
Indirect (unconjugated) Bilirubin (<1) Rise in RBC hemolysis
CBC
Elevation in amylase & lipase
Abd x-ray
Ultrasound
Gallbladder scan
Cholestre
🗑
|
||||
| Cholecystitis Medications | Ursodiol (Actigall) and Chenodiol (Chenix) (gradually reduce cholesterol content of gallstones; Monitor for severe diarrhea and live function studies – hepatotoxic)
Pain medication (morphine and Demerol)
Cholestyramine (Questran) (for itch (pruritus))
🗑
|
||||
| Vitamins needed with Cholecystitis | Fat-soluble (my fat dog KADE)
🗑
|
||||
| Cholecystitis foods to reduce or eliminate | Whole-milk products (cream, ice cream, cheese)
Doughnuts, deep-fried
Avocados
Sausage, bacon, hot dogs
Gravies with fat, cream
Most nuts
Corn chips and potato chips
Butter and cooking oils
Fried foods
Peanut butter
Chocolate candies
🗑
|
||||
| Treat Cholecystitis with | Cholecystectomy
Dietary Management
N/V = NPO
Supplement vitamins if obstruction
Extracorporeal shock wave lithotripsy (ESWL)
May see hematuria
Can effect kidneys
Some sedation
Complementary therapy, Goldenseal – inhibits growth of many pathogens
🗑
|
||||
| Cholesystectomy Post-op Care | Will have pain, and gas
NPO, then low-fat
Ambulation
Return to activities in 1 to 3 weeks
Insentive sperometer, pain control
🗑
|
||||
| T-tube for Cholesystitis | Bile drains from the duct until < edema
Sterile
Protect skin (like vomit; hurts, burns)
Maintain accurate I/O
Fowler’s position with tube inferior
Some blood tinged drainage, then greenish-brown
After 48hrs, report >500ml drainage in 24 hours
🗑
|
||||
| Gallbladder Cancer | Rare, poor prognosis due to the location of the liver
Anorexia, weight loss, nausea, vomiting, general malaise, jaundice, hepatosplenomegaly (enlargement of spleen and liver)
Severe RUQ pain with a palpable mass
Surgery, radiation, chemotherapy
🗑
|
||||
| Liver Basics | Metabolizes protein, carbs, fat, steroid hormones, and most drugs
Synthesizes blood proteins like albumin and clotting factors
Detoxifies
Converts ammonia to urea for kidneys excretion
Produces bile
Stores glycogen, minerals, and fat soluble vitamins
🗑
|
||||
| Effects of Hepatocellular Failure | < protein metabolism
< albumin and clotting factors
Disturbed glucose metabolism and storage
< bile production
< fat-soluble vitamin absorption
Impaired hormone metabolism
Jaundice (Sclera, Palms, Roof of mouth, yellow blanching)
🗑
|
||||
| Hepatic Portal Hypertension | Impaired blood flow through the liver causes high pressure in the portal vein, the large vein that brings blood from the intestine to the liver.
Results in congestion and dilation of veins
🗑
|
||||
| Hepatic Portal Hypertension Manifestations | Esophageal varicies (also hemorrhoids)
Caput medusae (umbilicus vericies)
Spleenomegly
Ascites (< albumin, edema)
Portal encephalopathy (< mental state, toxins not filtered (ammonia), cerebral edema)
Hepaorenal syndrome (< blood = acute renal failure
🗑
|
||||
| Hepatic Portal Hypertension Complications | Spleenomegaly
Ascities (abd edema, < albumin, > aldosteron)
Esophageal Varices
Hepatic Encephalopathy (toxic blood, > ammonia, asterixis)
Hepatorenal Syndrome (renal failure, < blood to kidney)
Spontaneous Bact. Peritonitis (Abd pain, tender, fever)
🗑
|
||||
| Spleenomegaly | Enlarged spleen
Leads to destruction of RBC and WBC’s
Anemia, leukopenia, & thrombocytopenia develop
🗑
|
||||
| Azotemia | increased nitrogen and uria in blood
🗑
|
||||
| Hepatitis | Inflammation of the liver
🗑
|
||||
| 5 Viral Hepatitis | HAV
HBV
HCV
HDV or Hepatitis Delta
HEV
🗑
|
||||
| 3 Phases of Hepatitis | Preicteric (Flu-like, n/v, diarrhea, constipation, mild RUQ pain, tenderness)
Ictoric (5-10 days after, jaundice, pruritis, clay color stools, < preicteric symptoms)
Posticteric or convalescent (> energy, < pain/GI symptoms, enzymes and bilirubin normal
🗑
|
||||
| Hepatitis A | Referred to as Infectious Hepatitis
Often in epidemics
Fecal/oral route
Comes from poor sanitation (can't work food)
Shellfish!
