Your SlideShare is downloading. ×
0
 
<ul><li>Abd pain (esp. RUQ, may radiate)  </li></ul><ul><li>Dietary hx </li></ul><ul><li>Changes in bowel habits  </li></u...
<ul><li>Abnormal bowel sounds </li></ul><ul><li>Abdominal distention or ascites  </li></ul>
 
<ul><li>Enzyme found in all tissues. High concentrations in liver, bile ducts, placenta, & bone. </li></ul><ul><li>Damaged...
<ul><li>Enzymes found in liver; elevated levels indicate liver disease  </li></ul><ul><li>AST (SGOT) = aspartate aminotran...
<ul><li>It’s the breakdown product of Hb </li></ul><ul><li>Total & direct bilirubin usually measured to screen or monitor ...
<ul><li>Lipase - enzyme secreted by pancreas that catalyzes breakdown of triglycerides into fatty acids.  </li></ul><ul><l...
<ul><li>Types: </li></ul><ul><ul><li>Cholecystitis - inflammation of gallbladder  </li></ul></ul><ul><ul><li>Cholelithiasi...
<ul><li>Normally balance of bile salts, lecithin & cholesterol keep gallstones from forming. </li></ul><ul><li>If abnormal...
<ul><li>Low fat, high carb, high protein, high fiber diet with small frequent feedings </li></ul><ul><li>Pain control  </l...
<ul><li>MEDICATION </li></ul><ul><ul><li>In people with functioning GB, bile salts taken by mouth may dissolve gallstones....
<ul><li>Done through abd incision (open cholecystectomy) or through smaller incisions via laparoscope (laparoscopic cholec...
<ul><li>Common risk factors include: </li></ul><ul><ul><li>IV drug use </li></ul></ul><ul><ul><li>Acetaminophen overdose  ...
<ul><li>Pre-icteric </li></ul><ul><li>Icteric   </li></ul><ul><li>Post-icteric   </li></ul>
<ul><li>Are tests to detect presence of hepatitis antibodies; tests  specific to Hepatitis A, B, or C viruses. </li></ul><...
<ul><li>Similar to that of a typical viral syndrome; often goes unrecognized </li></ul><ul><li>Spread via: </li></ul><ul><...
<ul><li>Treatment:    </li></ul><ul><ul><li>No specific treatment for Hepatitis A.  </li></ul></ul><ul><ul><li>Rest recomm...
<ul><li>Prognosis </li></ul><ul><ul><li>Least serious & most mild; will not become “chronic” disease.  </li></ul></ul><ul>...
<ul><li>Pre-exposure </li></ul><ul><ul><li>travelers to intermediate and high  HAV-endemic regions </li></ul></ul><ul><li>...
<ul><li>a.k.a. “serum hepatitis” (but actually still a virus)  </li></ul><ul><li>Spreads through blood & sexual contact (i...
<ul><li>Symptoms: </li></ul><ul><li>Hepatitis B carriers can infect others, even if they are without symptoms. </li></ul>
<ul><li>Sexual </li></ul><ul><li>Parenteral </li></ul><ul><li>Perinatal </li></ul>Hepatitis B Virus  Modes of Transmission
<ul><li>SCHEDULE:  </li></ul><ul><ul><li>given as series of 3 injections.  </li></ul></ul><ul><ul><li>All 3 doses necessar...
<ul><li>Transmitted through blood or other body fluid contact </li></ul><ul><li>Risk factors:  </li></ul><ul><ul><li>Recei...
<ul><li>Ever injected illegal drugs </li></ul><ul><li>Received clotting factors made before 1987 </li></ul><ul><li>Receive...
<ul><li>Treatment     </li></ul><ul><ul><li>no cure ; no vaccine  </li></ul></ul><ul><ul><li>Some benefit from tx with int...
<ul><li>Screen and test all donors </li></ul><ul><li>Risk-reduction counseling & services </li></ul><ul><ul><li>Obtain his...
<ul><li>Percutaneous exposures </li></ul><ul><ul><li>-Injected drug use </li></ul></ul><ul><li>Per mucosal exposures </li>...
<ul><li>Treatment </li></ul><ul><ul><li>Same as for hep B. </li></ul></ul><ul><li>Prognosis  </li></ul><ul><ul><li>similar...
<ul><li>Most outbreaks associated with focally contaminated drinking water </li></ul><ul><li>Minimal person-to-person tran...
<ul><li>Drinking water (and beverages with ice) of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not p...
<ul><li>Toxic Hepatitis </li></ul><ul><ul><li>Caused by exposure to toxic to the liver substances  </li></ul></ul><ul><ul>...
<ul><li>Get vaccinated against HAV & HBV. </li></ul><ul><li>Immunoglobulin may prevent infection; many times given after e...
