pancreas liver gallbladder Flashcards
After a meal, excess glucose molecules are taken up by the liver, combined, and then stored as glycogen
Glycogenesis (gli-co- genesis)
When blood glucose level falls, the process is reversed, and the glucose molecules are returned to the blood
Glycogenolysis (gli-co-geno-lysis)
Fats and protein broken down in response to low blood glucose levels, and molecules are used to make new glucose
Gluconeogenesis (glu-co-neo-genesis)
Primary palmar erythema
Heredity.
Pregnancy (due to alterations in skin function and vasculature).
Idiopathic.
Secondary palmar erythema
Livercirrhosisand its many causes includingalcohol abuse.[(Palmar erythema develops as a result of abnormal oestradiol levels.)
Hereditary liver disease such asWilson’s diseaseandhereditary haemochromatosis.
Locally, inflammatory process causes the liver to swell
Bile channels compressed; damage the cells that produce bile
Then blood flow through the liver is impaired, causing pressure to
rise in the portal circulation
Systemic effects related to altered metabolic functions performed by
the liver and to the infectious response in viral
Hepatitis
Signs and symptoms
Hepatitis
Signs and symptoms of systemic effects: rash, arthritis, fever,
malaise and angioedema, (the rapid swelling [edema] of
thedermis,subcutaneous tissue,mucosa and submucosal
tissues.)
: caused by exposure to toxic chemicals; drugs
Noninfectious: Hepatitis
Exposure to fecal contaminated water, food or
medical equipment. Most common type of viral
hepatitis
hep A
Blood borne, found in all body fluids of infected….
Transmit by intimate contact with carriers, exposure to
infected blood
hep B
Becomes “C”hronic and a “C” arrier of Hep.
Increases risk of chronic liver infections
Hep C
Caused by delta agent… RNA virus that can only
survive in the presence of Hep B..therefore blood
borne
hep D
Similar to Hep A.. Trasmit via water or food… rare in
US. No long term effects
Hep E
: Identified in some blood donors and transmits by
blood transfusion… does not cause chronic hepatitis..
But effects not fully known
Hep G
Signs and symptoms regardless of cause are similar
Preicteric phase
Hepatitis
Malaise, severe headache, right upper quadrant abdominal pain, anorexia, nausea, vomiting, fever, arthralgia (joint pain), rash, enlarged lymph nodes, urticaria, liver enlargement and tenderness
Icteric phase
Hepatitis
Jaundice, light or clay-colored stools, dark urine
Posticteric phase
Hepatitis
Fatigue, malaise, and liver enlargement
Medical diagnosis
Hepatitis
Elevated levels of serum enzymes (AST, ALT, GGT), serum and urinary bilirubin, and urinary urobilinogen
Medical treatment
Hepatitis
No cure: treat to promote healing and manage symptoms
Antipyretics, corticosteroids, and antiemetics
Diet: high calorie, high carbohydrate, moderate to high protein, and moderate to low fat with supplementary vitamins
Prevention
Hepatitis
Vaccines; immune globulin (IG); hepatitis B immune globulin (HBIG)
Nursing Assessment
Hepatitis
General health state, drug and alcohol use, chemical exposure, dietary habits, blood transfusions, recent travel, gastrointestinal disturbances, and changes in skin, urine, or stools
Vital signs, skin, weight changes, and mental status
Chronic, progressive disease
Degeneration and destruction of liver cells
Fibrotic bands of connective tissue impair the flow of blood and lymph and distort the normal liver structure
Cirrhosis
Incidence
Cirrhosis
Fifth leading cause of death in ages 40 to 60 in the United States
More common in men than in women
Related to alcoholic liver disease or chronic viral infection
Types
Cirrhosis
Alcoholic
Postnecrotic
Biliary
Cardiac (severe and longstanding, hepatic congestion can lead to fibrosis; if congestion is due to right heart failure, it is calledcardiac cirrhosis)
s/s
Cirrhosis
Early: slight weight loss, unexplained fever, fatigue, and dull heaviness in the right upper abdomen
Progresses: anorexia, nausea, vomiting, diarrhea or constipation, flatulence, dyspepsia, esophageal varices, infections, and epistaxis
Later: jaundice; testicular atrophy, impotence, and gynecomastia; ascites; amenorrhea; palmar erythema and spider angiomas; confusion and decreasing consciousness; peripheral neuropathy
Complications
Cirrhosis
Portal hypertension, esophageal varices, ascites, hepatic encephalopathy, and hepatorenal syndrome
Medical Treatment
Cirrhosis
Bed rest
Diet high in carbohydrates and vitamins with moderate to high protein unless blood ammonia level is elevated
Intravenous fluids
Anemia may require blood transfusions
Water and sodium likely to be restricted
Cathartics and antibiotics for hepatic encephalopathy
Medical diagnosis
Cirrhosis
Liver function tests, CBC, prothrombin time, protein, electrolytes, albumin, bilirubin, urine bilirubin, urobilinogen, liver biopsy, liver scan, ultrasonography, angiography, CT, and MRI
Liver biopsy
Medical Treatment continued
Ascites
Cirrhosis
Various types of diuretics Salt-poor albumin may be given intravenously Paracentesis Peritoneal-venous shunt of the transjugular intrahepatic portosystemic shunt
Bleeding esophageal varices
Medical Treatment continued
Cirrhosis
Drug therapy,
sclerotherapy (inj. of med),
surgical ligation, and
placement of an
esophageal-gastric
balloon tubeRarely begins in the liver but frequent site of metastasis
Cirrhosis is a predisposing factor
As disease progresses, signs and symptoms are essentially the same as those of cirrhosis
Cancer of the Liver
Signs/symptoms
Cancer of the Liver
Signs/symptoms: liver enlargement, weight loss, anorexia, nausea, vomiting, dull pain in upper right quadrant of abdomen
Because early signs and symptoms of liver cancer are vague, the condition often not diagnosed until advanced
test
Cancer of the Liver
Tests: liver scan and biopsy, hepatic arteriography, endoscopy, and measurement of alpha-fetoprotein levels
If the cancer is confined to one area, a lobectomy may be done; otherwise chemotherapy is the primary treatment
Cholecystitis
Inflammation of the gallbladder
Caused by gallstones but can be due to bacteria, toxic
chemicals, tumors, anesthesia, starvation, and opioids
When gallstones present, called Cholelithiasis.
