med surg 40 disorders of liver, gallbladder, pancreas

organs in quadrants of GI

overall of liver

• URQ

• protected by ribcage

• “hepa”

4 major roles of liver

• detoxifying ammonia

• drug metabolism

• stores glycogen

• produces bile, coagulation factors, albumin

(albumin helps keep fluid where they belong)

bile

• produced in liver → cystic duct → gallbladder

• absorption of soluble vitamins, help remove toxins

bilirubin can be increased when one is

anemic, cirrhosis, or bile duct obstruction

history & assessment

• changes in weight/ skin color. itching, easy bruising, headaches, enlarged lymph nodes, dyspnea, breast enlargement in men

• anorexia, ab pain, n&s, diarrhea, GI bleeding

• alcohol use, use of acetaphetomin

dx tests and procedures

check ammonia levels, coagulation, bilirubin, liver enzymes

• with ammonia, reduce protein. take Lactose (laxative)

HIDA nuclear scan: isotope injected into vein, collects in liver, shows diseases

CT

MRI

ultrasound to visualize organs

dx tests and procedures

liver biopsy

• lay 2 hours post-op on right side to keep pressure on liver (think coagulation factors, prevent hemorrhaging)

hepatitis

inflamed liver. virus grows & damages cells

s&s: fever, rash, angioedema (hives), arthritis, fever, malaise

risk: tylenol, alcohol

types of hepatitis

A: fecal → oral route. contaminated foods

B: blood and body. sexual. newborns may be affected

C: blood and body (no vaccine available) cause cirrhosis

D: body fluids. cause infection only when B is present

E: fecal → oral route

phases of hepatitis

preicteric:

• before jaundice. most infectious. headache, malaise, ruq pain, n&s, fever, joint point, rash, liver enlarged and tender

icteric:

• jaundice. dark urine. light stool. increased bilirubin. edema bc low albumin. itchy

post icteric:

• fatigue, malaise, liver enlargement, s&s start to subside. 2-12 weeks recovery

complications with hepatitis

• esophageal varices (may bleed out) #1

• hypertension

• hepatic encephalopathy (enlarged head. confused)

• ascites

tx for hepatitis

• rest

• anti-emetics, steroids, anti-pyretics

• low fat and high protein (unless ammonia high)

• avoid alcohol and tylenol

• avoid sharing razors, toothbrush

• protected sex

alcohol-induced liver disease

fatty liver:

• too much alc. often no signs. can fix w/ good diet

alcoholic hepatitis:

• inflammation bc heavy alc. heavy signs

alcoholic cirrhosis:

• scar tissue replaces liver cells. need transplant (at end stage too. need steroids and immunosuppressant for life)

cirrhosis

chronic, progressive. scar tissue replaces liver cells
healthy liver → fatty liver → liver fibrosis → cirrhosis

complications w cirrhosis

• esophageal varices & portal hypertension

• ascites

• hepatic encephalopathy (due to high ammonia levels → must be on seizure precautions and mild protein)

tx for cirrhosis

• rest

• diet high in vitamins and moderate protein unless ammonia

• water and salt likely restricted

• IV fluids

• anemic → blood transfusion

• paracentesis

tx for bleeding esophageal varies

• to constrict bv and lower pressure: octreotide

• vitamin K

• Protonix (ppi)

• sclerotherapy: solution into vein → hardens and closes it

dx tests for bile / gallbladder disorders

cholecystitis

inflammation of gallbaldder

• causes: gallstones, bacteria, toxins & chemicals, starvation, tumors, anesthesia, opioids

cholelithiasis

gallstones

can be anywhere in biliary tract: gallbladder, cystic duct or common bile duct

• cause: high cholesterol / high calorie

• female, fat, fair, 40+, fertile

s&s of cholecystitis and cholelithiasis

• clay-colored stool if bile duct obstructed / steatorhea

• pancreli-paste (enzymes) given for digestion of fats, carbs, proteins. give w meals. capsule

complications & tx for cholecystitis and cholelithiasis

• pancreatitis

• abscesses

• cholangitis (inflamamtion of bile duct)

• rupture of gallbladder

pancreatitis

inflammation of pancreas. causes irreversible damages. severe abdominal pain

• can develop diabetes

• causes: alcohol, gallbladder disease, cystic fibrosis. ERCP

• s: ab pain ulq, vomiting, jaundice, flushing, dyspnea, fever, hypotensive

• distended abdomen. absent bowel sounds

complicaitons & dx pancreatitis

• psudeocyst, abscess, hypocalcemia

• will see elevated levels of everything & higher coagulation time

tx pancreatitis

• low fat & low sugar diet. enzymes w meals

what is the first sign of rejection for transplant?

fever