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Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders
Chapter 24
Liver, Gallbladder and Pancreas
Gallbladder Disorders
Cholelithiasis and Cholecystitis Patho
– gallstones form due to• abnormal bile composition
• biliary statis
• inflammation of gallbladder
Risk factors– age, family hx., females - oral contraceptive
Gallbladder Disorders
Cholelithiasis
asymptomatic
epigastric fullness after fatty meal
biliary colic
jaundice
Acute cholecystitis
RUQ pain - back
a/n/v
fever with chills
Gallbladder Disorders
Treatment– laparoscopic cholecystectomy
Nursing Diagnoses– Pain– Imbalanced Nutrition– Risk for Infection
Let’s Review
Liver
Hepatitis
Liver Disorders
Hepatitis– inflammation of the liver due to virus, ETOH,
drugs, toxins, may be acute or chronic
Viral Hepatitis Hepatitis A - infectious hepatitis
– fecal-oral route– benign, self-limiting
Liver Disorders
Hepatitis B – transmission - infected blood and body fluids
• at risk - healthcare workers, drug users, multiple sexual partners, hemodialysis clients
Hepatitis C– transmission - infected blood and body fluids– manifestations - mild, non-specific– world wide cause of chronic hepatitis
Hepatitis Worldwide
Liver Disorders
Disease pattern– incubation– prodromal– icteric– convalescent
Liver Disorders
Nursing Care– teaching
• handwashing
• blood and body fluid precautions
• vaccines for persons at high risk
Advanced Cirrhosis
Liver Disorders
Cirrhosis– end state of chronic liver disease, progressive
and irreversible• alcoholic cirrhosis, biliary, or secondary to hepatitis
– Manifestations• liver enlg. Tender, wt loss, weakness, anorexia
• ascites, gynecomastia, jaundice, edema, anemia, pancytopenia
Liver Disorders
Complications– portal hypertension– splenomegaly– ascites– esophageal varices– hepatic encephalopathy– hepatorenal syndrome
What are your assessments, interventions?
What are your goals?
How would you chart this?
Systemic effects ofCirrhosis
Liver Disorders
Liver Cancer– usually poor outcomes
Liver Trauma– blunt or penetrating - hemorrhage
Liver Abscess
Hepatitis
Nursing Care?
Teaching needs?
Complications?
Pancreatitis
Pancreatitis
Pancreatitis– inflammation of pancreas characterized by
release of pancreatic enzymes into pancreatic tissue itself leading to hemorrhage and necrosis
Risk factors– alcoholism, gallstones
Pancreatitis
Manifestations– abrupt onset of severe epigastric/abdominal
pain• relieved by leaning forward, sitting up
• initiated by fatty meal or alcohol intake
– n/v– abd. distention and rigidity, decreased b.s.– fever, 24 hours later jaundice
Pancreatitis
Pancreatitis
Diagnostic tests– labs - amylase and lipase– Ultra sound, ERCP, C-T
scan, needle bx
Treatment– hydration, pain control
and antibiotics
Pancreatic Cancer
Pancreatic Cancer
Very lethal Risk factors
– smoking, chemical or environmental toxins
Manifestations– non-specific, a/n, wt. loss, dull epigastric pain
Treatment– surgery - Whipple, radiation and chemotherapy