Understanding Liver Pancreatic And Gallbladder Disorders. – Flashcards
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Define hepatitis:
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Hepatitis is an inflammation of the liver, resulting from viral of bacterial infection, drugs, alcohol, or chemicals toxic to the liver, and some metabolic or vascular disorders.
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Which medication can be toxic to the liver?
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Acetaminophen (Tylenol)
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The infecting organism causes inflammation of the liver, with resulting damage to liver cells and loss of liver function. If damage involves the bile canaliculi, what will occur?
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Jaundice will occur.
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Which type of hepatitis is the most common type and has low mortality rate?
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Hepatitis A virus (HAV)
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Which type of hepatitis is the most common type among some groups, including health care workers and intravenous drug users?
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Hepatitis B virus (HBV)
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Which type of hepatitis is an RNA virus that was identified in 1995? This hepatitis is a bloodborne infection, transmission may occur with transfusion, hemodialysis, IV drug use, sexual contact, and mother to newborn.
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Hepatitis G virus (HGV)
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The hepatitis viruses are very resistance to a wide range of anti-infective measures, such as:
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Drying , heat, ultraviolet light exposure, freezing, and bleaching and other disinfectants. At least 30 mins in boiling water is required to destroy them.
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What is the best method to preventing the transmission of the hepatitis virus?
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The best method of preventing the transmission are careful attention to cleanliness and the use of vaccines to Hepatitis A and Hepatitis B or the use of immune globulin after exposure. Hand hygiene, standard precautions, and immune globin.
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When can immune globulin (IG) be given?
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IG can be given up to 2 weeks after exposure to Hepatitis A and up to 1 week with a repeated injection in 1 month after Hepatitis B exposure.
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What kind of precaution should a health care provider use while caring for a patient with hepatitis virus?
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Health care workers must use hand hygiene and standard precautions at all times to prevent transmission.
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Define active immunity:
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Active immunity is the specific virus to which the body has developed antibodies.
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Hepatitis usually shows a typical pattern of loss of liver functions, which generally occurs in 3 stages. What are the 3 stages?
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1) Prodromal Stage: 1 week; Flu like symptoms, Right upper quadrant pain. 2) Icteric Stage: 2-6 weeks; Jaundice, Worsening Symptoms 3) Convalescent: 2-6 weeks; Returning to normal liver function.
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What are some complications for hepatitis?
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Hepatitis may lead to fulminant (sudden, severe), acute or chronic liver failure, chronic infection, carrier, and risk for liver cancer.
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What are some diagnostic tests for hepatitis?
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1) Serum liver enzymes which will be elevated. 2) Serum bilirubin which may be elevated. 3) Prothrombin time may be prolonged. 4) Serologic tests can determine the specific virus causing the hepatitis via viral antigens and also identify the presence of antibodies to the virus. 5) Abdominal x-ray which may show an enlarged liver. 6) Liver biopsy is done to assess liver damage and healing.
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What are the therapeutic measures for hepatitis?
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Treatment goals are to identify the causes of hepatitis, monitor liver status, and provide symptoms relief and supportive care. To promote healing, limited activity with bathroom privileges and adequate nutrition are ordered. As the patient improves the activities may be increased as tolerated. Patient are restricted from using any alcohol or drugs that are known to be toxic to the liver. *Rest, nutrition, interferon therapy, antivirals, avoidance of alcohol and liver toxic drug.*
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What are some nursing diagnoses for hepatitis?
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Pain, imbalanced nutrition, risk for impaired skin integrity, risk for ineffective self health management.
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What is acute liver failure?
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Acute liver failure is a rare but serious conditions that can develop rapidly, sometimes in just 2 days. Sudden massive loss of liver tissue.
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The outcome of disease may be decided within how many hours of diagnosis?
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48-72 hours.
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What are some liver failure prevention?
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Ways to avoid hepatitis and cirrhosis that can lead to liver failure include the following: 1) Washing hands after using the bathroom and before handling food. 2) Do not share personal grooming items (especially toothbrushes or razors) 3) Obtain hepatitis A and B vaccines. 4) Eat a balanced diet. 5) Avoid or drink alcohol in moderation. 6) Use acetaminophen safely. 7) Avoid exposure to blood. 8) Use condoms for safer sex. 9) Ensure sanitary conditions and equipment when obtaining a body piercing or tattoo. 10) Do not share IV needles.
