AH3 liver/pancreas

cirrhosis CM

brain fog

fetor hepaticas

spider nevi 

gynecomastia

jaundice

pruritus

ascites

loss of sexual hair

liver flap —> asterexis

bleeding tendency

anemia

ankle edema

liver biopsy indication

diagnosis of hepatocellular carcinoma or cirrhosis

liver biopsy complications

peritonitis —> blood or bile may contaminate

cirrhosis complications

portal HTN

hepatic encephalopathy

hepatocellular carcinoma

nutritional deficiencies

hepatic encephalitis

nutrition: low protein

tx: magsalate, lactulose

portal HTN

obstructed blood flow through the liver results in increased pressure throughout the portal venous system

• cirrhosis = the liver hardens not allowing the portal vein the elasticity it needs to return blood to the heart → portal vein experiences increased pressure → pressure increases the pressure of the veins from stomach to LE = esophageal varices

portal HTN CM

esophageal varices, hematemesis, gastropathy, melena, splenomegaly, dilated abdominal veins (caput medusae), ascites, hemorrhoids

EGTT (esophagogastric tamponade tube)

for esophageal varices

4 lumen esophageal tube that compresses the varcies to stop the bleeding

has outlets to suction aspirated secretions

EGTT monitor

airway, sx of aspiration, VS, emotional response, cognitive status

EGTT complications

hepatic encephalopathy

confused patients may pull on it causing asphyxiation

rupture = asphyxiation

aspirate on blood and secretions

pharm treatments

analgesics: opioids or NSAIDs

PPI or H2 blocker

vitamin D, K, B12 → in the TPN

corticosteroids → inflammatory process = increased glucose, immunosuppression

abx: gut related or pneumonia

• pipercillin (nephrotoxic), tazobactum, cefepime, possibly antifungal

pancrelipase → enzyme replacement for chronic pancreatitis

PPI

-prazole

omeprazole

esomeprazole

lansoprazole

pantoprazole

rabeprazole

H2 blockers

-tidine

famotidine

rantidine

nizatidine

cimetidine

acute pancreatitis

pancreatic duct becomes obstructed by gallstones or biliary sludge and enzymes backup causing autodigestion and inflammation of the pancrease

• amylase increases (acute - amylase)

• lipase decreases

acute pancreatitis CM

severe mid-epigastric pain/tenderness

back pain

chronic weight loss, poor diet

NV, abdominal distention

grey-turner, cullens sign

steatorrhea

fever, inflammation

decreased peristalsis

jaundice

tachycardia

acute pancreatitis complications

fluid and electrolyte imbalance

arrhythmias

acid base imbalance (metabollic acidosis)

shock → decreased tissue perfusion

seizures

hypocalcemia 

hemorrhaing

sepsis

pseudocyst

thrombosis → fluid shift

mild pancreatitis nutrition

no NV or evidence of paralytic ileus → give food (low fat, low residue)

subjectively hungry

oral or enteral

clear liquids advanced to low fat low residue soft diet

moderate pancreatitis nutrition

discontinue oral nutrition if pt develops post-prandial pain or NV

insert NG or Jejunostomy tube

• goal: 25 kcal/kg of ideal body weight w/in 72 hours

• J tube bypasses stomach straight into ileum to avoid pancreatic secretions

severe pancreatitis nutrition

bowel rest

severe abdominal pain

nutrition and fluid needs are not met

start TPN → if no bag available give dextrose 10% to prevent hypoglycemia 

client teaching for pancreatitis

nutrition

medication

pulmonary hygiene

• cough and deep breathing

• postural drainage

• O2, CiPAP

lifestyle mods

• no alcohol

• no smoking

• increased hydration

• activity

• diet compliance