Hepatic/Biliary Disorders Flashcards
Hepatitis B
- transmitted primarily by blood
- long incubation period
- most develop antibodies and recover w/o complications
Risk Factors for Hep B
- blood transfusion
- frequent exposure to blood/blood products
- multiple sex partners
- IV drug use
Hep B S/S
- anorexia
- insomnia
- low grade fevers
- indigestion
- RUQ pain
- jaundice
- rashes
- arthralgia
Chronic Hep B Complications
- cirrhosis
- end stage liver disease
- death usually imminent w/in 1-3 yrs w/o successful liver transplant
- liver cancer
Hep B Prevention
- Hep B vaccine
- eliminate risky behavior
- Hep B hyperimmune globulin
When to get Hep B Hyperimmune Globulin
- post exposure prophylaxis for people at risk
- recently exposed to body fluids of individuals w/ Hep B
- babies of moms w/ hep , sexual partners, healthcare workers, police/fire men, morticians
Hep C
- occurs most commonly after IV drug use or blood transfusions (prior to 1992)
- multiple partners/needle sticks
- asymptomatic for decades
- leading cause of liver disease
Acute Hep C S/S
- jaundice
- n/v
- malaise
Chronic Hep C S/S
- usually on accidental findings or cirrhosis occurs
- jaundice
- bleeds/bruises easily
- dry/itchy skin
- ascites
- pedal edema
- hepatic encephalopathy
Alcoholic Hepatitis
over-ingestion of alcohol leads to liver disease
S/S of Alcoholic Hepatitis
- jaundice
- anorexia, n/v, abdominal pain
- spider angiomas
- palmar erythema
- enlarged liver or small & hardened
- splenic enlargement
- ascites, pedal edema, hepatic encephalopathy
Treatment for Alcoholic Hepatits
- alcohol cessation
- monitor for withdrawal
- rest
- adequate hydration
- treatment of symptoms
Alcohol Withdrawal Stage 1
- after 8 hrs
- anxiety
- insomnia
- nausea
- abdominal pain
Alcohol withdrawal Stage 2
- after 1-3 days
- high BP
- increased body temp
Alcohol Withdrawal Stage 3
- after 1 week
- hallucinations
- fever
- seizure
- agitation
Drug-Induced Hepatitis
-acute liver failure caused by ingestion of certain meds
What meds can cause drug-induced Hep?
- acetaminophen
- Dilantin
- statins
- sulfa antibiotics
S/S of Drug-Induced Hep
Abrupt -fever/chills -rash/itching -arthralgia -anorexia/nausea Late -jaundice -enlarged liver -dark urine
Treatment for Drug-Induced Hep
- discontinue offending meds
- antidote if available
- monitor liver damage-albumin, total protein
What is the antidote for acetaminophen?
oral mucomyst
Cirrhosis
final stage of chronic liver disease that results in scarring of the liver
- damage can not be undone but if treated early can be limited
- compensated and uncompensated
Compensated Cirrhosis
-liver can still do its job b/c there are enough healthy cells to make up for the damage and scarring
Uncompensated Cirrhosis
liver has to much scarring and patient develops complications
Compensated Cirrhosis S/S
-asymptomatic or vague early Later -intermittent low grade fevers -epistaxis -vascular spiders, palmer erythema -dyspepsia, mild abdominal pain
Uncompensated Cirrhosis S/S
- jaundice
- ascites
- pedal edema
- esophageal varices
- hepatic encephalopathy
Nursing Management for Cirrhosis
- assess symptoms, hx, mental status, med list
- promote adequate rest
- sitting to promote max lung expansion
- O2 may help
- daily weights
- strict I&O’s
- nutrition
- skin
- injury precautions
Complications w/ Cirrhosis
- bleeding/hemorrhage
- hepatic encephalopathy
- fluid volume excess
Cholelithiasis
formation of stones in the gallbladder
- pigment stones
- cholesterol (bile) stones
Pigment Stones
common in people w/ certain medical conditions
Cholesterol (bile) Stones
Most common
- excess cholesterol in bile
- gallbladder doesn’t empty properly
Risks for Cholelithiasis
- obesity/rapid weight loss
- female
- multiple pregnanc
- estrogen therapy
- diabetes
- fam hx
S/S of Cholelithiasis b/c Gallbladder Disease
- RUQ pain especially after meal of fried/fatty foods
- biliary colic-pain comes on suddenly
S/S of Cholelithiasis b/c Obstruction of Bile Duct
- fever
- GB enlarged/may be palpable
- biliary colic
- nausea
- unable to get comfortable
Cholecystitis
inflammation of the gallbladder
-becomes distended and inflamed from repeated episodes of obstruction of cystic duct
Symptoms of Cholecystitis
- RUQ pain and rigidity radiating to below right shoulder and to back b/t scapula
- n/v
- Murphy’s sign (stops inhaling due to pain caused by palpation)
Treatment for Cholecystitis
- bowel rest
- ursodiol to help dissolve small stones
- cholecystectomy
Post-Op Cholecystectomy
- no lifting > 5 lbs for 1-2 weeks
- may shower on day 2
- ambulate early
- wash puncture sites w/ soap and water
- allow steri strips to fall of on their own
- regular diet as tolerated
- Norco/Percocet
- diarrhea up to 6 months is not uncommon
What is performed after lap chole when their is suspicion that remaining stones are obstructing bowel duct?
Endoscopic Retrograde Cholangiopancreatography
ERCP
Pancreatitis
inflammation of the pancreas
Acute Pancreatitis
- sudden inflammation of pancreas
- gallstones or alcohol are common cause
- mild or life threatening but usually subsides
- usually has undiagnosed chronic pancreatitis
Acute Pancreatitis S/S
- severe abdominal pain-24-48 hours after heavy meal or alcohol
- n/v
- abdominal distention/decreased BS
- guarding
- low grade fever
- increased pain w/ movement
- pain relieved somewhat by leaning over
- elevated amylase and lipase
Treatment for Acute Pancreatitis
- strict NPO
- IV fluids
- IV analgesics
- IV antibiotics
- antiemetic
- close monitoring
- may need transfer to ICU
Complication from Acute Pancreatitis
- F/E imbalances
- hypovolemic shock
- pancreatic necrosis
- multi-system organ failure
Chronic Pancreatitis
- inflammation of pancreas that does not improve over time
- common cause is heavy alcohol consumption w/ smoking
- caused by gallstones inside duct
S/S of Chronic Pancreatitis
- recurring attacks of pain
- vomiting
- anorexia
- weight loss
- malnutrition/malabsorption
Treatment for Chronic Pancreatitis
- prevention-smoking/alcohol cessation
- proper nutrition
- pain meds
- pancreatic enzyme replacement
- PPI