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What are the initial symptoms of liver failure?
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Fatigue, GI upset, and diarrhea.
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As liver failure worsens the symptoms become more severe. What are the symptoms?
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Jaundice, hepatic encephalopathy which increases bilirubin causing confusion and coma, bleeding, and abdominal distention.
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What are the diagnostic testes for liver failure?
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X-ray which may show a rapid reduction in size; sudden elevation of liver enzymes in ALT, AST, and bilirubin; PT, PTT, and INR is elevated; K+ and blood glucose levels drop.
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What are therapeutic interventions for acute liver failure?
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Bed rest; Eliminate all drugs; Possible dialysis; High calories, low sodium, and protein diet; Lactulose, Neomycin, Magnesium Citrate, Sorbitol; Transplant.
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Define cirrhosis:
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Cirrhosis is the progressive, irreversible replacement of healthy liver tissue with scar tissue. 12th leading causes of death, caused by chronic liver disease.
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What is the most common cause of cirrhosis in the US?
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Chronic alcohol use is the most common causes of cirrhosis in the US.
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What is the Pathophysiology of cirrhosis?
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Health liver cells exposed to toxins become inflamed. The liver cells are infiltrated with fat and WBC and are replaced by fibrosis tissue. The liver makes some repairs, but if the damage continues over many years and more and more liver cells are replaced with fatty tissue and scar tissue cirrhosis can develop. The liver becomes hardened and lumpy. Early in the disease the liver is enlarged, firm and hard from the inflammatory process. Blood flow through the liver becomes impaired die to the liver shrinking and is covered with gray connective tissue. As the disease progresses, liver function is impaired and after many years cirrhosis can lead to chronic liver failure. (*Inflammation of liver cells, infiltration with fat and WBC, fibrotic scar tissue replaces liver tissue, abnormal regeneration, impaired liver blood flow, impaired liver functions.)
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What are some signs and symptoms of cirrhosis?
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Anorexia, Nausea, vomiting, weight loss, and fatigue which are due to decreased metabolic function of the liver. Jaundice may be present due to dryness from bile products deposited in the skin causing dry skin. Enlarged liver which will be firm and tender. Dull right upper quadrant pain, bruising, and ascites.
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What are diagnostic testes for cirrhosis?
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Elevated ALT, AST, ALP, ammonia, bilirubin, PT. Decreased albumin. Liver biopsy.
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What are some therapeutic measures for cirrhosis?
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Prevent disease progression and treat complications. Ascites can be treated with diuretic; Sodium and fluid restriction 800-1000 mL/day, and albumin infusion for severe ascites; Paracentesis can be done to remove accumulated fluid from the peritoneal cavity; When large amount of fluid are removed albumin may be given to replace lost of protein to prevent fluid shift; ascites may be treated by replacement of a shunt called Transjugular Intrahepatic Portosystemic Shunt (TIPS) which helps reduces portal pressure by allowing blood to bypass the lover and be carried to the heart. TIPS helps reduces fluid accumulation and aids in reducing the risk for bleeding.
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What are the complications of cirrhosis?
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*Remember CHEAP* Clotting defects. Hepatorenal syndrome. Encephalopathy. Ascites. Portal hypertension.
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Define portal hypertension:
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Portal hypertension is persistent blood pressure elevation in the portal circulation of the abdomen. Liver damage causes a blockage of blood flow in the portal vein. Increased resistance from delayed drainage causes enlargement of the visible abdominal veins around the umbilicus, rectal hemorrhoids, enlarged spleen, and esophageal varices.
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Define varices:
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Dilated veins.
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When does varices usually develop?
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Varices develops from the funds of the stomach upward and may extend into the upper esophagus.The most serious result of portal hypertension is bleeding esophageal varices due to the walls of the esophageal veins being thin and tears easily.
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Define ascites:
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Ascites is an inflammation of serous fluid in the abdominal cavity. The fluid accumulates from portal hypertension and low production of albumin by the failing liver and aldosterone accumulation. Insufficient amount of albumin causes plasma to seep into the abdominal cavity. The kidney responds by saving sodium and water causing an enlarged abdomen which will cause severe respiratory distress as a result of elevation of the diaphragm.
