Liver, Biliary, And Pancreas Flashcards
What can happen to liver cells?
They can regenerate if no complications occur
What is jaundice?
A symptom, not a disease
What is hepatitis?
- Inflammation of the liver
- viral is most common
- five major: A, B, C, D, E, and G
What are some viruses that can cause inflammation of the liver?
- cytomegalovirus
- Epstein-Barr virus
- herpes virus
- coxsackievirus
- rubella virus
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
What might be present with acute hepatitis if puritis is not?
Jaundice
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
What are the complications of hepatitis?
- low mortality rate
- severe hepatic failure (rare)
- chronic hepatitis
- cirrhosis
- hepatocellular carcinoma
How is hepatitis diagnosed?
- serum liver enzymes
- liver function
- liver biopsy (final dx)
Important information about Hepatitis A
Vaccine available
Provides 6-8 weeks of temporary passive immunity
Important information about Hepatitis B
Vaccine available
Common form
Can live up to 7 days outside body
Important information about Hepatitis C
Can be cured with drug treatment
No vaccine available
Important information about Hepatitis D
Also tested for B because requires B to replicate
Response to treatment is poor, relapse is common
No vaccine
Important information about Hepatitis E
No vaccine
Two vaccines being considered
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
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
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
