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Older Adults Pt 2 > 5.1 Care for Hepatobiliary System and Colorectal Cancer > Flashcards

5.1 Care for Hepatobiliary System and Colorectal Cancer Flashcards

1
Q

Hepatobiliary and Pancreatic Disorders

A

Hepatobiliary Disorders related to

  • Liver
  • Gallbladder
  • Bile Ducts
  • Bile

Pancreas
- Included as pancreas ducts join the common bile duct in conjunction with hepatobiliary system

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2
Q

Liver Function

A
  • Glucose Metabolism
  • Ammonia Conversion
  • Protein Metabolism
  • Fat Metabolism
  • Vitamin and Iron Storage
  • Bile Formation
  • Bilirubin Excretion
  • Drug metabolism
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3
Q

Bilirubin

A
  • Formed from senescent (old) RBC’s
  • Bilirubin is what gives bile and feces its color
  • Small amount is found in the blood
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4
Q

Unconjugated (Free) Bilirubin

A
  • Heme released from hemoglobin during RBC breakdown, biliverdin converts to bilirubin and released into plasma where it binds with albumin.
  • The remainder becomes unconjugated hemoglobin
  • Bilirubin travels from blood stream to liver
  • Molecule is not water soluble
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5
Q

Conjugated Bilirubin

A
  • When unconjugated bilirubin combines with glucuronic acid, it becomes water soluble and less toxic.
  • Bilirubin is converted from unconjugated to conjugated bilirubin in the liver
  • This happens by sugar attaching to the unconjugated bilirubin turning it into bile and entering the small intestines
  • Bilirubin is eventually eliminated in stool
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6
Q

Bilirubin Labs

A
  • Normal to have bilirubin in the blood
    Direct (Conjugated) - Less than 0.3 mg/dL
    Total Bilirubin - 0.1 - 1.2 mg/dL
    Indirect is Total Bilirubin minus Direct Bilirubin
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7
Q

Liver Dysfunction

A
  • Leads to jaundice caused by increased serum bilirubin levels (>2 mg/dL)
  • Leads to portal hypertension
  • Ascites
  • Varices (enlarged vein)
  • Hepatic Encephalopathy (altered LOC due to Liver Failure)
  • Coma
  • Nutritional deficiencies
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8
Q

Hepatitis

A
  • Inflammation of the liver

Viral Hepatitis

  • Systemic viral infection causing inflammation and necrosis of liver cells
  • Can cause fibrosis of liver and progress to cirrhosis

Non-Viral Hepatitis
- Caused by toxins or drug induced

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9
Q

Hepatitis A,B,C,D,E

A

A/E - Transmitted through food or water contaminated by feces
B/C - Transmitted through puncture wounds or contact with bodily fluids (blood, saliva, semen). Also injection drug use or sex
D - Transmitted through puncture wound or infected blood

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10
Q

Liver Function Tests

A
  • Serum Aminotransferase - Detects hepatitis. Indicates injury to liver cells
  • Alanine Aminotransferase (ALT) - Levels increase in liver disorders. Used to monitor hepatitis, cirrhosis and toxic medication treatment
  • Aspartate Aminotransferase (AST) - Not specific to liver disease but levels may be increased in cirrhosis, hepatitis, and liver cancer
    Gamma-Glutamyl Transferase (GGT) - Associated with cholestasis (bile flow stopped) and alcoholic liver disease
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11
Q

Nursing Assessment of Hepatitis

A

Physical assessment for

  • Low-grade fever
  • Jaundice
  • Rash
  • Hepatomegaly (enlarged liver)
  • Splenomegaly (enlarged spleen)
  • Abnormal lab values
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12
Q

Diagnostic For Hepatitis

A
  • Testing patient blood for specific antigen/antibodies
  • DNA quantification
  • Liver function tests
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13
Q

Nursing Care for Hepatitis

A
  • Assess for Jaundice
  • Comfort measures
    Education
  • Nutrition (small frequent meals)
  • Adequate fluid intake (avoid carbonated beverages except sparkling water)
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14
Q

Hepatitis A (HAV)

A
  • RNA virus
  • Transferred through contaminated food/water, sex, food handlers with HAV. (Poor hand hygiene)
  • Takes 2-6 weeks to notice (intubation)
  • Lasts 4-8 weeks
  • Mild flu like symptoms, low grade fever, anorexia, jaundice, dark urine, indigestion, epigastric distress, enlargement of liver and spleen.