<ul><li>Avoid sharing plates, utensils, or bathrooms with someone who has hepatitis A. </li></ul><ul><li>Do not share razo...
<ul><li>Caused by accumulation of triglycerides and other fats in hepatic cells </li></ul><ul><ul><li>Leading to faulty li...
<ul><li>It’s a chronic, progressive disease characterized by inflammation, fibrosis, and liver cell degeneration  </li></u...
<ul><li>chronic ETOH abuse (leading cause)  </li></ul><ul><ul><li>chronic liver disease.  </li></ul></ul><ul><ul><li>hepat...
<ul><ul><li>Laennec's or alcoholic </li></ul></ul><ul><ul><li>Post necrotic (usually after hepatitis or toxic exposure) </...
<ul><li>In early stages, signs of liver disease include: </li></ul>
<ul><li>In late stages, signs vary: </li></ul>
<ul><li>ALP, AST & ALT may be elevated. </li></ul><ul><li>Alkaline phosphatase levels may increase. </li></ul><ul><li>Tota...
<ul><ul><li>Offending medications & alcohol stopped.  </li></ul></ul><ul><ul><li>Rest & good dietary intake stressed </li>...
<ul><ul><li>Excess Fluid Volume </li></ul></ul><ul><ul><li>Risk for hemorrhage </li></ul></ul><ul><ul><li>Risk for hepatic...
<ul><li>Portal hypertension (inc. vascular pressure in portal vein & its </li></ul><ul><li>  branches) </li></ul><ul><li>A...
<ul><li>Is dilation of esophageal veins in lower aspect of esophagus  </li></ul><ul><ul><li>r/t portal hypertension caused...
<ul><li>Food & fluid restrictions with active bleeding </li></ul><ul><li>Vasoconstrictors initially given to control activ...
<ul><li>Hepatocellular carcinoma accounts for 80-90% of all primary liver cancers.  Many liver tumors metastatic from othe...
<ul><li>Symptoms     </li></ul><ul><ul><li>Abd pain tenderness, particularly in RUQ  </li></ul></ul><ul><ul><li>Enlarged a...
<ul><li>Symptomatic interventions </li></ul><ul><li>Pain management  </li></ul><ul><li>Self-image issues  </li></ul><ul><l...
<ul><li>Sudden attack causing inflammation of pancreas </li></ul><ul><li>Exact cause  not well understood. </li></ul><ul><...
<ul><li>S&S: </li></ul><ul><li>Risk factors  </li></ul>
<ul><li>Diagnosis :   </li></ul><ul><ul><li>Incr. serum amylase & lipase Incr. LFTs </li></ul></ul><ul><ul><li>Ultrasound ...
<ul><li>Hypovolemia </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Acute renal failure </li></ul><ul><li>Paralytic ileus <...
<ul><li>Ongoing inflammation of pancreas </li></ul><ul><li>  Progressive disorder associated with destruction of pancreas ...
<ul><li>Diagnosis: </li></ul><ul><ul><li>difficult because routine blood studies (such as amylase and lipase levels) do no...
<ul><li>CT scan of upper abdomen showing a pancreatic tumor in  head of pancreas, seen here in middle of picture  </li></u...
<ul><li>Risk Factors:  </li></ul><ul><li>S&S: </li></ul>
<ul><ul><li>Only ~  20% of pancreatic cancers operable  </li></ul></ul><ul><ul><li>Radiation therapy  </li></ul></ul><ul><...
