Hepatobiliary system (continued)

Bilirubin and Jaundice

what is billirubin?

breakdown and RBC’s and when increased, jaundice happens

what are the two types of billirubin?

unconjugated (indirect)

conjugated (direct)

unconjugated

• bound to albumin

• travels to liver

• not water soluble

conjugated

• processed by the liver

• water soluble

• excreted in the stool

what is juandice?

yellowing of the skin and eyes

TYPES OG JAUNDICE

hemolytic jaundice: problem causes lab

problem: excess RBC formation

causes: hemolytic anemia, sickle cell crisis, transfusion reactions

lab: increased indirect billirubinbilirubin

hepatocellular jaundice: problem, causes, lab

problem: damaged liver cells

causes: hepatitis, cirrhosis, liver cancer

lab: increased indirect billirubun bilirubin

obstructive jaundice: problem, causes, labs

problem: blocked bile flow

causes: gallstones, tumors, strictures

labs: increased direct bilirubin

OBSTRUCTED BILE FLOW SIGNS

what are obstructed bile flow signs?

• jaundice

• pruritus

• clay-colored stools

• dark urine

• steatorrhea (fatty stools)

• bleeding tendencies (vitamin k absorption decreases)

RISK FACTORS FOR HEPATOBILIARY DISEASE

what are risk factors for hepatobiliary disease?

• obesity

• sedentary lifestyle

• family history

• alcohol abuse

• drug abuse

ASSESSMENT FINDINGS FOR HEPATOBILIARY DISEASE

assessment findings:

• jaundice

• RUQ pain/tenderness

• abdominal distention

• N/V

• edema

• petechiae

• weight loss

• hepatomegaly

IMPORTANT LABS

ALT and AST elevated are associated with:

liver damage/inflammation

ALP elevation is associated with:

biliary obstruction

how does murphy sign work? and what does it indicate?

provider presses RUQ during inspiration, client suddenly stops inhaling due to pain

• this indicated cholecystitis

LIVER BIOPSY

what do we need patients to do before a liver biopsy?

• check coagulation studies

• obtain informed consent

• baseline assessment

what do we need to do/tell patients after a liver biopsy?

• lie on RIGHT side for at least 2 hours

• monitor for bleeding

what are 3 things that we need to report immediately?

• dyspnea

• cyanosis

• restlessness

this can indicate a pneumothorax (collapsed lung)

HIDA SCAN

what is a HIDA scan?

a scan that checks for

• gallstones

• bile duct obstruction

• tumors

• bile leaks

what is the nursing care for HIDA scan?

• client must lie still

• radioactive tracer is safe no special precautions afterward

OLDER ADULT CHANGES HEPATOBILIARY

older adult changes within the liver:

• smaller liver

• less protein synthesis

• slower drug metabolism

• reduced regeneration

older adult changes within the gallbladder:

• less bile flow

• increased risk of gallstones

older adult changes with the pancreas:

• less lipase

• impaired fat absorption

• decreased glucose tolerance

older adult changes with the intestines:

• slower mobility

• delayed nutrient absorption

• increased digestion

NURSING PRIORITIES WITH HEPATOBILIARY

nursing priorities:

• nutrition

• pain

• impaired liver function

• fatigue

• infection prevention

nutrition nursing priority:

• small frequent meals

• assess nausea and appetite

• give antiemetics before meals

pain nursing priority:

• assess pain location and severity

• provide pain relief

nursing priority impaired liver function:

• avoid alcohol and fatty foods

• monitor for complications

• follow treatment plan

nursing priority fatigue:

• pace activities

• cluster care when appropriate

• use assistive devices

nursing priority for infection prevention:

• hand hygiene

• early ambulation

• cough/deep breathe

• adequate nutrition