MANAGEMENT

  • PREVENTION
  • Hand hygiene, vaccine, safe food/water
  • Bed rest during acute stage and adequate nutrition
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15
Q

Hepatitis B (HBV)

A
  • DNA Virus
  • Transferred through mucosal exposure to infectious blood and bodily fluids
  • Can also be transferred Perinatal (during birth) and Percutaneous (puncture wound)
  • Intubation 60-150 days (average 90)
  • Fever, Malaise (discomfort), generalized aching, anorexia, diarrhea, clay-colored stool, jaundice, abdominal pain.
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16
Q

HBV Management

A
  • Alpha Interferons (SubQ)
  • Antivirals - Entecavir (ETV) Tenofovir (TDF)
  • Vaccine for high risk and routine vaccine for infants
  • Passive immunization for those exposed
  • Infection control measures
  • MAJOR WORLDWIDE CAUSE OF CIRRHOSIS AND LIVER CANCER
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17
Q

Hepatitis C (HCV)

A
  • RNA Virus
  • Transmitted same as B
  • MOST COMMON BLOODBORNE INFECTION
  • MOST COMMON REASON FOR LIVER TRANPLANT AND VERY COMMON CAUSE OF LIVER CANCER
  • CHRONIC CARRIER STATE FREQUENTLY OCCURS
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18
Q

HCV

A
  • Intubation takes 15-160 days
    Manifestations
  • Mild, similar to other forms of hepatitis
  • Over decades it can cause cirrhosis and is the leading cause of liver transplants.
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19
Q

HCV MANAGEMENT

A
  • Antiviral medication 8-24 weeks
  • Avoid alcohol (potentiates disease)
  • Medications affecting liver should be avoided
  • PREVENTION IS KEY (education on needle sharing reduction)
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20
Q

Hepatitis D (HDV)

A
  • Caused by defective RNA virus that requires HBV to replicate
    TRANSMISSION
  • Only those who have hepatitis B are at risk.
  • Blood/sexual contact, IV or injections, hemodialysis, multiple blood transfusions.
    Incubation
  • Between 30-150 days
    MANIFESTATIONS
  • Likely to develop liver failure or chronic active hepatitis and cirrhosis. Similar to other forms of hepatitis
    MANAGEMENT
  • Interferon Alfa is the only drug to treat HDV
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21
Q

Hepatitis E

A
  • RNA Virus (Occurs primarily in developing countries)
  • Transmitted via fecal-oral route
  • Waterborne infection (heavy rain, fecal contaminated food and water)
  • Incubation 15-65 days
    MANIFESTATIONS
  • Same as Hepatitis A, abrupt onset, not chronic
    MANAGEMENT
  • Prevention
  • Good hygiene
  • Avoid sources of contaminated water
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22
Q

Cirrhosis

A
  • Chronic Progressive Disease
  • Overgrowth of fibrous connective tissue in liver (scaring)
  • Obstructs blood flow
  • Can lead to decreased function of liver
  • Twice as common in men than women
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23
Q

Cirrhosis Etiology

A
  • Most common is alcohol induced liver disease and Chronic Hepatitis C
  • Chronic inflammation and necrosis cause damage to hepatocytes (liver cells) which release cytokines that activate the production of collagen.
  • Protein malnutrition is common in patients with cirrhosis
  • Environmental factors can also accelerate liver damage such as air pollution, asbestos, UV radiation, occupational exposures.
24
Q

3 Types of Cirrhosis

A

Alcohol - Scar tissue surrounds portal areas
Post-Necrotic - Broad bands of scar tissue
Biliary - Scar occurs around bile ducts

25
Q

Clinical Manifestations of Cirrhosis

A 
- Fatigue is an early symptom (many symptoms don't show until later) 
Later Signs
- Hepatomegaly
- Portal Obstruction
- Ascites
- Infection/Peritonitis 
- Varices
- Edema
- Vitamin Deficiency (thiamine, folic acid, b12) 
- Anemia
- Thrombocytopenia
- Leukopenia 
- Mental deterioration
- Peripheral Edema 
- Jaundice (from decreased ability to excrete bilirubin)
26
Q