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Define hepatic encephalopathy:
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Hepatic encephalopathy is caused by elevated ammonia, a by product of protein metabolism which disrupts mental status. The damage liver is unable to make the ammonia water double for erection in the urine.
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What are some nursing diagnosis for cirrhosis?
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Pain, excess or deficient fluid volume, imbalanced nutrition.
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What are some signs and symptoms for hepatic encephalopathy?
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Progressive confusion; asterixis or flapping tremors in the hands caused by toxins at peripheral nerves; and fetor hepaticus or foul breath caused by metabolic end products related to sulfur.
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What are some therapeutic interventions for esophageal varices?
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Main goal is to stop bleeding immediately, maintain normal clotting, and treat infection. Bleeding varices can be treated with banding which will close the varcies, sclerotherapy which may vasoconstrict, vitamin K which is often deficient in liver disease, antibiotics because of bacterial infection is either a precursor to bleeding varices or common cause.
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What are some therapeutic interventions for hepatic encephalopathy?
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Lactulose may be given to make the colon contents more acidic to create an insoluble form of ammonia that is then excreted in the stool; Neomycin an intestinal antibiotic which may reduce colonic bacterial that change ammonium to ammonia. Restricting dietary protein to reduce ammonia production; and dialysis.
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What are some nursing diagnosis for acute and cirrhosis?
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1) Excess fluid volume. 2) Imbalanced nutrition. 3) Pain. 4) Risk for Disturbed thought processes. 5) Risk for ineffective breathing pattern. 6) Risk for deficient fluid volume. 7) Risk for infection.
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What are some patient education for cirrhosis?
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1) Disease process. 2) Signs and Symptoms to report. 3) Adequate rest. 4) Diet. 5) Avoid narcotics, sedatives, tranquilizers, and alcohol. 6) Follow up care.
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What kind of patient's are candidates for liver transplant?
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Liver failure, no cancer, no complications, otherwise stable patients are candidates for liver transplant.
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Why are cancer patients not considered for liver transplant?
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Patients who have cancer are not considered for liver transplant because the drugs used to suppress tissue rejection by the immune system can cause the caner cells to grow at an increased rate.
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After the surgical implantation of a donor liver, the patient must be closely observed for evidence of donor organ rejection. The patient will be in the intensive care unit and what kind of drugs would the patient be placed on?
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Cyclosporine (Cyclosporine A); Tacrolimus (Protopic); Azathioprine (Imuran); Prednisone (Deltasone); Myconphenolate mofetil (Cellcept)
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Cyclosporine (Cyclosporine A); Tacrolimus (Protopic); Azathioprine (Imuran); Prednisone (Deltasone); Myconphenolate mofetil (Cellcept): Why would the patient be placed on these medications for after the liver transplant?
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To suppress immune system responses and prevent tissue rejection.
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As a nurse caring for a liver transplant patient what are some important signs of rejection should you be observing for?
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1) Pulse greater than 100 beats/minute. 2) Temperature greater than 101 F 3) Reports of right upper quadrant pain. 4) Increased jaundice. 5) Decrease in bile from the T-tube or change in bile color. 6) Elevated liver enzymes.
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How does cancer of the liver result?
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Cancer of the liver usually results from metastasis from a primary cancer at a distant location.
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Patient's with which kind of medical history has an increased risk for cancer of the liver?
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Chronic hepatitis B and C, nutritional deficiencies, exposure to hepatotoxins, heavy alcohol use, smoking patients have an increased risk for cancer of the liver.
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Symptoms of cancer of the liver includes:
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Encephalopathy, Bleeding, Jaundice, Ascites.
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What are the diagnosis for cancer of liver?
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Serum alkaline phosphatase; Abdominal x-ray; Liver scan; Ultrasound; Biopsy.
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What are the therapeutic interventions for cancer of liver?
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Surgery and Chemotherapy.
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Pathophysiology of acute pancreatitis:
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Acute pancreatitis is an inflammation of the pancreas appears to be caused by a process called autodigestion. The pancreas normally secretes digestive enzymes causing them to be elevated, and Fluid loss causes shock.
