Exam 3: Hepatobilliary Disorders Flashcards
Liver
The largest internal organ in the body.
The functional unit of the liver is
Lobules
Liver Cancer
Characterized by rapid tumor growth and metastasis
Causes of Liver Cancer include
- Chronic Liver Disease
- Hepatitis B and C
- Cirrhosis of the Liver (Review - Will be included in the exam!)
- Exposure to chemical and toxins
What are risk factors for liver cancer?
- Cigarette Smoking
- Alcohol
- Aflatoxin
What are clinical manifestations of liver cancer?
- Pain
- Weight Loss
- Loss of Strength
- Anorexia
- Anemia
- Hepatomegaly
- Jaundice
- Ascites
What assessments and diagnostics are used to observe a patient for liver cancer?
- H&P
- X-ray
- Laboratory Findings
- Liver Scan
- CT Scan
- Ultrasound
- PET Scan
- Biopsy
- Laparotomy
Metastasis Sites
- Lung
- Regional Lymph Nodes
- Adrenal
- Bone
- Kidneys
- Heart
- Pancreas
- Stomach
Medical Management for Liver Cancer
Radiation Therapy
Chemotherapy
Percutaneous Biliary Drainage
Complications of Liver Cancer
- Sepsis
- Leakage of Bile
- Hemorrhage
- Reobstruction
What is included in non surgical management of Liver Cancer?
- Laser Hyperthermia
- Radiofrequency thermal ablation
- Transcatheter Arterial Embolization
What is included of surgical management of liver cancer?
- Surgical resection
- Lobectomy
- Cryosurgery
- Liver transplantation
Nursing Management of Liver Cancer includes
- Glucose infusion
- Blood Transfusion
- Monitoring for hypothermia, hemorrhage and bile leak
- Self care
Cholecystitis
Inflammation of the gallbladder
Cholethiasis
Stones in the gallbladder
Precipitating Factors of Cholelithiasis/Cholecystitis
- Cause is unknown
- Extensive burns
- Recent surgery
- Prolong fasting, TPN
- Infection: E. Choli
What are clinical manifestations of Cholelithiasis/Cholecystitis?
- Pain (RUQ referee to the right shoulder/scapula)
- Fever
- Jaundice
- Indigestion, pain, tenderness in RUQ
- N/V, restlessness, diaphoresis
- Increased WBC
- Fat intolerance
What is the collaborative care/nursing therapeutics indicated for cholecystitis and cholelithiasis?
- Pain Management (Demerol)
- Gastric Decompression(used if N/V is severe to prevent further gallbladder stimulation)
- Biliary Stone Removal
- Cholecystectomy: T-placement
- Questran (tx of pruritus)
- Low fat diet (decreases stimulation of the gallbladder)
Acute pancreatitis
Is an acute inflammatory process of the pancreas
What are causes of acute pancreatitis?
- Biliary Tract Disease (obstruction)
- Alcoholism (increases the production of digestive enzymes in the pancreas)
- Trauma (post surgical, abdominal)
- Viral Infection
- Duodenal ulcer, abscess, Kapasi’s Sarcoma
- Drugs (corticosteroids, thiazide diuretics, oral contraceptives, sulfonamides, NSAIDs)
- Auto digestion of pancreas (bile back flow into the pancreatic ducts)
Clinical Manifestations of Acute Pancreatitis
- Abdominal Pain located in LUQ
- N/V
- Hypotension, tachycardia
- Jaundice
- Decreased bowel sound, abdominal distention
- Grey Turner’s Sign
- Cullen Sign
- Low grade fever, leukocytosis
- Shock (may be d/t hemorrhage into the pancreas, toxemia from the activate pancreas enzymes or Hypovolemia as a result of fluid shift into the retroperitoneal space)
What is the goal for treatment fo acute pancreatitis?
- Relief of pain
- Prevention or alleviation of shock
- Reduction of pancreatic secretion
- Control of F&E imbalance
- Prevention and treatment of infection
What are the nursing therapeutics for patients with acute pancreatitis?