Upcoming SlideShare
Loading in...5
×

Biliary

1,211

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,211
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
54
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • S&amp;P
  • 2 2 2
  • Transcript of "Biliary"

    1. 2. <ul><li>Abd pain (esp. RUQ, may radiate) </li></ul><ul><li>Dietary hx </li></ul><ul><li>Changes in bowel habits </li></ul><ul><li>Changes in color or consistency of stool </li></ul><ul><li>Nausea & vomiting </li></ul><ul><li>Appetite changes </li></ul><ul><li>Weight changes </li></ul>
    2. 3. <ul><li>Abnormal bowel sounds </li></ul><ul><li>Abdominal distention or ascites </li></ul>
    3. 5. <ul><li>Enzyme found in all tissues. High concentrations in liver, bile ducts, placenta, & bone. </li></ul><ul><li>Damaged or diseased tissue releases enzymes into blood, so serum ALP measurements can be abnormal in many conditions, including bone & liver disease </li></ul><ul><li>Normal range - </li></ul>
    4. 6. <ul><li>Enzymes found in liver; elevated levels indicate liver disease </li></ul><ul><li>AST (SGOT) = aspartate aminotransferase </li></ul><ul><ul><li>Norm = </li></ul></ul><ul><li>ALT (SGPT) = alamine aminotransferase </li></ul><ul><ul><li>Norm = </li></ul></ul><ul><li>GGT = glutamine transferase </li></ul><ul><ul><li>Norm = </li></ul></ul>
    5. 7. <ul><li>It’s the breakdown product of Hb </li></ul><ul><li>Total & direct bilirubin usually measured to screen or monitor liver or GB dysfunction. </li></ul><ul><li>Conjugated bilirubin </li></ul><ul><li>Unconjugated bilirubin </li></ul><ul><li>Total serum bilirubin </li></ul><ul><li>Normal Values    </li></ul><ul><ul><li>direct bilirubin: </li></ul></ul><ul><ul><li>total bilirubin: </li></ul></ul><ul><li>May also do an 24 urine for Bilirubin </li></ul>
    6. 8. <ul><li>Lipase - enzyme secreted by pancreas that catalyzes breakdown of triglycerides into fatty acids. </li></ul><ul><li>Normal Values: </li></ul><ul><li>Amylase - enzyme which helps digest glycogen & starch. </li></ul><ul><li>Normal value: </li></ul><ul><li>May also be done as a 24 hr urine </li></ul>Although these are pancreatic enzymes, increased levels may indicate GB disease.
    7. 9. <ul><li>Types: </li></ul><ul><ul><li>Cholecystitis - inflammation of gallbladder </li></ul></ul><ul><ul><li>Cholelithiasis - gall stones </li></ul></ul><ul><li>Predisposing Factors: “the 4 Fs” </li></ul><ul><li>Symptoms    </li></ul><ul><ul><li>Abd fullness or c/o gas </li></ul></ul>
    8. 10. <ul><li>Normally balance of bile salts, lecithin & cholesterol keep gallstones from forming. </li></ul><ul><li>If abnormally high levels of bile salts or cholesterol, stones can form. </li></ul><ul><li>Symptoms usually occur when stones block one of the biliary ducts </li></ul><ul><ul><li>may be dx on routine x-ray or abd CT. </li></ul></ul>
    9. 11. <ul><li>Low fat, high carb, high protein, high fiber diet with small frequent feedings </li></ul><ul><li>Pain control </li></ul>
    10. 12. <ul><li>MEDICATION </li></ul><ul><ul><li>In people with functioning GB, bile salts taken by mouth may dissolve gallstones. However, process may take 2 years or longer, & stones may return after therapy ends. </li></ul></ul><ul><li>LITHOTRIPSY </li></ul><ul><ul><li>Electrohydraulic shock wave lithotripsy (ESWL); electromagnetic high-energy shock waves break up stones </li></ul></ul><ul><ul><li>Use is limited if there are a large number of stones present, if the stones are very large, or in the presence of acute cholecystitis. </li></ul></ul>
    11. 13. <ul><li>Done through abd incision (open cholecystectomy) or through smaller incisions via laparoscope (laparoscopic cholecystectomy). </li></ul><ul><li>In complex or complicated cases, open cholecystectomy usually recommended. </li></ul><ul><li>Drains may be left in place to drain fluids if any inflammation or infection. </li></ul><ul><li>Laparoscopic surgery has lower rate of complications, shorter hospital stay, and better cosmetic results than open procedure. </li></ul><ul><li>Recovery </li></ul><ul><ul><li>3 weeks for recovery from open gallbladder removal. </li></ul></ul><ul><ul><li>Laparoscopic cholecystectomy shorter hospital stay (or done as outpatient). </li></ul></ul>