Not destroyed by detergents (Needs 195*F and Bleach)
6 mo apart 2 shot vaccine, so plan trips early
Can get post treatme
🗑
|
||||
| Hepatitis B | Transmitted by blood, body fluid
Can carry, have no symptoms, and pass to others
High risk (IV drug users, Multiple partners, Healthcare workers
Vaccine is 3 dose
Increased risk for liver cancer
🗑
|
||||
| Hepatitis C | Primary cause of chronic hepatitis, cirrhosis, and liver cancer
Often chronic (and/or cirrhosis) before diagnosed.
Body fluids and blood (Iv drugs, blood products, needle stick)
Acute disease usually asymptomatic (but symptoms may be mild/ nonspecific
🗑
|
||||
| Hepatitis D | Infects people already infected with Hepatitis B
Increases the severity of Hepatitis B
Transmission (Blood, Body fluids)
🗑
|
||||
| Hepatitis E | Rare
Transmitted by fecal contamination of water
Fatal in pregnant women
🗑
|
||||
| Other Hepatitis | Fulminant (Rapid progression, Usually B and D together)
Toxic (High meds, alcohol)
Autoimmune (Against liver, causes inflammation)
🗑
|
||||
| Diagnostic Tests for Hepatitis | > ALT, AST, and alkaline phosphate
> Serum bilirubin
Viral antigens and antibodies (carrier?)
Liver Biopsy (rule out cancer, detect cirrhosis/hepatitis)
Nursing care: immediate direct pressure, lie right side, monitor for bleeding, don’t cough or str
🗑
|
||||
| Nonsurgical Management of Hepatitis | Physical rest
Diet therapy
High caloric meals
Drug therapy includes: (Antiemetics: Zofran, Finergran) (Antiviral medications: Interferon Alpha, Peginterferon Alpha)
🗑
|
||||
| Hepatitis Teaching Points | Immunization available for A and B
Postexposure prophylaxis - exposed but your taking immunoglobin.
Avoid sexual activity until antibiody titers are negative
No alcohol or OTC drugs (some, like tylenol)
Don’t share razors or toothbrush
🗑
|
||||
| Antiviral Treatment of Hepatitis | Interferon alpha or long acting interferon both interfere with replication of the virus and decrease the viral load
Helps reduce liver inflammation and fibrosis
SubQ injections
May cause: flu symptoms and depression
Do not get pregnant while taking!!!
🗑
|
||||
| Cirrhosis | End stage of chronic liver disease that is irreversible (liver failure)
Liver tissue is gradually destroyed & replaced by fibrous scar tissue
The scar disrupts the blood flow through the liver to the vena cava and portal hypertension develops
🗑
|
||||
| 3 Types of Cirrhosis | Alcoholic (End: alcoholic liver disease, fatty liver, malnutrition, most common)
Posthepatic (chronic viral hepatitis, caused by any type of hepatitis, "non-alcoholic" fatty liver)
Biliary (obstructed bile flow, retained bile damages/destroys liver)
🗑
|
||||
| Cirrhosis Symptoms | Enlarged liver
Dull ache in epigastric, RUQ
Weight loss weakness anorexia
Diarrhea or constipation
Complications depend on the amount of damage sustained by the liver
Spider Angiomas
Palmar Erythema
Edema
Neuropathy
Mental Changes
🗑
|
||||
| Cirrhosis Complications | Portal hypertension
Ascites
Bleeding esophageal varices
Coagulation defects
Jaundice
Portal-systemic encephalopathy
Hepatorenal syndrome
Spontaneous bacterial peritonitis
🗑
|
||||
| Cirrhosis Diagnostics | Liver function tests (AST , ALT , alkaline phosphate)
CBC with platelets
Serum electrolytes
Coagulation studies
Bilirubin
Serum albumin and ammonia
Abdominal Ultrasound
EGD or ERCP
Liver Biopsy
🗑
|
||||
| Cirrhosis Medications | Diuretic: Spironolactone (Aldactone), Furosemide (Lasix)
Laxative: Lactulose (Chronulac)
< ammonia
Anti-infective: Neomycin sulfate, < ammonia prod.
