pancreatic cancer, hepatitis and liver cancer

hepatitis

• inflammation of liver cells

• Inflammation reduces blood flow and can lead to necrosis

• viral, toxic, or secondary infection

• acute or chronic

• cirrhosis: permanent scarring from chronic inflammation

• patients may be symptom free and may be unaware that they are contagious

hepatitis A

fecal-oral

symptoms: may be asymptomatic

headache, malaise, fatigue, anorexia, fever, dark urine, jaundice, tender liver

Teaching:

• PPE with incontinent clients

• proper hand hygiene

• caution when traveling to underdeveloped countries

• outbreaks in day care centers or institutions with poor hygiene

• vaccine available

Hepatitis B

blood/body fluids

signs and symptoms:

• malaise, fatigue, jaundice, dark urine

• arthraligias (joint pain)

• rash

• long incubation period (1-6 months): pt is contagious for a long time before having symptoms

Teaching:

• prevention: blood screening, clean syringes, needleless IVs, immunizations

Hepatitis C

teaching:

• blood or sexual contact

• most common reason for liver transplant

• no vaccine available

• small amounts of alcohol causes progression

• treatment is antivirals

• prevent with safe sex and clean needles

Hepatitis D

blood

• only patients with hepatitis B are at risk

• more likely to progress to chronic cirrhosis

• antivirals

Hepatitis E

fecal-oral transmission

• usually by contaminated water in areas with poor sanitation

• handwashing

• jaundice is almost always present

Liver cancer

symptoms:

• malaise

• anorexia

• lethargy

• weight loss

• fever

• feeling of abdominal fullness

• painful RUQ mass

• manifestations of liver failure: jaundice, increase LFTs

Liver cancer treatment

• radiation

• chemotherapy

• surgery: preop teachings (need to increase vitamin K for clotting)

  Postop care:

  • Promote oxygenation

  • maintain fluid and electrolyte balance- monitor for hypovolemia

  • Monitor for bleeding and infection: sepsis is common complication

• palliative end of life care

Liver transplant

• used in treatment of end stage liver disease, primary malignant neoplasm of the liver

pancreatic cancer

patho: most arise from epithelium of ductal system

over half are in head of pancreas

common bile duct obstructed

Risk factors:

• smoking

• high fat diet

• diabetes mellitus

• chemicals

clinical manifestations of pancreatic cancer

• abdominal pain

• weight loss/anorexia

• fatigue

• hepatomegaly

• jaundice

• dark urine

• clay colored stool

• ascites

• signs of obstruction

diagnostic studies of pancreatic cancer

• ultrasound, CT scan

• amylas, lipase, LFTs

• tumor markers

• abdominal paracentesis: remove fluid

complications of pancreatic cancer

• venous thromboembolism

• fistulas

• peritonitis

treatment of pancreatic cancer

• whipple procedure

• chemotherapy

• radiation

• narcotics

• oral enzyme replacement

• insulin therapy

Postop care of pancreatic cancer whipple

• monitor VS hourly

• monitor I&Os, monitor urine output, make sure it is greater than 20 Ml/Hr

• monitor signs of bleeding and shock

• promote pulmonary hygiene: turn and cough, repositioning

• control pain

• monitor drainage tubes

• maintain nutritional support

• check blood glucose

• weigh

• administer insulin and pancreatic enzymes

What is colon cancer

usually adenocarcinoma

starts as benign polyp

• can be removed during a colonoscopy

• if left untreated, chance of malignancy increases- usually asymptomatic but occult blood is found

• can metastasize- liver is most common cancer

• most common site is rectalsigmoidal region

Risk factors of colon cancer

• age

• family history

• IBD or polyps

• alcohol

• smoking

• obesity

• history of gastrectomy

• high fat, high protein, low fiber diet

What does colon cancer look like

• Change in bowel habits

• blood in stool

• anemia, anorexia, weight loss, fatigue

left sided lesions colon cancer symptoms

• abdominal pain

• distention

• cramping

• narrow stools

• constipation

• Bright red blood in the stool

Right sided lesions colon cancer symptoms

• Dull abdominal pain

• Melena

Rectal lesions colon cancer signs

• tenesmus (ineffective, painful straining)

• rectal pain

• feeling of incomplete emptying of bowels

• alternating constipation and diarrhea

• bloody stools

Earlier lesions in the colon (right side) pain is going to be:

abdominal pain and blood

if lesion is later on in colon, stool is formed, symptoms will be:

obstruction because lesions are blocking passage of formed stool: narrow stool, constipation, distention

Assessment and findings of colon cancer

• fecal occult testing

• barium enema

• colonoscopy with biopsy

• CEA (colon cancer marker)

  • not reliable, not all lesions secrete CEA

  • Can be used to assess prognosis

  • If tumor is removed CEA should return to normal within 48 hours

Management of symptoms

symptoms of obstruction:

• IV fluids

• NG suctioning

• Blood transfusions is a lot of blood loss

Treatment depending on stage:

• surgery to remove tumor

• supportive therapy if spread

• adjuvant therapy: multiple therapies to improve outcome

Nursing interventions of colon cancer

• surgical prep

• emotional support

• post op care: prevent pneumonia

• maintain nutrition

• provide wound care

• monitor for complication

• Colostomy teaching and care: irrigating, replacing device and emptying

• support body image

Nutrition with colostomy

• Avoid foods that cause excessive odor and gas:

• Cabbage, eggs, asparagus, fish, beans

• monitor nutritional deficiencies

• watch for foods that cause diarrhea: fruits, high fiber foods, soda, coffee, tea, carbonated beverages

• drink at least 2 L of water per day

Potential complications

• paralytic ileus or mechanical obstruction

• sepsis

• surgical wound complication: infection

• Anastomotic complications: developed at place where colon was replaced: Dehiscence of anastomosis and fistulas

Gastric cancer symptoms

Early: resembles benign ulcers (pain relieved by antacids)

Later: indigestion, early fullness, weight loss, abdominal pain just above umbilicus, loss of appetite, bloating after meals, nausea and vomiting

Diagnostics for gastric cancer

• EGD for biopsy

• ultrasound to assess depth and lymph node involvement

• CT to assess before surgery and for staging

Gastric cancer medical treatment

• removal of tumor and removal of stomach (gastrectomy)

• If can’t be removed, chemotherapy for comfort and to relieve symptoms

• Radiation for palliative care for obstructions, bleeding or pain

Nursing management of gastric cancer

• reduce anxiety

• promote nutrition: small, frequent, non-irritating foods

• fluids between, NOT WITH meals, and foods low in carbs and sugars to reduce dumping syndrome

• Parenteral support

• Lifelong b12 injections for gastrectomy

• relieve pain

• promote psychosocial support

• promote home and community based care