Hepatic, Pancreatic, & Gallbladder Disorders PPT

what are the following all considered:

cholelithiasis, cholecystitis, & cholangitis

gallbladder disorders

what ARE cholelithiasis?

gall stones

what are the common locations for gallstones?

the gallbladder, cystic duct, common bile duct,

what’re the baseline non-modifiable risk factors for cholelithiasis (gall stones)?

age, family hx, being native American/ persons of northern European heritage (family history of familial hyperlipidemia or high fat diet); obesity & hyperlipidemia; females

what medications would you use to treat cholelithiasis (gall stones)?

clofibrate, ceftriaxone, estrogen-containing meds (contraception and hormone replacement)

what’re some conditions that are risk factors for cholelithiasis (gall stones)?

conditions that lead to biliary stasis: pregnancy, fsting, & prolonged parenteral nutrition

what’re some diseases that are risk factors for cholelithiasis (gall stones)?

cirrhosis, ileal disease/resection, Crohn’s disease, jejunal bypass, sick-cell anemia, glucose intolerance (DM1)

what are the 7 F’s that are risk factors for cholelithiasis (gall stones)?

Fair, Family, Fat, Forty, Female, Flatulence, Foul smelling stool (steatorrhea)

what’re the modifiable risk factors for cholelithiasis?

obesity, hyperlipidemia, EXTREME low-cal diets with rapid weight loss (bariatric surgery), & diets high in cholesterol

what should you discuss your cholelithiasis pt to promote their health?

the dangers of “yo-yo” dieting, with cycles of weight loss followed by weight gain and extremely low calorie diets — encourage high serum cholesterol levels to discuss using cholesterol-lowering drugs with PCP

what are some protective (reduce incidence) affects for cholelithiasis?

physical activity, high-fiber, low carb, and consuming high unsaturated fats

a pt presents with early symptoms of epigastric fullness after meals or mild distress, heartburn and flatulance after eating a fatty meal, biliary colic (stone is blocking cytic or common bile duct): steady pain in epigastric or RUQ of abdomen (may radiate) lasting up to 5 hours with N/V. jaundice may occur is common bile duct is obstructed. what’s going on? (also this CAN be asymptomatic)

cholelithiasis

what is the test of choice for cholelithiasis?

ultrasound of gallbladder

what are the key txs for cholelithiasis pts?

• discuss pt’s relationship btwn fat intake & pain (teach to reduce fat)

• WITHHOLD oral food and fluids during episodes of acute pain - insert NG tube & connect to low suction if ordered

• admin morphine/fentanyl/other for severe pain

• place in FOWLER’s

• monitor vital q4hrs (or less)

a pt presents with an episode of biliary colic (cramping pain when lodged in cystic or common bile duct) that involves RUQ pain that radiates to the back, right scapula, or shoulder — pain is aggravated by movement or deep breathing (can last 12-18 hours)?

acute cholelithiasis

what’re the less specific manifestation of acute cholelithiasis?

anorexia, N/V, fever & chills, absent bowel sounds, abd guarding and redound tenderness suggest peritoneal involvement

what’s a positive murphy’s sign and when is it seen?

this is when the RUQ is palpated and it causes severe pain with inspiratory arrest— acute cholelithiasis

what are the tx options for acute cholelithiasis?

• NSAIDs

• opioid narcotics: morphine, fentanyl

• antiemetics

• antibiotics

when can chronic cholecystitis occur?

after repeated attacks of acute cholecystitis; often asymptomatic

what’s empyema?

a collection of infected fluid within the gallbladder — happens in cholecystitis

what can cholecystistis cause?

gangrene of the gall bladder with perforation leading to peritonitis, abscess formation (can lead to pancreatitis, liver damage, and intestinal obstruction)

what is pancreatitis?

the inflammation of the pancreas characterized by the release of pancreatic enzymes into the pancreatic tissue itself leading to hemorrhage and necrosis

what’s the mortality rate of pancreatitis?

10%

what forms of pancreatitis occur?

acute or chronic

when does acute pancreatitis occur?

when there’s an obstruction of pancreatic enzymes resulting in inflammation

ehat are the general risk factors for pancreatitis?