    12. 14. <ul><li>Common risk factors include: </li></ul><ul><ul><li>IV drug use </li></ul></ul><ul><ul><li>Acetaminophen overdose </li></ul></ul><ul><ul><li>Risky sexual behaviors </li></ul></ul><ul><ul><li>Eating contaminated foods </li></ul></ul><ul><ul><li>Travel to endemic area, like Asia, Africa, or South or Central America </li></ul></ul><ul><ul><li>Living in a nursing home or rehabilitation center </li></ul></ul><ul><ul><li>Family member who recently had hepatitis A </li></ul></ul><ul><ul><li>Alcohol use </li></ul></ul><ul><ul><li>Organ transplant recipient </li></ul></ul><ul><ul><li>AIDS </li></ul></ul><ul><ul><li>Blood transfusion received prior to 1990 </li></ul></ul><ul><ul><li>Newborns of mothers with hepatitis B or C </li></ul></ul><ul><ul><li>Healthcare workers, including dentists and dental hygienists, because of blood contact </li></ul></ul><ul><ul><li>Receiving a tattoo </li></ul></ul>
    13. 15. <ul><li>Pre-icteric </li></ul><ul><li>Icteric </li></ul><ul><li>Post-icteric </li></ul>
    14. 16. <ul><li>Are tests to detect presence of hepatitis antibodies; tests specific to Hepatitis A, B, or C viruses. </li></ul><ul><li>Hepatitis A virus (HAV)- incubation period of </li></ul><ul><li>Hepatitis B virus (HBV) -incubation period of </li></ul><ul><li>Hepatitis C virus (HCV) - incubation period of </li></ul><ul><li>Normal Values: negative results </li></ul>
    15. 17. <ul><li>Similar to that of a typical viral syndrome; often goes unrecognized </li></ul><ul><li>Spread via: </li></ul><ul><ul><li>fecal-oral route by oral ingestion of fecal contaminants </li></ul></ul><ul><ul><li>Contaminated water, shellfish from contaminated water, food contaminated by handlers infected with hepatitis A </li></ul></ul><ul><ul><li>Also spread by oral-anal sexual activity </li></ul></ul><ul><li>Usually not life threatening. </li></ul><ul><li>May be more severe in those over 40 </li></ul><ul><li>Many people who have hepatitis A don’t know it; symptoms similar to GI illness. </li></ul>
    16. 18. <ul><li>Treatment:    </li></ul><ul><ul><li>No specific treatment for Hepatitis A. </li></ul></ul><ul><ul><li>Rest recommended during acute phase </li></ul></ul><ul><ul><li>Avoid alcohol & anything toxic to liver, including Tylenol. </li></ul></ul><ul><ul><li>Avoid fatty foods during acute phase; may lead to vomiting. </li></ul></ul>
    17. 19. <ul><li>Prognosis </li></ul><ul><ul><li>Least serious & most mild; will not become “chronic” disease. </li></ul></ul><ul><ul><li>Over 85% recover within 3 months; over 99% recover by 6 months. </li></ul></ul><ul><ul><li>Fatality rate: ~ 0.1% </li></ul></ul><ul><li>Prevention    </li></ul><ul><ul><li>Avoid unclean food & water, thorough hand washing after using the restroom, & thorough cleansing if any contact with infected body fluids </li></ul></ul><ul><ul><li>2 vaccines (Havrix & Vaqta) available. People who should consider vaccination include: </li></ul></ul><ul><ul><ul><ul><li>Those traveling to areas or countries with high levels of Hepatitis A </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Men who have sex with men </li></ul></ul></ul></ul><ul><ul><ul><ul><li>IV drug users </li></ul></ul></ul></ul><ul><ul><li>Immune globulin administered to those in close contact with people with Hepatitis A. </li></ul></ul>
    18. 20. <ul><li>Pre-exposure </li></ul><ul><ul><li>travelers to intermediate and high HAV-endemic regions </li></ul></ul><ul><li>Post-exposure (within 14 days) </li></ul><ul><ul><li>Routine </li></ul></ul><ul><ul><li>household and other intimate contacts </li></ul></ul><ul><ul><li>Selected situations </li></ul></ul><ul><ul><li>institutions (e.g., day-care centers) </li></ul></ul><ul><ul><li>common source exposure (e.g., </li></ul></ul><ul><ul><li>food prepared by infected food handler) </li></ul></ul>
    19. 21. <ul><li>a.k.a. “serum hepatitis” (but actually still a virus) </li></ul><ul><li>Spreads through blood & sexual contact (infected body fluids). </li></ul><ul><ul><li>seen with incr. freq. among IV drug users who share needles & among male homosexual population. </li></ul></ul>
    20. 22. <ul><li>Symptoms: </li></ul><ul><li>Hepatitis B carriers can infect others, even if they are without symptoms. </li></ul>
    21. 23. <ul><li>Sexual </li></ul><ul><li>Parenteral </li></ul><ul><li>Perinatal </li></ul>Hepatitis B Virus Modes of Transmission
