ADH2 Final: Liver, Pancreas, Varices

Common causes of hepatitis: (3)

1. viruses (herpes, varicella-zoster)

2. drugs/toxins (tylenol)

3. alcohol

How does Hepatitis A (HAV) spread? (3)

1. fecal-oral route

2. eating contaminated food/water

• shellfish common

3. contact w/ infected stool

Hepatitis B (HBV) spreads how? (4)

1. Blood/ body fluids

2. unprotected sex

3. sharing needles

4. infected mother → baby

How does hepatitis C spread? (3)

1. blood-to-blood (needles)

2. organ transplants

3. tattoo/piercings w/ dirty equipment

Facts abt Hepatitis D? (2)

1. can only infect someone who already has Hep B

2. Spreads the same way as hep B

• body fluids

• sex

Common symptoms of Hepatitis? (6)

1. flu-like findings (fatigue, fever, N)

2. jaundice

3. dark urine (bilirubin)

4. clay colored stool (decreased bile)

5. RUQ pain

6. joint pain

Lab changes in hepatitis? (4)

1. Increased ALT (liver injury)

2. Increased AST

3. Increased ALP

4. Increased Bilirubin → jaundice

Liver biopsy pre procedure care:

pt is fasting @ midnight day of procedure

• incase they need surgery d/t complications

Liver biopsy During procedure: (2)

1. supine

2. pt holds breath for 10 secs to keep liver still

Liver biopsy post-procedure: (2)

1. right-side-lying to reduce bleeds

2. monitor VS, abd pain, bleeds, s/s pneumothorax

Nurse care hepatitis: (2)

1. rest liver

• no alcohol!

• no unnecessary meds!

• limit physical activity

2. high carb, high cal diet

Hepatitis complications:(4)

1. Chronic hepatitis → cancer!

2. Fulminant Hepatitis (sudden + severe liver failure!!)

3. hepatic encephalopathy

4. liver failure

Symptoms Hepatic encephalopathy? *4)

ammonia levels build in brain

1. stupor

2. confused

3. asterixis (hand flapping)

4. fruity, musty “liver breath” (aka fetor hepaticus)

What exactly is cirrhosis?

• what does it lead to? (3)

scarring of the liver (healthy cells replace w/ nonfunctioning scar tissue)

1. blocked blood flow

2. blocked bile flow

3. liver failure

Causes of cirrhosis? (5)

1. alcohol 

2. hep B or C

3. toxins/meds

4. bile duct blockage (biliary cirrhosis)

5. autoimmune disease

Symptoms of cirrhosis? (8)

1. RUQ pain

2. ascites 

3. pruritus

4. confused

5. splenomegaly → thrombocytopenia

6. spider angiomas (spider-like blood vessels)

7. jaundice

8. GI bleed (esophageal varices)

Cirrhosis labs: (4)

1. Increased bilirubin

2. Increased ammonia

3. Decreased albumin → ascites

4. Decreased platelets

Care for Cirrhosis: (6)

1. HOB >30 degrees

2. Elevate feet

3. Low Na diet

4. Measure abd girth

5. Monitor mental status

6. Protect skin (fragile and itchy)

Meds for Cirrhosis? (3)

1. Diuretics

2. BB (reduce portal HTN and esophageal varices bleeds)

3. Lactulose

• removes ammonia through stool 

Whats paracentesis and Pre + Post (2) op care:

• removes ascites fluid from belly

Pre: void bladder

Post:

1. measure fluid

2. weigh pta

What procedure reduces Portal HTN?

TIPS (Transjugular Intrahepatic Portosystemic shunt)

• shunt placed through liver to reduce Portal HTN

Complications of Cirrhosis?

1. Portal Systemic Encephalopathy

• toxicity in brain bc liver cant filter blood (ammonia build-up)

• Lactulose to clear up ammonia

2. Esophageal Varices

What are Esophageal Varices?

huge, fragile veins in esophagus caused by portal HTN

• bleeds easily → life threatening

• Portal hypertension = elevated BP in veins carrying blood from intestines to liver

Tx for Esophageal Varices? (5)

1. Esophagogastric Balloon Tamponade

2. Sclerotherapy (inject to shrink)

3. Ice Saline lavage (to vasoconstrict)

4. Blood transfusions

5. Banding (ligation)

Classic signs of pancreatitis? (4)

1. severe, constant LUQ/ epigastric pain

2. pain radiates to back

3. worse when lying FLAT

4. better when lean forward or fetal position

2 Skin signs of pancreatitis:

1. Cullen’s sign:

• bruise around belly button

2. Turner’s sign

• bruising on flanks

What lab diagnoses pancreatitis? (2)

1. Elevate Serum Lipase!!

2. Elevated Serum Amylase!!

Nurse care pancreatitis? (6)

1. NPO until no pain

2. IV hydrate

3. NG tube if vomit

4. NO alc or smoking

5. Bland, low fat meals when able to eat

6. Monitor glucose

• pancreas makes insuiln

Whats a pancreatic enzyme to treat pancreatitis?

• what’s its function?

Pancrelipase!!

• replaces pancreatic enzymes → helps digest fat and protein

Pancrelipase teachings: (5)

1. take w/ every meal and snack

2. can sprinkle capsule on food

3. drink water after taking

4. wipe lips after (can irritate skin)

5. take AFTER antacids/ H2 blockers

Complications of pancreatitis? (6)

1. Hypovolemia (fluid loss)

2. Pancreatic infx

3. Type 1 Diabetes

4. Lung issues (effusions/atelectasis)

5. Coagulation problems

6. Multi-organ failure

Surgeries for Pancreatitis: (4)

1. ERCP

• removes gallstones blocking pancreatic duct

2. Cholecystectomy

• if result of cholecystitis/gallstones

3. Sphincterotomy:

• enlarges pancreatic duct

4. Pancreatojejunostomy:

• reroutes pancreatic secretion to jejunum