Care of Patient with Cirrhosis

A
  • Promotion of Rest
  • Improving nutritional status
    (Monitoring I&O, encouraging small frequent meals, high calorie diet with sodium restriction, supplemental vitamins)
    (Restrict protein if at risk for encephalopathy)
    (Water soluble forms of fat soluble vitamins for steatorrhea (fat excretion in stool))
  • Providing skin care
  • Reducing risk of injury
27
Q

Complications of Cirrhosis

A
  • Stem from portal hypertension
  • Bleeding/Hemorrhage
  • Hepatic encephalopathy (altered mental status)
  • Fluid volume excess
28
Q

Portal Hypertension

A
  • Obstruction in liver from cirrhosis leads to hypertension in the portal venous system
  • Causes splenomegaly, large collateral veins, ascites, esophageal varices
29
Q

Ascites

A
  • Protein malnutrition causes decreased oncotic pressure which leads fluid into peritoneal cavity
  • Ascites is the accumulation of protein rich fluid
30
Q

Esophageal Varices

A
  • Fragile veins at the lower end of the esophagus (bleed easily)
  • Varices are enlarged or swollen veins
31
Q

Management of Portal Hypertension

A
  • Not curable
  • Primary goal is to prevent complications and bleeding
  • Managed through diet, mediation, endoscopic therapy, surgery, or radiology.
    MEDICATIONS
  • Beta-blockers to lower portal pressure
32
Q

Gallbladder Disease

A
  • Cholelithiasis (Gallstones) most common disorder for biliary system
  • Cholecystitis - Inflamed gallbladder usually associated with cholelithiasis
  • Development of gallstones is related to abnormalities in composition of bile or bile stasis
33
Q

Etiology of Cholelithiasis

A
  • Unknown cause
  • Result of stasis of bile and supersaturation of cholesterol, bile salts and calcium in bile
    Risk factors of low bile flow
  • Immobility
  • Pregnancy
  • Inflammatory/Obstructive lesions of biliary system

Cholecystitis - Inflammation caused by obstruction with stones or sludge

SERIOUS COMPLICATIONS

  • Gangrenous cholecystitis
  • Pancreatitis
  • Biliary Cirrhosis
  • Gallbladder rupture which leads to peritonitis
34
Q

Nursing Assessment of Cholelithiasis

A

Obtain Subjective Data

  • Clay-colored stool
  • Steatorrhea (fatty stools)
  • Flatulence
  • Dark urine (tea colored)
  • Pain
  • Pruritis
  • Jaundice
35
Q

Diagnostic Studies of Cholelithiasis

A
  • Increased WBC
  • Increased serum bilirubin
  • Increased urinary bilirubin
  • Increased liver enzyme levels
  • Increased serum amylase levels
  • Increased alkaline phosphatase
  • Absence of urobilinogen in urine
  • Abnormal gallbladder ultrasound findings
36
Q

Collaborative Care for Gallstones

A
  • Pain control

- Endoscope and X-ray to view ducts and gallbladder

37
Q

Surgery for Gallstones

A

Laparoscopic Cholecystectomy (Treatment of choice)

  • Removal of gallbladder through 1-4 small holes
  • Minimal post-op pain and few complications
  • Return to work in a week

Open (incisional) Cholecystectomy

Endoscopic Sphincterotomy - Endoscope inserted through mouth and stomach until reaches bile duct in duodenum. Stones are removed through a basket.

38
Q

Nursing Interventions/Care for Gallstones

A
  • Pain control (NSAIDs, Anticholinergics)
  • Control Infection
  • Antibiotic Treatment
  • Maintenance of fluid and electrolytes
  • NG tube for severe n/v
39
Q

Pancreas

A

Endocrine
- Regulates blood sugar
Exocrine
- Works with hepatobiliary system and GI system for digestion

40
Q

Pancreatitis

A
  • Acute inflammatory process of Pancreas

- Most often caused by gallstones

41
Q

Pancreatitis Etiology

A
  • Alcoholism
  • Biliary Tract Disease
  • Trauma, Infection
  • Most common cause is Gallstones
42
Q