Stones may be found anywhere in the biliary tract: gallbladder, cystic duct, or the common bile duct
Signs and symptoms
Cholecystitis and Cholelithiasis
From mild indigestion to severe pain, fever, jaundice
Also nausea, eructation, fever, chills, and right upper quadrant pain that radiates to the shoulder
If bile flow obstructed, bile production decreases and serum bilirubin rises; leads to obstructive jaundice
Some excess bilirubin is excreted in the urine, creating a dark, amber color
Digestion of fats is impaired, causing intolerance of fatty foods and steatorrhea
Complications
Cholecystitis and Cholelithiasis
Pancreatitis, abscesses, cholangitis, and rupture of the gallbladder
Medical diagnosis
Cholecystitis and Cholelithiasis
History and physical examination
Fluoroscopy using contrast medium injected directly into the biliary tree
Radiographs, radionuclide imaging, ultrasonography, and oral or intravenous cholangiography
White blood cell count, serum and urinary bilirubin, and serum enzymes
Medical treatment
Cholecystitis and Cholelithiasis
Analgesics, anticholinergics, and antibiotics Intravenous fluids Nasogastric tube Drug therapy Shockwave lithotripsy Endoscopic sphincterotomy Cholecystectomy
Islets of Langerhans
Alpha cells produce and secrete glucagon
Beta cells produce and secrete insulin
Delta cells produce somatostatin, which inhibits the release of glucagon and insulin
Glucagon is secreted when BG level drops and Insulin is secreted when BG rises
Pancreatitis
Inflammation of the pancreas
May be acute or chronic
Caused by biliary tract disorders or alcoholism Also viral infections; peptic ulcer disease; cysts; metabolic disorders; trauma from external injury, surgery, or endoscopy
Digestive enzymes activated by unknown mechanism begin to digest pancreatic tissue, fat, and elastic tissue in blood vessels
Chronic pancreatitis related to alcohol abuse
Signs and symptoms
Pancreatitis
Abdominal pain
Severe, with a sudden onset; centered in the upper left quadrant or the epigastric region and radiates to the back
Severe vomiting, flushing, cyanosis, and dyspnea often accompany the pain
Low-grade fever, tachypnea, tachycardia, hypotension
Abdomen may be tender and distended
Bowel sounds may be absent
Bleeding and shifting of fluid may lead to shock
Complications
Pancreatitis
Pseudocyst, abscess, hypocalcemia, and pulmonary, cardiac, and renal complications
Medical diagnosis
Pancreatitis
Elevated serum amylase, serum lipase, and urinary amylase levels
Elevated WBC count, elevated serum lipid and glucose level, and decreased serum calcium level
Ultrasonography and ERCP
Secretin stimulation test and fecal studies
Medical treatment
Pancreatitis
Nothing by mouth
Nasogastric tube
Intravenous fluids
Blood or plasma expanders
Urine output should be at least 40 mL/hour
Jejunal feeding tube or total parenteral nutrition
Once food permitted, usually bland, low-fat, high-carbohydrate diet divided into frequent, small meals
Prophylactic antibiotics
Nursing Assessment
Pancreatitis
Abdomen should be inspected for discoloration, distention, tenderness, and diminished bowel sounds
Quickly spreads to the duodenum, stomach, spleen, and left adrenal gland
Risk factors: chronic pancreatitis and smoking
Also high-fat diet, exposure to toxic chemicals
Cancer of the Pancreas
Signs and symptoms
Cancer of the Pancreas
Pain, jaundice with or without liver enlargement, weight loss, and glucose intolerance
Other signs and symptoms may be weight loss, upper abdominal pain, anorexia, vomiting, weakness, and diarrhea
Medical diagnosis
Cancer of the Pancreas
Transabdominal ultrasound, computed tomography, ERCP, and endoscopic ultrasonography
Serum amylase, lipase, bilirubin, and enzyme levels; carcinoembryonic antigen and CA 19-9 titers
Assessment
Cancer of the Pancreas
Assess gastrointestinal function, pain, and emotional state
If surgery planned, determine the patient’s knowledge about pre- and postoperative care
Cancer of the liver is usually
Secondary
Liver usually has pain to the what extremity
Right shoulder
