- Inflammation of the liver - viral is most common - five major: A, B, C, D, E, and G

Liver, Biliary, And Pancreas Flashcards by Cattabry Hebert

What can happen to liver cells?

They can regenerate if no complications occur

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What is jaundice?

A symptom, not a disease

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What is hepatitis?

Inflammation of the liver
viral is most common
five major: A, B, C, D, E, and G

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What are some viruses that can cause inflammation of the liver?

cytomegalovirus
Epstein-Barr virus
herpes virus
coxsackievirus
rubella virus

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What are the symptoms of acute hepatitis?

1-4 months
anorexia, vomiting, constipation, diarrhea, taste alterations, malaise, fatigue, headaches, low grade fever, arthralgia, skin rashes

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What might be present with acute hepatitis if puritis is not?

Jaundice

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What are symptoms of chronic hepatitis?

if jaundice is gone, infection may still be present
lifelong is most cases (B and C)
A has no symptoms in this stage

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What are the complications of hepatitis?

low mortality rate
severe hepatic failure (rare)
chronic hepatitis
cirrhosis
hepatocellular carcinoma

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How is hepatitis diagnosed?

serum liver enzymes
liver function
liver biopsy (final dx)

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Important information about Hepatitis A

Vaccine available

Provides 6-8 weeks of temporary passive immunity

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Important information about Hepatitis B

Vaccine available
Common form
Can live up to 7 days outside body

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Important information about Hepatitis C

Can be cured with drug treatment

No vaccine available

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Important information about Hepatitis D

Also tested for B because requires B to replicate
Response to treatment is poor, relapse is common
No vaccine

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Important information about Hepatitis E

No vaccine

Two vaccines being considered

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Collaborative care for hepatitis

Smaller meals more often 
Daily weight
Treat pruritis 
Rest
Oral care to stimulate appetite 
Only symptom management 
Avoid alcohol and hepatoxins 
Hand hygiene

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What is cirrhosis?

Final stage liver disease
Chronic and progressive
Liver cells try to regen but is too unorganized
Now known that cirrhosis can be reversible because of fibrosis regression

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What are the types of cirrhosis?

Alcohol, most common
Nutrition related
Primary sclerosis (affecting small bile ducts in the liver)
Primary sclerosis cholangitis (colitis association)
Cardia cirrhosis (R sided heart failure association)

What are the clinical manifestations of cirrhosis?

Thrombocytopenia (strongest indicator)
See page 3 on review
Symptoms related to neurologic, integumentary, gastrointestinal, hematologic, reproductive, metabolic, and cardiovascular systems

Complications of cirrhosis

Portal hypertension
Esophageal and gastric varices
Peripheral edema and ascites 
Hepatic encephalopathy
Hepato-renal syndrome

What are the diagnostic tests done for cirrhosis?

Liver tests (most are abnormal)
Laboratory values
Liver biopsy
Liver ultrasound

Collaborative care for cirrhosis

No specific therapy
Rest
Manage ascites (diuretics, shunts, or paracentesis, removal of fluid)
Liver transplant
Prevent gastric or esophageal varices
I/O's, daily weight, abd girth
Monitor for resp distress
Nutritional therapy
Monitor for bleeding

What is acute pancreatitis?

Acute inflammatory process of the pancreas
Mild edema to severe hemorrhagic necrosis
May recover, may develop chronic type
Can be life threatening

What are the risk factors for acute pancreatitis?

Alcohol (most common)
Gallbladder disease
High triglyceride levels
May be idiopathic

What are the symptoms of acute pancreatitis?

Abd pain (most predominant) aggravated by eating
Nausea, vomiting, decrease or absent bowel sounds, fever, hypotension, tachycardia, jaundice, abd tenderness, crackles, ecchymosis, shock (if hemorrhage occurs)

What are the diagnostic tests done for acute pancreatitis?

Serum lipase Increased liver enzymes, triglycerides, glucose, and bilirubin Decrease calcium level Increase urinary amylase level

Collaborative care for acute pancreatitis

``` Pain management Prevent shock Decrease pancreatic secretions Normal fluid/electrolyte balance Remove cause Prevent infection Treat hypotension Teach S&S of infection Avoid OTC's unless ordered ```

What is chronic pancreatitis?

Continuous inflammation and fibrosing process of pancreas Tissue becomes progressively destroyed and replaced by fibrotic tissue Strictures and calcification can occur May follow acute, may also occur in absence of acute phase

What are the two major types of chronic pancreatitis?

Obstructive and calcifying

What are the symptoms of chronic pancreatitis?

``` Abd pain and tenderness Malabsorption and weight loss Constipation Jaundice Dark urine Steatorrhea Diabetes mellitus ```

What are the diagnostic tests done for chronic pancreatitis?

``` Laboratory tests Secretin stimulation to assess pancreatic function Examine stools for fat ERCP, CT, MRI Ultrasound ```

Collaborative care for chronic pancreatitis?

``` Prevent attacks Control pain If acute attack, management is same of acute pancreatitis Control pancreatic insufficiency Bland, low fat, high carb diet Bile salts Enzyme replacement Surgery to divert bile flow or relieve ductal obstruction ```

What is choletithiasis? (In gallbladder disease)

Gall stones Common in women Unknown cause Different types (cholesterol gallstone is most common)

What is cholecystitis? (In gallbladder disease)

May involve pus Can become very distended Commonly associated with obstruction

What are the symptoms of acute cholecystitis?

Pain and tenderness in RUQ r/t phrenic nerve Abd rigidity Indigestion Fever

What are symptoms of chronic cholecystitis?

Hx of fat intolerance and heartburn May produce severe symptoms or none at all Severity depends on presence of obstruction or wether the stones move or not Attacks occur 3-6 hours after heavy meal or side lying

What are Complications of cholecystitis?

``` Gangrenous cholecystitis Subphrenic abscess Pancreatitis Cholangitis Biliary cirrhosis Fistulas Gallbladder rupture ```

What are diagnostic tests done for cholecystitis?

Ultrasound | Hx and physical exam

Collaborative care for cholecystitis

``` If acute: Pain control Infection control Maintain fluid and electrolyte balance NG if nausea and vomiting are severe Control secretions and counteract smooth muscle spasms with anticholinergic ```

Collaborative care for cholelithiasis

Bile acids may be given to dissolve the stones if they reoccur ERCP to clear stones Lithotripsy to break up stones

Other collaborative care for gallbladder diseases

``` Surgery T tube (keep bile duct patent) Fat soluble vitamin supplements Bile salts Cholestyramine may be prescribed Smaller more frequent meals Diet low in saturated fat, high in fibre and calcium Place in sims to alleviate pain ```