Serum bilirubin levels increase when - there is excessive destruction of RBCs - the liver cannot excrete bilirubin normally

Non Gastrointestinal Tube Flashcards by Cam Davies

Functions of the Liver

Metabolizes glucose and regulates blood glucose concentration
Converts glucose to glycogen to glucose to maintain normal levels
converts ammonia to urea
metabolizes protein, fats and drugs
forms and excretes bile
synthesizes factors needed for blood coagulation
excretes bilirubin

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Gluconeogenesis

synthesizes amino acids to form glucose

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Kupffer cells

engage in immunologic, detoxifying and blood filtering actions

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Gallbladder

stores bile produced by the liver
bile helps the body break down fats
upon eating the gallbladder empties bile into the intestines to help digest food

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Pancreas exocrine

produces enzymes that aid in digestion

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Pancreases endocrine

islets of Langerhands

key role in glucose regulation

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What do Beta Cells produce?

insulin and amylin

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Why do Delta cells secrete?

somatostatin

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What do PP cells secrete?

pancreatic peptide

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Bilirubin

RBC breakdown product
initially insoluble and transported in blood bound to protein
bilirubin is conjugated to become water soluble and stored in the liver as part of bile

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Jaundice

Serum bilirubin levels increase when

there is excessive destruction of RBCs
the liver cannot excrete bilirubin normally

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three forms of jaundice

Hemolytic: excess destroyed RBC
Hepatocellular: liver disease
Obstructive: block in the passage of bile between the liver and the intestinal tract

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Hepatitis

non specific term for inflammation of the liver
liver inflammation causes elevation in liver enzymes
viral infections: A,B,C,D,E,NANE

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Causes of Hepatitis

tumors
exposure ot hepatotoxic chemicals
drugs
alcohol abuse
invasion by an infectious microorganisms

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Viral Hepatitis

Hep B: has a vaccine series
Hep C: has no vaccine and is progressive to liver failure, cancer, and death
Hep C: virus has multiple genotypes with various characteristics

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Dx of Hepatitis

liver enzymes
bilirubin levels
prothrombin time
antibody test
direct viral measure
imaging-MRI, CT, Sono

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S/S of Hepatitis

Preicteric Phase: N/V, anorexia, fever, malaise, arthralgia, headache, RUQ pain, enlargement of spleen/liver/lymph nodes, weight loss, rash
Icteric Phase: Jaundice, pruritus, clay colors or light stools, dark urine, fatigue, anorexia, RUQ pain
Posticteric Phase: liver enlargement, malaise, fatigue

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Hepatitis Tx

symptomatic tx including rest, balanced, diet of small feedings, IV fluids
removal of offending agents
relief of any obstructive problems
if viral: some Rx of benefit
liver transplantation may be performed for those not responding to treatment

Drugs for Viral Hepatitis

interferons: naturally occurring cytokine with important role in immunity
given by injection 1x a week
side effects: flu like symptoms, depression

Cirrhosis

liver cell irreversibly damaged leading to scarring of liver tissue
impaired ability to metabolize hormones and detoxify chemicals
disturbances in digestion and metabolism
defects in blood coagulation
fluid and electrolyte imbalances

S/S of Cirrhosis

Chronic fatigue
anorexia
dyspepsia
N/V/Diarrhea
constipation with weight loss
gray/whitish stool
dark or tea colored urine
abdominal discomfort and dyspnea
enlarged liver and ascites
impaired coagulation

Liver Biopsy

reveals hepatic fibrosis, the most conclusive diagnostic procedure

Tx for Cirrhosis

No specific cute
Tx aimed at preventing further deterioration
Tx of nutritional problems
Vitamin K to correct coagulotherapy
restrict protein intake
avoid hepatotoxic drugs

Nursing implications for Cirrhosis

Monitor for alcohol withdrawal if relevant
daily weight
measure abdominal girth if enlarged
monitor response to drug therapy
monitor mental status

Advanced Cirrhosis

portal hypertension: intrahepatic veins may be compressed from scarring blood backs up unto portal system causing congestion and increased fluid pressure Ascites Hepatic Encephalopathy

Esophageal Varices

treat portal hypertension Antitussives and stool softeners Injection sclerotherapy via endoscopy variceal banding via endoscopy: placement of rubber band to restrict flow

Hepatic Encephalopathy

ammonia forms in the intestine as a result of bacterial action on ingested proteins and would normally be converted to urea by the liver and eliminated inability of the liver to convert ammonia leads to build up in the blood

S/S Hepatic Encephalopathy

``` Disorientation personality changes memory loss positive babinski reflex sulfurous breath oder lethargy to deep coma ```

Tx for Hepatic Encephalopathy

poor prognosis eliminate dietary protein deplete intestinal bacteria with abx Lactulose: reduces serum ammonia by attracting it from the blood forming a compound that is eliminated in the feces Levodopa: helps to restore neurotransmission in the brain

Tumors of the Liver

an abnormal mass of ells benign or malignant Primary lesions are rare or represent metastases

Tumors of the Liver Tx

Hepatic Lobectomy: removed malignant of benign tumor Metastatic tumors are inoperable IV chemotherapy

Gall Bladder disorders

Cholelithiasis | Cholecystitis

Cholelithiasis

gallstone formation with bile stasis | sx: beltching, flatulence, nausea, RUQ discomfort

Cholecystitis

inflammation or infection of the gall bladder | acutely ill and worsened sx, fever,

Nonsurgical Tx for Gall Blader disorders

``` antibiotic iv fluids low fat diet analgesics nasogastric suction ```

Surgical Tx for Gall Bladder disorders

laproscopic cholecystectomy | cholecystectomy

Pancreatitis

Mild: inflammation and edema of the pancreas Severe: generalized and complete enzymatic digestion of the pancreas occurs

Autodigestion

reflux of bile and duodenal contents into the pancreatic duct which activates the exocrine enzymes of digestion

S/S of Pancreatitis

``` N/V, flatulence fever jaundice hypotension steatorrhea: fowel smelling stools resulting from fat in stool ```

Cullens Sign

bluish gray discoloration at imbilicus

Turners Sign

bluish gray discoloration at flanks

Tx of Pancreatitis

``` Pain relief measures (NOT morphine due to increasing spasms sphincter) NPO NG suction to relieve N/V IV fluids (albumin) Atropine IV antibiotic therapy ```

Pancreatic Cancer S/S

``` epigastric and LUQ pain jaundice anorexia weight loss light colored stool dark urine pruritus ```

Correlating factors to Pancreatic Cancer

pancreatitis diabetes mellitus high fat diet chronic exposure to carcinogenic substances