    22. 24. <ul><li>SCHEDULE: </li></ul><ul><ul><li>given as series of 3 injections. </li></ul></ul><ul><ul><li>All 3 doses necessary for most effective & longest lasting immunity. </li></ul></ul><ul><ul><li>Required by OSHA to be offered “free of charge” by healthcare facilities for their employees at risk </li></ul></ul>
    23. 25. <ul><li>Transmitted through blood or other body fluid contact </li></ul><ul><li>Risk factors: </li></ul><ul><ul><li>Received a blood transfusion prior to July 1992 </li></ul></ul><ul><ul><li>Received blood, blood products, or solid organs from a donor who has hepatitis C </li></ul></ul><ul><ul><li>Injected street drugs or shared a needle with someone who has hepatitis C </li></ul></ul><ul><ul><li>Long-term kidney dialysis </li></ul></ul><ul><ul><li>Healthcare worker </li></ul></ul><ul><ul><li>Multiple sex partners </li></ul></ul><ul><ul><li>Had Hep C sex partner </li></ul></ul><ul><ul><li>Shared personal items, such as toothbrushes and razors, with someone who has hepatitis C </li></ul></ul><ul><ul><li>Were born to hepatitis C infected mother </li></ul></ul><ul><li>Most individuals are asymptomatic; damage occurs over decades. </li></ul>
    24. 26. <ul><li>Ever injected illegal drugs </li></ul><ul><li>Received clotting factors made before 1987 </li></ul><ul><li>Received blood/organs before July 1992 </li></ul><ul><li>Ever on chronic hemodialysis </li></ul><ul><li>Evidence of liver disease </li></ul><ul><li>Healthcare, emergency, public safety workers after needle stick/mucosal exposures to HCV-positive blood </li></ul><ul><li>Children born to HCV-positive women </li></ul>Based on increased risk for infection
    25. 27. <ul><li>Treatment    </li></ul><ul><ul><li>no cure ; no vaccine </li></ul></ul><ul><ul><li>Some benefit from tx with interferon. </li></ul></ul><ul><ul><li>Rest recommended during acute phase </li></ul></ul><ul><ul><li>should be immunized against hepatitis A & B. </li></ul></ul><ul><ul><li>Must be careful not to take vitamins, nutritional supplements, or new OTC medications without discussing with MD first </li></ul></ul><ul><ul><li>Should avoid any hepatotoxic substances, including alcohol. Even moderate amts of alcohol speed up the progression of hep C. </li></ul></ul><ul><li>Prognosis </li></ul><ul><ul><li>one of the most common causes of chronic liver disease in the U.S. today. Hepatitis C is now #1 cause for liver transplantation in the U.S. </li></ul></ul><ul><ul><li>80% of clients with acute hepatitis C ultimately develop chronic liver infection, & 20- 30% develop cirrhosis. </li></ul></ul><ul><ul><li>1- 5% may develop liver cancer. </li></ul></ul>
    26. 28. <ul><li>Screen and test all donors </li></ul><ul><li>Risk-reduction counseling & services </li></ul><ul><ul><li>Obtain history of high-risk drug and sex behaviors </li></ul></ul><ul><ul><li>Provide information on minimizing risky behavior </li></ul></ul><ul><ul><li>Vaccinate against hepatitis A and/or hepatitis B </li></ul></ul><ul><li>Safe injection & infection control practices </li></ul><ul><li>Identify persons at risk for </li></ul><ul><li>HCV & test to determine infection status </li></ul><ul><li>Provide HCV-positive persons with: </li></ul><ul><ul><li>Medical evaluation and management </li></ul></ul><ul><ul><li>Support group referrals </li></ul></ul><ul><ul><li>Counseling </li></ul></ul><ul><ul><ul><li>Prevent further liver damage </li></ul></ul></ul><ul><ul><ul><li>Prevent transmission to others </li></ul></ul></ul>
    27. 29. <ul><li>Percutaneous exposures </li></ul><ul><ul><li>-Injected drug use </li></ul></ul><ul><li>Per mucosal exposures </li></ul><ul><ul><li>-Sexual contact </li></ul></ul>
    28. 30. <ul><li>Treatment </li></ul><ul><ul><li>Same as for hep B. </li></ul></ul><ul><li>Prognosis </li></ul><ul><ul><li>similar to those of acute hepatitis B. </li></ul></ul><ul><ul><li>Acute illness usually subsides over 2-3 wks, & liver enzyme levels return to baseline in 16 wks. </li></ul></ul><ul><ul><li>10% may develop chronic hepatitis . </li></ul></ul>
    29. 31. <ul><li>Most outbreaks associated with focally contaminated drinking water </li></ul><ul><li>Minimal person-to-person transmission </li></ul><ul><li>U.S. cases usually have hx of travel HEV-endemic areas </li></ul>