Pancreatitis Pathophysiology

A
  • Injury to pancreas cells and activation of pancreatic enzymes (trypsin, elastase, lipase, kallikrein) leads to autodigestion of pancreas
  • Can cause edema, necrosis, bleeding, shock
    Mild Pancreatitis - Interstitial edema
    Severe Pancreatitis - Necrotic
  • Leads to endocrine/exocrine dysfunction, organ failure, sepsis
43
Q

Clinical Manifestations of Pancreatitis

A
  • ABD pain is most prominent
  • Pain is caused by distension of pancreas, peritoneal irritation, and obstruction of biliary duct
  • Pain most often in LUQ but can be mid-epigastric
  • Pain often radiates to back
  • Pain is aggravated by eating and not relieved by vomiting
  • CULLENS SIGN (periumbilical bruising)
  • GRAY-TURNERS SIGN (Bruising of the flank)
44
Q

Diagnostic Tests for Pancreatitis

A
  • ABD Pain and elevated serum amylase/lipase
  • Serum lipase is more sensitive than amylase when diagnosing
Can also include increased
- liver enzymes
- triglycerides
- glucose
- bilirubin
DECREASED
- calcium
45
Q

Pseudocyst

A
  • Complication of pancreatitis
  • Accumulation of fluid, enzymes and debris surrounded by a wall
  • ABD Pain
  • Palpable mass
  • n/v
  • Anorexia
  • If perforated can cause peritonitis
    TREATMENT
  • Surgical drainage
  • Percutaneous catheter allowing drainage
  • Endoscopic drainage
46
Q

Pancreatic Abscess

A
  • Complication of Pancreatitis
  • Collection of pus resulting in necrosis
  • If perforated can lead to peritonitis and sepsis
  • Upper ABD Pain
  • Mass
  • High fever
  • Leukocytosis (elevated WBC)
  • Restlessness
  • Anxiety
  • Diaphoresis
  • ABD Discoloration
  • Cyanosis
  • Jaundice
  • Dehydration
  • Symptoms of shock
    TREATMENT
  • Surgical drainage to prevent sepsis and antibiotic treatment
47
Q

Treatment of Pancreatitis

A
  • Pain control with IV morphine and antispasmodic agents
  • IVF fluid replacement to prevent shock
  • NPO and NG Suction to decrease pancreatic and acid secretions
  • Enteral Nutrition
  • Correcting electrolyte imbalance
  • Treating infection
  • Removing cause (gallstones)
  • Monitor blood glucose
48
Q

Nursing Care for Acute Pancreatitis

A
  • Rest for patient
49
Q

Colorectal Cancer Risk Factors

A
  • Obesity
  • Sedentary Lifestyle
  • High red meat diet
  • Smoking
  • Alcohol
  • Age
  • Family history
  • History of IBD
  • African American
  • Type 2 DM
50
Q

Screening for Colorectal Cancer

A
  • Begin at age 45
  • Stool DNA test (Cologuard)
  • Colonoscopy
51
Q

Manifestations

A
  • Change in bowel habits
  • Stool that is occult, tarry, melena bleeding
  • Tenesmus (feeling of need to pass stool but bowels are empty)
  • Symptoms of obstruction
  • Feeling of incomplete evacuation
52
Q

Treatment for Colorectal Cancer

A
  • Surgical Intervention
53
Q

Colostomy Care Complications

A
  • Skin irritation
  • Ulceration
  • Infection
  • Bleeding
54
Q

Colostomy Care

A

Assess stoma site for

  • Prolapse
  • Stenosis
  • Retraction
  • Herniation
Stoma should be
- Pink/Red
- Moist
- Warm to touch 
(Pale/Purple/Black should be reported as it is signs of impaired blood flow and tissue necrosis)
55
Q

Patient Education for Colostomies

A
  • Colostomy Care and what to expect
  • Assess barriers to learning
  • Assess patient and family ability to care or request home health services
  • Low fiber diet for 6-8 weeks post-op
  • Add new foods slowly to identify food intolerances
  • Avoid broccoli, cabbage, cauliflower, beans, eggs, fish to reduce gas
  • Adequate fiber to prevent constipation after 6-8 weeks
  • Maintain adequate hydration

Older Adults Pt 2 (17 decks)

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