Disorders in patients with liver, biliary and pancreatic problems

1. Interventions forInterventions for
clients with liver,clients with liver,
galdbladder andgaldbladder and
pancreaspancreas
disorders. Clientsdisorders. Clients
with malnutritionwith malnutrition
and obesity.and obesity.
..

2. HepatitisHepatitis
 Widespread viral inflammation of liver cellsWidespread viral inflammation of liver cells
 Hepatitis AHepatitis A
 Hepatitis BHepatitis B
 Hepatitis CHepatitis C
 Hepatitis DHepatitis D
 Hepatitis EHepatitis E
 Hepatitis F and G are uncommonHepatitis F and G are uncommon

3. Clinical ManifestationsClinical Manifestations
 Abdominal painAbdominal pain
 Changes in skin or eye colorChanges in skin or eye color
 Arthralgia (joint pain)Arthralgia (joint pain)
 Myalgia (muscle pain)Myalgia (muscle pain)
 Diarrhea/constipationDiarrhea/constipation
 FeverFever
 LethargyLethargy
 MalaiseMalaise
 Nausea/vomitingNausea/vomiting
 PruritusPruritus

4. Fatty LiverFatty Liver
(Steatohepatitis)(Steatohepatitis)
 Fatty liver is caused by the accumulation of fats in andFatty liver is caused by the accumulation of fats in and
around the hepatic cells.around the hepatic cells.
 Causes include:Causes include:
 Diabetes mellitusDiabetes mellitus
 ObesityObesity
 Elevated lipid profileElevated lipid profile
 Many clients are asymptomaticMany clients are asymptomatic

5. Hepatic AbscessHepatic Abscess
 Liver invaded by bacteria or protozoa causing abscessLiver invaded by bacteria or protozoa causing abscess
 Pyrogenic liver abscess; amebic hepatic abscessPyrogenic liver abscess; amebic hepatic abscess
 Treatment usually involves:Treatment usually involves:
 Drainage with ultrasound guidanceDrainage with ultrasound guidance
 Antibiotic therapyAntibiotic therapy

6. Liver TraumaLiver Trauma
 The liver is the most common organ injured in clients withThe liver is the most common organ injured in clients with
penetrating trauma of the abdomen, such as gunshot woundspenetrating trauma of the abdomen, such as gunshot wounds
and stab wounds.and stab wounds.
 Clinical manifestations include abdominal tenderness,Clinical manifestations include abdominal tenderness,
distention, guarding, rigidity.distention, guarding, rigidity.
 Treatment involves surgery, multiple blood products.Treatment involves surgery, multiple blood products.

7. CirrhosisCirrhosis
 Cirrhosis is extensive scarring of the liver, usually caused byCirrhosis is extensive scarring of the liver, usually caused by
a chronic irreversible reaction to hepatic inflammation anda chronic irreversible reaction to hepatic inflammation and
necrosis.necrosis.
 Complications depend on the amount of damage sustainedComplications depend on the amount of damage sustained
by the liver.by the liver.
 In compensated cirrhosis, liver has significant scarring butIn compensated cirrhosis, liver has significant scarring but
performs essential functions without causing significantperforms essential functions without causing significant
symptoms.symptoms.

8. ComplicationsComplications
 Portal hypertensionPortal hypertension
 AscitesAscites
 Bleeding esophageal varicesBleeding esophageal varices
 Coagulation defectsCoagulation defects
 JaundiceJaundice
 Portal-systemic encephalopathy withPortal-systemic encephalopathy with
hepatic comahepatic coma
 Hepatorenal syndromeHepatorenal syndrome
 Spontaneous bacterial peritonitisSpontaneous bacterial peritonitis

9. EtiologyEtiology
 Known causes of liver disease include:Known causes of liver disease include:
 AlcoholAlcohol
 Viral hepatitisViral hepatitis
 Autoimmune hepatitisAutoimmune hepatitis
 SteatohepatitisSteatohepatitis
 Drugs and toxinsDrugs and toxins
 Biliary diseaseBiliary disease
 Metabolic/genetic causesMetabolic/genetic causes
 Cardiovascular diseaseCardiovascular disease

