b75 chapter 24 gallbladder, liver and pancreatic disorder
TRANSCRIPT
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Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders
Chapter 24
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Liver, Gallbladder and Pancreas
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Gallbladder Disorders
Cholelithiasis and Cholecystitis Patho
– gallstones form due to• abnormal bile composition
• biliary statis
• inflammation of gallbladder
Risk factors– age, family hx., females - oral contraceptive
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Gallbladder Disorders
Cholelithiasis
asymptomatic
epigastric fullness after fatty meal
biliary colic
jaundice
Acute cholecystitis
RUQ pain - back
a/n/v
fever with chills
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Gallbladder Disorders
Treatment– laparoscopic cholecystectomy
Nursing Diagnoses– Pain– Imbalanced Nutrition– Risk for Infection
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Let’s Review
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Liver
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Hepatitis
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Liver Disorders
Hepatitis– inflammation of the liver due to virus, ETOH,
drugs, toxins, may be acute or chronic
Viral Hepatitis Hepatitis A - infectious hepatitis
– fecal-oral route– benign, self-limiting
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Liver Disorders
Hepatitis B – transmission - infected blood and body fluids
• at risk - healthcare workers, drug users, multiple sexual partners, hemodialysis clients
Hepatitis C– transmission - infected blood and body fluids– manifestations - mild, non-specific– world wide cause of chronic hepatitis
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Hepatitis Worldwide
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Liver Disorders
Disease pattern– incubation– prodromal– icteric– convalescent
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Liver Disorders
Nursing Care– teaching
• handwashing
• blood and body fluid precautions
• vaccines for persons at high risk
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Advanced Cirrhosis
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Liver Disorders
Cirrhosis– end state of chronic liver disease, progressive
and irreversible• alcoholic cirrhosis, biliary, or secondary to hepatitis
– Manifestations• liver enlg. Tender, wt loss, weakness, anorexia
• ascites, gynecomastia, jaundice, edema, anemia, pancytopenia
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Liver Disorders
Complications– portal hypertension– splenomegaly– ascites– esophageal varices– hepatic encephalopathy– hepatorenal syndrome
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What are your assessments, interventions?
What are your goals?
How would you chart this?
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Systemic effects ofCirrhosis
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Liver Disorders
Liver Cancer– usually poor outcomes
Liver Trauma– blunt or penetrating - hemorrhage
Liver Abscess
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Hepatitis
Nursing Care?
Teaching needs?
Complications?
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Pancreatitis
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Pancreatitis
Pancreatitis– inflammation of pancreas characterized by
release of pancreatic enzymes into pancreatic tissue itself leading to hemorrhage and necrosis
Risk factors– alcoholism, gallstones
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Pancreatitis
Manifestations– abrupt onset of severe epigastric/abdominal
pain• relieved by leaning forward, sitting up
• initiated by fatty meal or alcohol intake
– n/v– abd. distention and rigidity, decreased b.s.– fever, 24 hours later jaundice
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Pancreatitis
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Pancreatitis
Diagnostic tests– labs - amylase and lipase– Ultra sound, ERCP, C-T
scan, needle bx
Treatment– hydration, pain control
and antibiotics
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Pancreatic Cancer
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Pancreatic Cancer
Very lethal Risk factors
– smoking, chemical or environmental toxins
Manifestations– non-specific, a/n, wt. loss, dull epigastric pain
Treatment– surgery - Whipple, radiation and chemotherapy