• Etoh & gallstones (responsible for 80%)

• obstructive biliary disease (mostly XX 55-65 yrs of age)

• peptic ulcer disease

• meds: thiazide diurectics, NSAIDs, estrogens, steroids, and slicylates

• hyperlipidemia

what’re the different types of pancreatitis?

interstitial & necrotizing

what type of pancreatitis is milder and leads to inflammation and edema of pancreatic tissue and is often self limiting?

interstitial

what type of pancreatitis is inflammatory, hemorrhage, and necrosis or pancreatic tissue?

necrotizing

your pt presents with pain, ascites, abdom tenderness, distention and rigidity, fatty stools (steatorrhea/gray & foul-smelling), weight loss, jaundice; dark urin, as well as polyuria, polydipsia, & polyphagia (DB-like). what’s goin on?

pancreatitis

what does treating pancreatitis involve/require?

collaborative care

how do you treat acute pancreatitis?

it’s usually mild and self limiting so the care is focused on eliminated causative factors, reducing pancreatic secretions, and providing supporting care

what does severe necrotizing pancreatitis require?

intensive care tx

what does the tx for chronic pancreatitis focus on?

pain management & tx of malabsorption and malnutrition

more specifically, what does the tx for acute pancreatitis involve?

is supportive: hydration, pain control, antibiotics, and oxygenation

more specifically, what does the tx for chronic pancreatitis involve?

pain management without causing drug dependence

for a pancreatitis falre-up, what would you do tx wise?

NPO with NG suction with IV fluids and possibly total parenteral nutrition

what are the following the general characteristics of:

Ascites, Bleeding, Caput Medusae, Diminished liver function, Enlarged spleen

portal HTN

what happens if the liver stops working?

it will cause encephalitis (bili builds up and then causes brain inflammation) → permanent brain damage (brain = a pickle); hepatic itch (toxins and waste under skin; risk for bleeding

what are your priority assessments for the liver?

weight, abdominal girth, respiratory fxn, peripheral edema

what is viral hepatitis?

a systemic, viral infection that involves necrosis and inflammation of liver cells

what are the different types of viral hepatitis?

A, B, C, D, E, F, G

what can viral hepatitis cause?

either acute or chronic liver dysfunction and disease

how is hep A transmitted?

fecal-oral

what type of hepatitis is asymptomatic, can be acute: fever, malaise, anorexia, N/V/D, abd pain, and jaundice

A

what is the tx for hep A?

usually occurs at home unless severe & vaccination is encourgaed

how is hep B transmitted?

perinatal, percutaneous, sexual, and close person-to-person contact

what are the unique characteristics of hep B?

has a long incubation period & s/sx can be insidious and variable

can you prevent hep B?

yes — vaccinate

what types of hep have vaccines available?

A & B

what are the goals of tx for hep B?

prevent replication of the active virus, and reduce the effects of chronic liver inflammation

what is the leading cause of liver disease and is the primary indication for liver transplantation?

hep C

how is hep C transmitted?

through drug injections and through the transfusion of blood products (prior to 1992)

what are the symptoms of hep C?

mostly asymptomatic (acute or chronic)

how do you tx hep C?

antiviral therapy

what is fulminant hepatic failure?

the clinical syndrome of sudden and severely impaired liver fxn in a previously healthy person

what is going on with cirrhosis?

the normal liver cells get damages then scar (causing fibrotic tissue)

what does the nursing assessment focus on for cirrhosis pts?

the precipitating factors: long term etoh abuse, dietary intake & changes in mental status

what is a BIG med that affects the liver?

acetaminophen

a pt presents with abd distention & bloating, GI bleeding, bruising, and weight changes. what are these the tale tale signs of?

cirrhosis of the liver

what’re the nursing interventions for cirrhosis pts?

promoting rest and nutrition, skin care, and reducing risk of hemorrhage, fluid excess, and hepatic encephalopathy

what’re the manifestation of hepatocellular carcinoma (liver cancer)?

the same as cirrhosis

what’re the tx options for hepatocellular carcinoma (liver cancer)?

surgery or transplant

what’re the complications for liver tranplant?

bleeding, infx, rejectionm delayed graft fxn, biliary leaks and obstruction, heaptic artery thrombosis, & portal veint thrombosis