10. Clinical ManifestationsClinical Manifestations
 In early stages, signs of liver diseaseIn early stages, signs of liver disease
include:include:
 FatigueFatigue
 Significant change in weightSignificant change in weight
 Gastrointestinal symptomsGastrointestinal symptoms
 Abdominal pain and liver tendernessAbdominal pain and liver tenderness
 PruritusPruritus

11. Clinical ManifestationsClinical Manifestations

12. Abdominal AssessmentAbdominal Assessment
 Massive ascitesMassive ascites
 Umbilicus protrusionUmbilicus protrusion
 Caput medusae (dilated abdominal veins)Caput medusae (dilated abdominal veins)
 Hepatomegaly (liver enlargementHepatomegaly (liver enlargement

14. Cancer of the LiverCancer of the Liver
 One of the most common tumors inOne of the most common tumors in
the worldthe world
 Most common complaint: abdominalMost common complaint: abdominal
discomfortdiscomfort
 Treatment includes:Treatment includes:
 ChemotherapyChemotherapy
 SurgerySurgery

16. Liver TransplantationLiver Transplantation
 Used in the treatment of end-stage liver disease,Used in the treatment of end-stage liver disease,
primary malignant neoplasm of the liverprimary malignant neoplasm of the liver
 Donor livers obtained primarily from trauma victimsDonor livers obtained primarily from trauma victims
who have not had liver damagewho have not had liver damage
 Donor liver transported to the surgery center in aDonor liver transported to the surgery center in a
cooled saline solution that preserves the organ for up tocooled saline solution that preserves the organ for up to
8 hours8 hours

18. ComplicationsComplications
 Acute, chronic graft rejectionAcute, chronic graft rejection
 InfectionInfection
 HemorrhageHemorrhage
 Hepatic artery thrombosisHepatic artery thrombosis
 Fluid and electrolyte imbalancesFluid and electrolyte imbalances
 Pulmonary atelectasisPulmonary atelectasis
 Acute renal failureAcute renal failure
 Psychological maladjustmentPsychological maladjustment

19. Acute CholecystitisAcute Cholecystitis
 Acute cholecystitis isAcute cholecystitis is
the inflammation of thethe inflammation of the
gallbladder.gallbladder.
 CholelithiasisCholelithiasis
(gallstones) usually(gallstones) usually
accompaniesaccompanies
cholecystitis.cholecystitis.
 AcalculousAcalculous
cholecystitischolecystitis
inflammation can occurinflammation can occur
in the absence ofin the absence of
gallstones.gallstones.
 Calculous cholecystitisCalculous cholecystitis
is the obstruction of theis the obstruction of the
cystic duct by a stone,cystic duct by a stone,
which creates anwhich creates an
inflammatory response.inflammatory response.

20. Chronic CholecystitisChronic Cholecystitis
 Repeated episodes of cystic ductRepeated episodes of cystic duct
obstruction result in chronicobstruction result in chronic
inflammationinflammation
 Pancreatitis, cholangitisPancreatitis, cholangitis
 JaundiceJaundice
 IcterusIcterus
 Obstructive jaundiceObstructive jaundice
 PruritusPruritus

21. Clinical ManifestationsClinical Manifestations
 Flatulence, dyspepsia, eructation,Flatulence, dyspepsia, eructation,
anorexia, nausea and vomiting,anorexia, nausea and vomiting,
abdominal painabdominal pain
 Biliary colicBiliary colic
 Murphy’s signMurphy’s sign
 Blumberg’s signBlumberg’s sign
 Rebound tendernessRebound tenderness
 SteatorrheaSteatorrhea