- Hydration
- Pain Management
- Demerol (decreases pain and acts as antispasmatic)
- IV MS (longer effect)
- Shock (give plasma expander - albumin, LR and dextran)
- NPO (suppresses pancreatic enzymes to decrease stimulation of the pancreas and allow it to rest)
- NGT (decrease gastric distention, reduce vomiting and prevent gastric acidic contents from entering the duodenum)
- Small frequent feeding (bland diet)
- High Carbohydrate Diet (least stimulating to already inflamed pancreas)
Pathophysiology for Cholelithiasis
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Pathophysiology of Cholecystitis
Associated with obstruction cased by gallstones or biliary sludge.
Acute cholecystitis
Acute attacks -> sudden, severe pain in RUQ
Chronic Cholecystitis
Repeated attacks of pain d/t gallstones periodically blocking cystic duct.
Inflammation -> scarring/thickening of gallbladder wall.
Acaclulus Cholecystitis
Cholecystitis in the absence of a stone.
High mortality rate.
Main cause is bile stasis. (Bile can’t escape and causes increased bile viscosity)
Clinical manifestations of Cholelithiasis
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Clinical Manifestations of Cholecystitis
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Gangrenous Cholecystitis
Death of gallbladder tissue
Serious infection throughout the body
Subphrenic Abscess
Infection of fluid b/w the diaphragm and liver
Usually associate with peritonitis
How can cholelithiasis lead to pancreatitis?
Stone blockage backs up enzymes back into the pancreas.
Causes flatulence
Cholangitis
Inflammation of biliary ducts
Biliary cirrhosis
Tissue replaced with scar tissue d/t damage to the biliary duct
Fistula
Any abnormal connection between organs.
Usually between gallbladder and portion of duct.
Choledocholithiasis
Presence of gallstone in common bile duct - total obstruction.
Diagnostic studies for Cholelithiasis and Cholecystitis
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Conservative Therapy for Cholelithiasis
- Usodiol and Chenodiol (bile acids) - dissolve stones ***
- ERCP with endoscopic sphincterectomy
- extracorporeal shock-wave lithotripsy (disintegrates gallstones)
Conservative Therapy for Cholecystitis
- Focus on control of pain and infection and maintenance of F&E balance
- NG tube insertion (for severe N/V, prevents gallbladder stimulation)
- Cholecystostomy (drains purulent material from obstructed gallbladder)
- Ketorlac/Demerol (NSAIDS) - for pain***
- Anticholinergics (decrease secretion and counteract SM spasms **
Surgical Therapy for Cholelithiasis and Cholecystitis
NOT SURE IF NEED TO KNOW BUT REVIEW IT
Drug therapy for Cholelithiasis and Cholecystitis
- Analgesics: morphine
- Anticholinergics: atropine
- Fat soluble vitamins: ADEK
- Bile Salts
- Cholestyramine: binds bile salts in intestine
Nutritional Therapy for Cholecystitis and Cholelithiasis
- Smaller and more frequent meals with some fat to promote some gallbladder emptying
- Reduce calorie diet if obese (low saturated fats, high fiber and Ca)
Cholecystectomy
Removal of gallbladder.
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T-PLACEMENT
Connected to a bag; drains bile when there is an obstruction and prevents further obstruction.
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Questran
Binds with bile salts in intestine and increases their excretion in the feces to prevent pruritus.
Describe pancreatitis pain
- Located in LUQ but may be midepigastrum
- Commonly radiates to the back because of the retroperitoneal location of the pancreas.
- Sudden onset
- Severe, deep and piercing
- Continuous or steady
- Aggravated by eating frequently
- Onset when patient is in recumbent position
- Not relieved by vomiting
Grey Turner’s Sign
Bluish flank discoloration, especially with rupture or bleeding
Cullen’s Sign
Bluish periumbilical discoloration typically resulting from seepage of blood-stained exudate from the pancreas
Goals for Collaborative Care of Pancreatitis
- Relief of Pain
- Prevention or Alleviation of Shock
- Reduction of Pancreatic Secretions (causes pain)
- Control of F&E imbalances
- Prevention and treatment of infection