    30. 32. <ul><li>Drinking water (and beverages with ice) of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not peeled or prepared by traveler </li></ul><ul><li>IG prepared from donors in Western countries does not prevent infection </li></ul><ul><li>Unknown efficacy of IG prepared from donors in endemic areas </li></ul><ul><li>No vaccine at present </li></ul>
    31. 33. <ul><li>Toxic Hepatitis </li></ul><ul><ul><li>Caused by exposure to toxic to the liver substances </li></ul></ul><ul><ul><li>(ie> carbon tetrachloride) </li></ul></ul><ul><li>Drug-Induced Hepatitis </li></ul><ul><ul><li>Considered a hypersensitivity reaction </li></ul></ul><ul><ul><li>Caused by exposure to medications (ie- Tylenol) </li></ul></ul>
    32. 34. <ul><li>Get vaccinated against HAV & HBV. </li></ul><ul><li>Immunoglobulin may prevent infection; many times given after exposure. </li></ul><ul><li>Avoid contact with blood or blood products; use standard precautions at all times </li></ul><ul><li>Avoid sexual contact with a person infected with hepatitis or unknown health history. Practice safe sex at all times. </li></ul><ul><li>Wash your hands after going to the bathroom & before handling food. </li></ul>
    33. 35. <ul><li>Avoid sharing plates, utensils, or bathrooms with someone who has hepatitis A. </li></ul><ul><li>Do not share razors, needles, or toothbrushes. </li></ul><ul><li>When traveling to endemic areas, do not eat uncooked or partially cooked foods. Drink bottled water. </li></ul><ul><li>Do not use recreational IV drugs. If already an IV drug user, never share needles and seek help from a needle exchange or drug treatment program. </li></ul><ul><li>Be cautious when receiving tattoos or piercings. </li></ul><ul><li>DO NOT drink alcohol at the same time that you take acetaminophen. </li></ul>
    34. 36. <ul><li>Caused by accumulation of triglycerides and other fats in hepatic cells </li></ul><ul><ul><li>Leading to faulty liver functioning </li></ul></ul><ul><li>Causes: </li></ul><ul><ul><li>ETOH abuse </li></ul></ul><ul><ul><li>DM </li></ul></ul><ul><ul><li>Preg </li></ul></ul><ul><ul><li>Long-term TPN usage </li></ul></ul><ul><li>Tx: </li></ul><ul><ul><li>Eliminating cause </li></ul></ul><ul><ul><li>Dietary restrictions </li></ul></ul>
    35. 37. <ul><li>It’s a chronic, progressive disease characterized by inflammation, fibrosis, and liver cell degeneration </li></ul><ul><li>Normal liver tissue replaced by diffuse fibrosis </li></ul><ul><ul><li>Irreversible reaction to hepatic inflammation </li></ul></ul><ul><ul><li>Alteration in vascular system/lymphatic bile duct channels </li></ul></ul>
    36. 38. <ul><li>chronic ETOH abuse (leading cause) </li></ul><ul><ul><li>chronic liver disease. </li></ul></ul><ul><ul><li>hepatitis B and/or C </li></ul></ul><ul><ul><li>medications </li></ul></ul><ul><ul><li>autoimmune inflammation of the liver </li></ul></ul><ul><ul><li>disorders of biliary system </li></ul></ul><ul><ul><li>metabolic disorders of iron & copper (hemochromatosis and Wilson's disease). </li></ul></ul><ul><ul><li>malnutrition </li></ul></ul>
    37. 39. <ul><ul><li>Laennec's or alcoholic </li></ul></ul><ul><ul><li>Post necrotic (usually after hepatitis or toxic exposure) </li></ul></ul><ul><ul><li>Biliary (R/T chronic biliary obstruction) </li></ul></ul><ul><ul><li>Cardiac (R/T right sided CHF) </li></ul></ul>
    38. 40. <ul><li>In early stages, signs of liver disease include: </li></ul>
    39. 41. <ul><li>In late stages, signs vary: </li></ul>
    40. 42. <ul><li>ALP, AST & ALT may be elevated. </li></ul><ul><li>Alkaline phosphatase levels may increase. </li></ul><ul><li>Total serum bilirubin & urobilinogen levels may rise. </li></ul><ul><li>Total serum protein and albumin levels decrease. </li></ul><ul><li>Prothrombin time prolonged; platelet count low </li></ul><ul><li>Decreased H&H </li></ul><ul><li>Elevated ammonia levels </li></ul><ul><li>Serum creatinine level possibly elevated </li></ul>
    41. 43. <ul><ul><li>Offending medications & alcohol stopped. </li></ul></ul><ul><ul><li>Rest & good dietary intake stressed </li></ul></ul><ul><ul><li>Ascites treated with diuretics, fluid and salt restriction, & paracentesis </li></ul></ul><ul><ul><li>Coagulopathy may be treated with blood products or vitamin K. </li></ul></ul><ul><ul><li>Shunt (Levee) placed to drain ascites </li></ul></ul>