B-blocker
Ferrous sulfate, folic acid
Vitamin K (Sub Q)
Oxazepam (not liver filtered, < anxiety/it
🗑
|
||||
| Treatments for Cirrhosis | 2g Na, < fluid (edema/acites)
Paracentesis (aspirate peritoneal cavity, void prior, HOB ^, I/O, client wt. pre/post, measure abd girth)
Esophageal varices (Endoscopic variceal ligation, Endoscopic Sclerotherapy)
Transjugular intrahepatic shunt
Transpl
🗑
|
||||
| Management of Cirrhosis Potential Hemorrhage | Drug therapy—possibly nonselective beta blocker
Gastric intubation with lavage
Esophagogastric balloon tamponade
🗑
|
||||
| Liver Cancer | Higher incidences with alcoholic cirrhosis, Hep B and C
Poor prognosis
🗑
|
||||
| Liver Cancer Manifestations | Fatigue
Weakness
Anorexia
Weight loss
Malaise
Poor appetite
Jaundice
Feeling of abdominal fullness
Painful RUQ mass
Manifestations of liver failure
🗑
|
||||
| Liver Trauma | Blunt/penetrating trauma
Disrupts hemodynamics (shock)
Monitor: > abd pain, < BP, bruising, light headedness, change in vital signs, shortness of breath
Dx with abd CT
Surgery (exploration if bleeding)
Fresh frozen plasma with clotting factors, plate
🗑
|
||||
| Pancreas Function | Exocrine Function (Enzymes breaks down dietary protein, Amalayse breaks down starch, Lipase breaks down fats in to glycerol and fatty acids)
Endocrine function (Glucogon and insulin production essential for metabolism of fats, carbohydrates, and protein)
🗑
|
||||
| Pancreatitis | Inflammation of the pancreas
Release of enzymes into the pancreatic tissue
🗑
|
||||
| Acute Pancreatitis | Self-destruction of pancreas (autodigestion)
Often self-limiting, can develop to necrotizing hemorrhagic pancreatitis
Causes: gallstones, ETHO, surgical trama, toxins, contraceptions, steroids, genetics
May recover completely, or have recurrent attac
🗑
|
||||
| Acute Pancreatitis Manifestations | Sudden continuous severe epigastric/LUQ pain, may radiate to back
Fatty meal, any meal, ETHO, sugars
N/V, distention/rigidity, < bowel sounds, fever/jaundice
Retroperitoneal bleed 3-6 days after: Turner’s (flank bruising), Cullen’s (umbilicus bruising)
🗑
|
||||
| Acute Pancreatitis Complications | Intravascular volume depletion
Acute Respiratory Distress Syndrome
Pleural effusion
Pancreatic necrosis
Abscess
DIC (Problem with clotting, Bleed freely)
Peritonitis and paralytic ileus
Multisystem Organ Failure
🗑
|
||||
| Chronic Pancreatitis | Irreversible, leads to pancreatic insufficiency
R/T alcoholism
Insoluble proteins calcify, block pancreatic ducts, cause fibrosis of tissue
Chronic obstruction
Has remissions and exacerbations
Leads to loss of exocrine and endocrine function
🗑
|
||||
| Chronic Pancreatitis Manifestations | Continuous gnawing dullness with recurrent intense epigastric and LUQ pain, radiates to back
Days to weeks
Intervals between episodes become shorter
Anorexia nausea vomiting weight loss
Ascites
Steatorrhea (Fatty stool)
Dark urine
🗑
|
||||
| Chronic Pancreatitis Treatments | Analgesics
Insulin
Nutrition
Pancreatic enzyme supplement (Pancrelipase (Lipancreatin), enhances digestion of starches and fats; supplies enzymes protease, amylase, and lipase; promotes nutrition and decreases # of BMs)
Acid reducers
Surgery
🗑
|
||||
| Pancreatitis Diagnostics | Amylase and Lipase
Trypsin (<80 mcg/L)
WBC
Glucose
Ultrasound
CT/MRI
Possible ERCP (endoscopic retrograde cholangiopancreatography – differentiates inflammation and fibrosis from carcinoma fiberoptic scope)
Percutaneous fine needle biopsy
🗑
|
||||
| Pancreatic Cancer Manifestations | Usually not detected until late
Anorexia, weight loss, n/v, gas
Dull epigastric pain
Hepatomegly (liver enlargement)
Head of the pancreas = clay color stool, dark urine
Body of the pancreas = pain with eating or laying supine
Palpable mass and asci
🗑
|
||||
| Pancreatic Cancer Risk Factors | Smoking
Obesiety
High intake of fat
Chronic pancreatitis
Diabetes mellitus
Cirrhosis
🗑
|
||||
| Pancreatic Cancer Treatment | Partial pancreatetomy
Whipple’s procedure (Removal of the head of pancreas, entire duodenum, distal 3rd of the stomach, portion of jejunum, & lower half of common bile duct; client in the intensive care setting; often requires chemo & radiation)
🗑
|
||||
| Postop care for Whipple Procedure | NPO (NG tube, TPN)
Blood sugars (insulin)
Assess for hemorrhage and Turner’s/Cullen’s sign
Monitor wound/drains
Risk for fistula (abnormal openings)
Assess BS and stool (lack may be bowel obstruction, peritonitis)
Monitor for infection (^ HR, fever)
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
nimeggs
Popular Nursing sets