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What are the acute pancreatitis complications?
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Shock, chronic pancreatitis, and disseminated intravascular coagulation (DIC).
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Pancreatitis is most commonly associated with:
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Alcohol consumption, Biliary disease such as chronic gallstones, Blunt trauma, and Certain drugs such as Thiazide.
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What are some prevention for pancreatitis?
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Cautions patients who drink alcohol to stop. Patients with biliary disease need to seek medical treatment so that the pancreatitis does not develop as a complication. Monitor patients, especially elderly for abdominal complaints when placed on medications.
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Patient's with acute pancreatitis are very ill, what are some signs and symptoms your should watch for?
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Abdominal pain, guarding, rigid abdomen, hypotension or shock, respiration distress, low grade fever, nausea and vomiting, jaundice.
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What are the complications for pancreatitis?
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Cardiovascular failure, acute respiratory distress syndrome, acute renal injury, hemorrhage, infection.
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What are the diagnostic testes done for pancreatitis?
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Serum amylase, Serum lipase, X-ray, CT scan, Ultrasound.
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What are the therapeutic interventions for pancreatitis?
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NPO, IV fluids such as TPN and nutrition, NG suction, Analgesics such as anti-anxiety agents, Oxygen, Blood products PRN.
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Define pancreatitis:
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Pancreatitis is an inflammation of the pancreas, it may be either acute or chronic.
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Define chronic pancreatitis:
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Chronic pancreatitis is a continuous, progressive disease that replaces functioning pancreatic tissue with fibrosis tissue as a result of inflammation. Pancreatic ducts becomes obstructed and ulceration.
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What are the prevention for chronic pancreatitis?
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Alcohol consumption, Biliary disease treatment, Nutritional intake monitoring.
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What are the signs and symptoms for chronic pancreatitis?
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Remissions and exacerbations. Left upper quadrant pain. Anorexia and weight loss. Malabsorption. Diabetes mellitus.
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What are the diagnosis for chronic pancreatitis?
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Pancreatic enzymes normal, high fecal fat level, changes on CT scan.
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What are the therapeutic interventions for chronic pancreatitis?
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Analgesics, Pancreatic enzyme replacement, Surgery.
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What are the nursing diagnoses for acute and chronic pancreatitis?
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Pain, Imbalanced nutrition, Risk for ineffective breathing pattern, Risk for injury.
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Define cancer of the pancreas:
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Cancer of the pancreas is the 4th leading cause of cancer death in men in the US and the 5th leading cause in women.
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Pathophysiology of cancer of the pancreas:
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Most primary tumors of the pancreas are ducal adenocarcinomas and occur in the exocrine parts of the pancreas.
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Name the risk factors for cancer of pancreas.
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High fat diet, Smoking, Diabetes mellitus, Alcohol, Chronic pancreatitis.
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What are the signs and symptoms for cancer of pancreas?
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Weight loss, abdominal pain radiates to the back, anorexia, nausea and vomiting, weakness, jaundice.
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What are the diagnostic tests for cancer of pancreas?
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Serum amylase/Lipase, alkaline phosphatase, bilirubin, coagulation studies, carcinoembryonic antigen (CEA), CT, ERCP, Biopsy.
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What are the therapeutic interventions for cancer of pancreas?
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Surgery such as Pancreatectomy and Whipple procedure; Stent to relieve biliary obstruction; Chemotherapy; Radiation.
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Explain what a Whipple procedure is.
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When the tumor is located at the head of the pancreas, the Whipple procedure is done to remove the head of the pancreas, the lower portion of the common bile duct, most of the duodenum, and possibly parts of the stomach nearby.
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What are complications of a Whipple procedure?
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Whipple procedure include failure of the suture lines to hold, causing leakage of pancreatic enzymes and bile into the abdomen.
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What are the nursing diagnoses for cancer of pancreas?
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Pain, imbalanced nutrition, risk for deficient volume, risk for impaired skin integrity.
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What are some patient education for cancer of pancreas?
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Management of hyperglycemia, pancreatic enzyme replacement, dressing/drain care, complications to report, hospice referral.
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What are the 3 gallbladder disorders?