    42. 44. <ul><ul><li>Excess Fluid Volume </li></ul></ul><ul><ul><li>Risk for hemorrhage </li></ul></ul><ul><ul><li>Risk for hepatic encephalopathy </li></ul></ul><ul><ul><li>Imbalanced nutrition: less then body requirements </li></ul></ul><ul><ul><li>Ineffective breathing pattern </li></ul></ul><ul><ul><li>Impaired comfort </li></ul></ul><ul><ul><li>Risk for infection </li></ul></ul><ul><ul><li>Risk for impaired skin integrity </li></ul></ul>
    43. 45. <ul><li>Portal hypertension (inc. vascular pressure in portal vein & its </li></ul><ul><li> branches) </li></ul><ul><li>Ascites </li></ul><ul><li>Coagulation defects </li></ul><ul><li>Jaundice </li></ul><ul><li>Hepatic encephalopathy leading to hepatic coma </li></ul><ul><li>Hepatorenal syndrome </li></ul><ul><li>Esophageal varices </li></ul><ul><li>Spontaneous bacterial peritonitis </li></ul>
    44. 46. <ul><li>Is dilation of esophageal veins in lower aspect of esophagus </li></ul><ul><ul><li>r/t portal hypertension caused by obstructed portal vein circulation in damaged liver. </li></ul></ul><ul><li>Causes: </li></ul><ul><ul><li>Incr. intra-abd pressure </li></ul></ul><ul><ul><li>ETOH abuse </li></ul></ul><ul><ul><li>Cirrhosis </li></ul></ul><ul><li>S&S: </li></ul><ul><ul><li>Hematemesis </li></ul></ul><ul><ul><li>Melena </li></ul></ul><ul><ul><ul><li>black, tarry stool or vomit composed largely of blood </li></ul></ul></ul>
    45. 47. <ul><li>Food & fluid restrictions with active bleeding </li></ul><ul><li>Vasoconstrictors initially given to control active bleeding </li></ul><ul><li>Iced saline lavage by NG tube </li></ul><ul><li>IV & transfusion therapy </li></ul><ul><li>Endoscopic sclerotherapy (to sclerosis varices) </li></ul><ul><li>Sengstaken-Blakemore tube (esophageal balloon tamponade) </li></ul>
    46. 48. <ul><li>Hepatocellular carcinoma accounts for 80-90% of all primary liver cancers. Many liver tumors metastatic from other primary sites. </li></ul><ul><li>Occurs more often in men & those 50- 60 years old. </li></ul><ul><li>Cause: unknown, but contributing factors: </li></ul><ul><ul><li>chronic liver disease </li></ul></ul><ul><ul><li>hepatitis B and C </li></ul></ul><ul><ul><li>exposure to known hepatic carcinogens or toxins </li></ul></ul><ul><li>Incidence: ~ 4 in 10,000 people. </li></ul>
    47. 49. <ul><li>Symptoms    </li></ul><ul><ul><li>Abd pain tenderness, particularly in RUQ </li></ul></ul><ul><ul><li>Enlarged abdomen </li></ul></ul><ul><ul><li>Easy bruising or bleeding </li></ul></ul><ul><ul><li>Jaundice </li></ul></ul><ul><ul><li>enlarged, tender liver on palpation. </li></ul></ul><ul><li>Treatment    </li></ul><ul><ul><li>Aggressive surgery or liver transplantation may be successful in treating small or slow-growing tumors if diagnosed early. </li></ul></ul><ul><ul><li>Chemotherapy & radiation not usually effective but may be used to shrink large tumors. </li></ul></ul><ul><li>Prognosis </li></ul><ul><ul><li>usual outcome poor, because only 10% to 20% of hepatocellular carcinomas can be surgically removed completely. </li></ul></ul><ul><ul><li>If cancer cannot be completely removed, disease usually fatal within 3-6 months. </li></ul></ul>
    48. 50. <ul><li>Symptomatic interventions </li></ul><ul><li>Pain management </li></ul><ul><li>Self-image issues </li></ul><ul><li>Grief counseling </li></ul><ul><li>Hospice care or home care </li></ul><ul><li>Referrals & community support </li></ul>
    49. 51. <ul><li>Sudden attack causing inflammation of pancreas </li></ul><ul><li>Exact cause not well understood. </li></ul><ul><li>Thought that pancreatic enzymes start to digest pancreatic tissue (autodigestion) </li></ul>
    50. 52. <ul><li>S&S: </li></ul><ul><li>Risk factors </li></ul>
    51. 53. <ul><li>Diagnosis : </li></ul><ul><ul><li>Incr. serum amylase & lipase Incr. LFTs </li></ul></ul><ul><ul><li>Ultrasound exam Endoscopic retrograde cholangiopancreatography (ERCP) </li></ul></ul><ul><ul><li>CT scan. </li></ul></ul><ul><li>TX: </li></ul><ul><ul><li>Depends on severity </li></ul></ul><ul><ul><li>Generally pt needs hospitalization with IV fluids to restore blood volume </li></ul></ul><ul><ul><li>Pain control </li></ul></ul><ul><ul><li>Keep NPO </li></ul></ul><ul><li>Prognosis: </li></ul><ul><ul><li>Usually recover fully & do not experience recurrence if cause removed. </li></ul></ul>
