Accessory Organ Disorders

Hepatitis

inflammation of the liver

• Occur because of injury sustained via acute or chronic infection from exposure to a specific hepatitis viral strain, from cellular insult attributed to large or excessive alcohol consumption, or through the accumulation of fat in the liver.

• With repetitive exposure to pathogens, fat deposits, or chemical compound irritants such as ethanol, this inflammatory state can become chronic and promote cellular damage, necrosis, and eventual hepatic fibrosis or scar tissue formation leading to cirrhosis

Cirrhosis

a more dynamic, late-stage condition that presents with advanced fibrosis or scarring of the liver

• Compensated = no physical manifestations of the disease, liver corrects itself

• Decompensated = development of clinical complications such as ascites, hepatic encephalopathy, gastrointestinal bleeding, and jaundice arise

Hepatitis B & D

Spread through contact with infected individuals or bodily fluids

Hepatitis A & E

spread via contact with food or water that was contaminated by an infected person’s feces

Hepatitis C

only spreads by contact with infected blood

Cirrhosis Cause

• chronic liver diseases, such as hepatitis or AUD.

• Risk factors include

  • excessive alcohol consumption

  • obesity

  • IV drug use and sharing needles

  • unprotected sexual activity

  • history of diabetes mellitus, and a history of hepatitis

Hepatitis Sx

• fever

• fatigue

• loss of appetite

• dark urine

• clay-colored bowel movements (white or light gray)

• joint pain.

• abdominal pain

• swelling

• nausea or vomiting

• jaundice of the eyes and skin

Cirrhosis Sx

• Increased bruising

• lower extremity edema

• spiderlike veins on the skin

• weight loss

• pruritus (itchy skin)

• ascites

• hepatic encephalopathy

• Dark colored urine

• Hyperbilirubinemia

Calculous Cholecystitis

gallbladder becomes inflamed due to an obstruction caused by a gallstone that may prevent the bile from being expelled

• Most common

Acalculous Cholecystitis

sudden inflammation of the gallbladder without the presence of gallstones.

• Acalculous cholecystitis is a life-threatening disorder due to a risk of perforation and necrosis

Cholecystitis Risk Factors

• Females under age of 50

  • Oral contraceptive

  • Hormone therapy

  • Pregnancy

• Family history

• Type 2 diabetes mellitus

• Obesity or losing and gaining weight rapidly

• Adults aged greater than or equal to 65 years old.

• Low levels of physical activity, a low-fiber diet, prolonged fasting, liver cirrhosis, hepatitis C, metabolic syndrome, and insulin resistance

Cholecystitis Sx

• pain in the upper right quadrant of the abdomen that may radiate to the right shoulder or neck (commonly after a high-fat meal)

• loss of appetite

• N/V

• Sweating

• Fever

• Jaundice

Cholecystitis Labs

• Full physical assessment and Hx

  • rule out cardiac Sx

• Murphy’s sign

• Elevated CRP

• Increased WBC

• Abdominal ultrasound

• endoscopic retrograde cholangiopancreatography (ERCP)

Cholecystitis Tx

• Rehydration with IV fluids and electrolytes

• Make pt NPO (to rest gallbladder)

• intravenous antibiotics

• Gallstone removal via cholecystectomy or ERCP

Pancreatitis

inflammation of the pancreas. It can be acute or chronic

• Release of trypsin that causes pancreatic acinar cell death with a resultant inflammatory response

Pancreatitis Risk Factors

• Diabetes and obesity

• Gallstones and alcohol consumption account for the most frequent causes of acute pancreatitis.

• Smoking

• increased age

• family history of pancreatitis

• postendoscopic retrograde cholangiopancreatography

• abdominal surgery, trauma, infection, and an injury to the abdomen

Pancreatitis Sx

• fever or chills

• tachycardia

• diaphoresis

• tachypnea

• jaundice

• nausea and vomiting

• Intense pain in the abdominal area and radiates to the back

  • pain management

Pancreatitis Labs

• amylase and lipase levels

• triglyceride level

• blood glucose

• CBC, and a metabolic panel

• CRP is also drawn to assess the severity of the inflammation and its progression.

• Arterial blood gases are ordered to assess oxygenation and acid-base balance.

Pancreatitis Tx

pain management and fluid and electrolyte replacement

• isotonic, crystalloid IV fluid, such as lactated Ringer's (LR), will be ordered for fluid resuscitation and electrolyte replacement

• Pain will be managed with an opiate in addition to an antiemetic.

• NPO to allow the pancreas time to rest and for the inflammation to begin to resolve

• Cholecyectomy