med surg exam 3- liver

hepatitis A transmission

fecal/oral, contaminated food/water

hepatitis A s/s

flu-like (fatigue, N, abdominal pain, joint pain), 6 weeks recovery, no permanent damage

hepatitis B transmission

percutaneous/permucosal blood + bodily fluids

(infected blood, mom to baby, unprotected sex, sharing needles)

hepatitis B s/s

similar to A, fatigue, dark urine, clay-colored stools, joint pain, loss of appetite

treatment of hep B

acute= rest, fluids, proper nutrition, chronic= weekly injection of antiviral for 6 months

hepatitis C transmission

blood (contact with infected blood, unprotected sex, sharking needs(

hep C s/s

often asymptomatic

treatment for hep C

direct-acting antiviral (DAA) for 24-48 weeks

hepatitis D transmission

percutaneous/permucosal blood + bodily fluids (unprotected sex, sharing needles)

s/s hep D

similar to B, hep B must precede hep D, acute or chornic

hepatitis E transmission

fecal/oral, contaminated food/water

s/s of hep E

sometime asymptomatic or show general signs, acute, chronic

ascites

accumulation of fluid in peritoneal or abdominal cavity 

s/s of ascites

abdominal distention + increased abdominal frith, weight gain, SOB, hypokalemia

treatment of ascites

diuretics, dietary restrictions (sodium and fluid restriction), paracentesis

cirrhosis

permanent scarring of the liver caused by chronic inflammation

s/s early cirrhosis

fatigue, weight loss, abdominal pain + distention, pruritic, confusion

s/s of late cirrhosis

jaundice, acities, edema, hepatic encephalopathy, esophageal varices and variceal bleeding

labs cirrhosis 

increased AST, ALT, increased billirubin, ammonia, increased PR/INR, decreased albumin, decreased H/H, platelets

nursing care with cirrhosis

HOB 30 degrees, wash with cold water and use lotion, monitor for overload (daily weights, I&Os, edema), measure abdominal firth, diet= high carb, high protein, moderate-fat, low-sodium

treatment of cirrhosis

medications (sparingly, diuretics, lactulose), paracentesis, liver transplant

diuretics

remove excessive fluid, SE: hypotension, hypokalemia, Ex- furosemide/lasix

lactulose 

lower pH, converting ammonia → ammonium, excreted through BM, SE: hypokalemia (increased stools), N/V

pancreatitis

inflammation of the pancreas

causes of pancreatitis

chronic alcohol use, high-fat, gallstones clog biliary duct, medications, smoking, metabolic disturbances (hyperlipidemia, hypercalcemia, hyperparathyroidism)

s/s of pancreatitis 

sudden severe pain, N/V, shock, abdominal skin discoloration (grey turner’s spots, Cullen’s sign), crackles, decreased or absent bowel sounds, tenderness with guarding, weight loss

labs pancreatitis

increased amylase, increased lipase, hypocalcemia (trousseau’s sign, chvostek’s sign), hypomagnesium

treatment of pancreatitis

underlying cause, minimization of pancreas stimulation (NPO, NG suction, IV hydration), pain relief, monitor for hypocalcemia + infection

diverticulosis

diverticula are secular dilations or outpourings of the mucosa in the colon

manifestations of diverticulosis

most asymptotic, abdominal pain, bloating, flatulence, changes in bowel habits, serious bleeding, or diverticulitits

diverticulitis

diverticula become inflamed

manifestations of diverticulitis

acute pain in LLQ, distention, decreased or absent bowel sounds, N/V, systemic symptoms of infection, possible abdominal tenderness

acute diverticulitis

bowel rest to reduce inflammation (clear liquids, bed rest, analgesia, IV fluids, abx,)

diagnostic diverticulitis 

sigmoidoscopy or colonoscopy, CT scan with oral contrast, occult blood, CBC/UA, barium enema, blood cultures, abdominal x-ray, or chest x-ray to rule out other causes