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Cholecystitis, Cholelithiasis, Choledocholithiasis.
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Define Cholecystitis:
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Cholecystitis is an inflammation of the gallbladder. Most often a response to obstruction of the common bile duct resulting in edema and inflammation; often bacterial invading the bile and causing irritation of the gallbladder.
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How does a chronic cholecystitis occur?
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Chronic cholecytitis results in repeated attacks of acute cholecystitis or chronic irritation from gallstones. The gallstones becomes fibrosis and thickened and does not empty easily or completely.
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Define cholelithiasis:
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Cholelithiasis is the formation of gallstones in the gallbladder that are most often composed of cholesterol in the US.
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Define choledocholithiasis:
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Choledocholithiasis refers to gallstones in the common bile duct. After a period of time the supersaturated bile crystallizes and begins to form stones.
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What are pigment stones?
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Pigment stones are another type of gallstones and appears to be composed of calcium bilirubinate, which occurs when free bilirubin combines with calcium.
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What are some causes (etiology) of gallbladder disorders?
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Bile stasis, high cholesterol intake, fasting, sedentary lifestyles, family history, being a female, risk increases with aging.
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What are the signs and symptoms of gallbladder disorders?
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Increased vital signs, vomiting, jaundice, epigastric pain, right upper quadrant tenderness, nausea, indigestion, positive Murphy signs, biliary colic.
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What are some complications of gallbladder disorders such as Cholecystitis, Cholelithiasis, Choledocholithiasis?
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Cholangitis which means inflammation of the bile ducts, Necrosis/Perforation of gallbladder, Empyema which is a collections of prudent drainage in the gallbladder, Fistulas, Adenocarcinoma of gallbladder, and Pancreatitis which is a major complication of choledocholithiasis if the pancreatic duct is obstructed.
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What are the diagnostic testes for gallbladder disorders?
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Ultrasound, ERCP, Radionuclide scan, WBC, Bilirubin, Serum amylase.
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What are the therapeutic interventions for gallbladder disorders?
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Analgesics, Bile acid sequestrants, Anti-emetic, and Diet.
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What are some cholelithiasis treatments?
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Treatments for cholelithiasis usually involve surgical removal of the gallbladder. Surgical procedures such as laparoscopy and traditional which a T-tube may be inserted. Extracorporeal Shock Wave Lithotripsy (ESWL) to destroy stones. Medications to dissolve stones such as ursodiol (Actigall) and cheodiol (Chenix).
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A T-tube drainage ranges from 500-1000 mL the 1st day, and how much does it decreases by the 3rd day?
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200 mL
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Patients with laparoscopy are usually discharge within:
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24 hours or less and recovery time is reduced with laparoscopic surgery.
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Patients with traditional cholecystectomy usually hospitalized for:
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2-3 days and incisional pain makes it difficult with coughing and deep breathing postoperatively because it causes the diaphragm to press on the operative site.
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Explain what a T-tube is.
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A T-tube is used to drain bile after a cholecystectomy until swelling of the duct subsides.
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What are the nursing diagnoses for gallbladder disorders?
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Acute pain and risk for deficient fluid volume.
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What are postoperative nursing diagnoses for gallbladder disorders?
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Risk for impaired skin integrity and risk for ineffective breathing pattern.
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Which vitamin is needed for blooding clotting?
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Vitamin K and when is a low amount it increases the risk for bleeding.
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What are potentially toxic to the cirrhosis patient due to impaired hepatic metabolism of these meds?
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Sedatives
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Headaches, nausea, and flu like symptoms are symptoms of:
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Hepatitis A
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Which elevated lab indicates chronic pancreatitis?
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Serum amylase
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Low serum albumin levels indicates:
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Malnutrition
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Because pancreatitis is very painful, patient satisfaction with pain control is:
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A priority
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Bile duct obstruction can result in:
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Jaundice, dark amber colored urine due to bile blockage.
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The nurse is caring for a patient who had an open cholecystectomy 24 hrs ago. Which following action should the nurse take to assist the patient and maintaining effective air breathing pattern?
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Pain relief, allows comfortable breathing and prevents shallow respirations and guarding. Splinting, making coughing more comfortable. Encouraging cough and deep breathing to keep lungs clear.