    52. 54. <ul><li>Hypovolemia </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Acute renal failure </li></ul><ul><li>Paralytic ileus </li></ul><ul><li>Hypovolemic or septic shock </li></ul><ul><li>Pleural effusion, respiratory distress syndrome, pneumonia </li></ul><ul><li>Multisystem organ failure </li></ul><ul><li>Disseminated intravascular coagulation </li></ul><ul><li>Diabetes mellitus </li></ul>
    53. 55. <ul><li>Ongoing inflammation of pancreas </li></ul><ul><li>  Progressive disorder associated with destruction of pancreas may be confused with acute pancreatitis due to similarities of the symptoms.  </li></ul><ul><li>S&S: </li></ul><ul><ul><li>Upper abdominal & back pain </li></ul></ul><ul><ul><ul><li>Usually constant, dull pain that gets worse with eating food or drinking alcohol & lessens when sitting up & leaning forward. </li></ul></ul></ul><ul><ul><ul><li>as disease progresses, attacks more often & last longer </li></ul></ul></ul><ul><ul><li>N&V </li></ul></ul><ul><ul><li>As disease progresses: </li></ul></ul>
    54. 56. <ul><li>Diagnosis: </li></ul><ul><ul><li>difficult because routine blood studies (such as amylase and lipase levels) do not necessarily show elevations </li></ul></ul><ul><ul><li>most important clue is accurate medical history. </li></ul></ul><ul><ul><li>Abd x-ray ( might show pancreatic calcification) </li></ul></ul><ul><ul><li>Ultrasound or CT </li></ul></ul><ul><ul><li>ERCP </li></ul></ul><ul><li>Risk factors:    </li></ul><ul><ul><li>ETOH abuse </li></ul></ul><ul><ul><li>Hyperlipidemia </li></ul></ul><ul><ul><li>Gallstones </li></ul></ul><ul><li>Tx: </li></ul><ul><ul><li>depends on S&S </li></ul></ul><ul><ul><li>most therapies centers focus on pain management & nutritional support </li></ul></ul><ul><ul><li>Oral pancreatic enzyme supplements </li></ul></ul><ul><ul><li>Low fat diet </li></ul></ul>
    55. 57. <ul><li>CT scan of upper abdomen showing a pancreatic tumor in head of pancreas, seen here in middle of picture </li></ul><ul><li>4th leading cause of cancer death in US </li></ul><ul><li>More than 30,000 deaths this year in US </li></ul><ul><li>Difficult to detect, hard to diagnose, early to metastasize (spread) & resistant to treatment. </li></ul><ul><li>Types Of Pancreatic Cancer    </li></ul><ul><ul><li>Most common type- pancreatic duct adenocarcinoma or simply pancreatic carcinoma </li></ul></ul><ul><ul><li>Endocrine cancers also known as islet cell or neuroendocrine cancers. </li></ul></ul>
    56. 58. <ul><li>Risk Factors: </li></ul><ul><li>S&S: </li></ul>
    57. 59. <ul><ul><li>Only ~ 20% of pancreatic cancers operable </li></ul></ul><ul><ul><li>Radiation therapy </li></ul></ul><ul><ul><li>Chemotherapy </li></ul></ul><ul><ul><li>Surgery: </li></ul></ul><ul><ul><ul><li>Whipple procedure: </li></ul></ul></ul><ul><ul><ul><ul><li>Most common surg. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>If the tumor is in head of pancreas, remove head of pancreas & part of small intestine, bile duct, & stomach. </li></ul></ul></ul></ul><ul><ul><ul><li>Distal pancreatectomy: </li></ul></ul></ul><ul><ul><ul><ul><li>removes body and tail of the pancreas if the tumor is in either of these parts. </li></ul></ul></ul></ul><ul><ul><ul><li>Total pancreatectomy: </li></ul></ul></ul><ul><ul><ul><ul><li>removes entire pancreas, part of small intestine, portion of stomach, common bile duct, gallbladder, spleen, & nearby lymph nodes. </li></ul></ul></ul></ul><ul><ul><li>Sometimes cancer cannot be completely removed. </li></ul></ul><ul><ul><li>If tumor blocking common bile duct or small intestine, can create a bypass. </li></ul></ul><ul><ul><ul><li>To relieve jaundice, pain, nausea & vomiting </li></ul></ul></ul><ul><ul><ul><li>Or may place a stent </li></ul></ul></ul><ul><ul><li>pancreatic enzymes or hormones after surgery </li></ul></ul><ul><ul><li>Those who do not have enough insulin may develop diabetes. </li></ul></ul><ul><li>Prognosis </li></ul><ul><ul><li>can be cured only when it is found at an early stage </li></ul></ul>
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×