22. Surgical ManagementSurgical Management
 Laparoscopic cholecystectomyLaparoscopic cholecystectomy
 Standard preoperative careStandard preoperative care
 Operative procedureOperative procedure
 Postoperative carePostoperative care
 Free air pain result of carbon dioxide retention in theFree air pain result of carbon dioxide retention in the
abdomenabdomen
 AmbulationAmbulation
 Return to activities in 1 to 3 weeksReturn to activities in 1 to 3 weeks

23. TraditionalTraditional
CholecystectomyCholecystectomy
 Standard preoperative careStandard preoperative care
 Operative procedureOperative procedure
 Postoperative carePostoperative care
 Meperidine hydrochloride via patient-controlledMeperidine hydrochloride via patient-controlled
analgesia pumpanalgesia pump
 AntiemeticsAntiemetics
 Wound careWound care
 Care of the T-tubeCare of the T-tube
 Nothing by mouthNothing by mouth
 Diet therapyDiet therapy

24. Cancer of the GallbladderCancer of the Gallbladder
 Anorexia, weight loss, nausea, vomiting, general malaise,Anorexia, weight loss, nausea, vomiting, general malaise,
jaundice, hepatosplenomegaly, chronic, progressively severejaundice, hepatosplenomegaly, chronic, progressively severe
epigastric or right upper quadrant painepigastric or right upper quadrant pain
 Poor prognosisPoor prognosis
 Surgery, radiation, chemotherapySurgery, radiation, chemotherapy

25. Acute PancreatitisAcute Pancreatitis
 Serious and possibly life-threatening inflammatory processSerious and possibly life-threatening inflammatory process
of the pancreasof the pancreas
 Necrotizing hemorrhagic pancreatitisNecrotizing hemorrhagic pancreatitis
 LipolysisLipolysis
 ProteolysisProteolysis
 Necrosis of blood vesselsNecrosis of blood vessels
 InflammationInflammation
 Theories of enzyme activationTheories of enzyme activation

27. Complications of AcuteComplications of Acute
PancreatitisPancreatitis
 HypovolemiaHypovolemia
 HemorrhageHemorrhage
 Acute renal failureAcute renal failure
 Paralytic ileusParalytic ileus
 Hypovolemic or septic shockHypovolemic or septic shock
 Pleural effusion, respiratory distressPleural effusion, respiratory distress
syndrome,pneumoniasyndrome,pneumonia
 Multisystem organ failureMultisystem organ failure
 Disseminated intravascular coagulationDisseminated intravascular coagulation
 Diabetes mellitusDiabetes mellitus

28. Clinical ManifestationsClinical Manifestations
 Generalized jaundiceGeneralized jaundice
 Bowel soundsBowel sounds
 Abdominal tenderness, rigidity, guardingAbdominal tenderness, rigidity, guarding
 Pancreatic ascitesPancreatic ascites
 Significant changes in vital signsSignificant changes in vital signs

29. Clinical ManifestationsClinical Manifestations
 Cullen’s signCullen’s sign
Turner’s signTurner’s sign

30. Chronic PancreatitisChronic Pancreatitis
 Progressive destructive disease of theProgressive destructive disease of the
pancreas, characterized bypancreas, characterized by
remissions and exacerbationsremissions and exacerbations
 Nonsurgical management includes:Nonsurgical management includes:
 Drug therapyDrug therapy
 Analgesic administrationAnalgesic administration
 Enzyme replacementEnzyme replacement
 Insulin therapyInsulin therapy
 Diet therapyDiet therapy

31. Pancreatic AbscessPancreatic Abscess
 Most serious complication ofMost serious complication of
pancreatitis; always fatal if untreatedpancreatitis; always fatal if untreated
 High feverHigh fever
 Blood culturesBlood cultures
 Drainage via the percutaneousDrainage via the percutaneous
method or laparoscopymethod or laparoscopy
 Antibiotic treatment alone does notAntibiotic treatment alone does not
resolve abscessresolve abscess

32. Pancreatic CarcinomaPancreatic Carcinoma
 Nonsurgical managementNonsurgical management
 Drug therapyDrug therapy
 Radiation therapyRadiation therapy
 Biliary stent insertionBiliary stent insertion