Interventions for Interventions for clients with liver, clients with liver, galdbladder and galdbladder and pancreas disorders. pancreas disorders. Clients with Clients with malnutrition and malnutrition and obesity.obesity.

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HepatitisHepatitis Widespread viral inflammation of liver cellsWidespread viral inflammation of liver cells Hepatitis A Hepatitis A Hepatitis B Hepatitis B Hepatitis C Hepatitis C Hepatitis D Hepatitis D Hepatitis E Hepatitis E Hepatitis F and G are uncommonHepatitis F and G are uncommon

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

Fatty Liver (Steatohepatitis)Fatty Liver (Steatohepatitis)

Fatty liver is caused by the accumulation of fats in and Fatty 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

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

Liver TraumaLiver Trauma The liver is the most common organ injured in clients with The liver is the most common organ injured in clients with

penetrating trauma of the abdomen, such as gunshot wounds penetrating 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.

CirrhosisCirrhosis Cirrhosis is extensive scarring of the liver, usually caused by Cirrhosis is extensive scarring of the liver, usually caused by

a chronic irreversible reaction to hepatic inflammation and a chronic irreversible reaction to hepatic inflammation and necrosis.necrosis.

Complications depend on the amount of damage sustained Complications depend on the amount of damage sustained by the liver.by the liver.

In compensated cirrhosis, liver has significant scarring but In compensated cirrhosis, liver has significant scarring but performs essential functions without causing significant performs essential functions without causing significant symptoms.symptoms.

ComplicationsComplications

Portal hypertensionPortal hypertension Ascites Ascites Bleeding esophageal varicesBleeding esophageal varices Coagulation defectsCoagulation defects JaundiceJaundice Portal-systemic encephalopathy with Portal-systemic encephalopathy with

hepatic comahepatic coma Hepatorenal syndromeHepatorenal syndrome Spontaneous bacterial peritonitisSpontaneous bacterial peritonitis

EtiologyEtiology

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

Clinical ManifestationsClinical Manifestations

In early stages, signs of liver disease In 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 Pruritus Pruritus

Clinical ManifestationsClinical Manifestations

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

Cancer of the LiverCancer of the Liver

One of the most common tumors in One of the most common tumors in the worldthe world

Most common complaint: abdominal Most common complaint: abdominal discomfortdiscomfort

Treatment includes:Treatment includes: ChemotherapyChemotherapy SurgerySurgery

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 victims Donor 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 a Donor liver transported to the surgery center in a

cooled saline solution that preserves the organ for up cooled saline solution that preserves the organ for up to 8 hoursto 8 hours

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

Acute CholecystitisAcute Cholecystitis Acute cholecystitis is Acute cholecystitis is

the inflammation of the the inflammation of the gallbladder.gallbladder.

Cholelithiasis Cholelithiasis (gallstones) usually (gallstones) usually accompanies accompanies cholecystitis.cholecystitis.

Acalculous cholecystitis Acalculous cholecystitis inflammation can occur inflammation can occur in the absence of in the absence of gallstones.gallstones.

Calculous cholecystitis Calculous cholecystitis is the obstruction of the is the obstruction of the cystic duct by a stone, cystic duct by a stone, which creates an which creates an inflammatory response.inflammatory response.

Chronic CholecystitisChronic Cholecystitis Repeated episodes of cystic duct Repeated episodes of cystic duct

obstruction result in chronic obstruction result in chronic inflammationinflammation

Pancreatitis, cholangitisPancreatitis, cholangitis JaundiceJaundice IcterusIcterus Obstructive jaundiceObstructive jaundice Pruritus Pruritus

Clinical ManifestationsClinical Manifestations Flatulence, dyspepsia, eructation, Flatulence, dyspepsia, eructation,

anorexia, nausea and vomiting, anorexia, nausea and vomiting, abdominal pain abdominal pain

Biliary colicBiliary colic Murphy’s signMurphy’s sign Blumberg’s signBlumberg’s sign Rebound tendernessRebound tenderness Steatorrhea Steatorrhea

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 the Free 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

Traditional CholecystectomyTraditional Cholecystectomy

Standard preoperative careStandard preoperative care Operative procedureOperative procedure Postoperative carePostoperative care

Meperidine hydrochloride via patient-controlled Meperidine 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

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 severe jaundice, hepatosplenomegaly, chronic, progressively severe epigastric or right upper quadrant painepigastric or right upper quadrant pain

Poor prognosisPoor prognosis Surgery, radiation, chemotherapySurgery, radiation, chemotherapy

Acute PancreatitisAcute Pancreatitis Serious and possibly life-threatening inflammatory process Serious 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

Complications of Acute Complications of Acute PancreatitisPancreatitis

HypovolemiaHypovolemia HemorrhageHemorrhage Acute renal failureAcute renal failure Paralytic ileusParalytic ileus Hypovolemic or septic shockHypovolemic or septic shock Pleural effusion, respiratory distress Pleural effusion, respiratory distress

syndrome,pneumoniasyndrome,pneumonia Multisystem organ failureMultisystem organ failure Disseminated intravascular coagulationDisseminated intravascular coagulation Diabetes mellitusDiabetes mellitus

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

Clinical ManifestationsClinical Manifestations

Cullen’s signCullen’s sign

Turner’s signTurner’s sign

Chronic PancreatitisChronic Pancreatitis Progressive destructive disease of the Progressive destructive disease of the

pancreas, characterized by remissions pancreas, characterized by remissions and exacerbationsand exacerbations

Nonsurgical management includes:Nonsurgical management includes: Drug therapyDrug therapy Analgesic administrationAnalgesic administration Enzyme replacementEnzyme replacement Insulin therapyInsulin therapy Diet therapyDiet therapy

Pancreatic AbscessPancreatic Abscess Most serious complication of Most serious complication of

pancreatitis; always fatal if untreatedpancreatitis; always fatal if untreated High feverHigh fever Blood culturesBlood cultures Drainage via the percutaneous Drainage via the percutaneous

method or laparoscopymethod or laparoscopy Antibiotic treatment alone does not Antibiotic treatment alone does not

resolve abscessresolve abscess

Pancreatic CarcinomaPancreatic Carcinoma

Nonsurgical managementNonsurgical management Drug therapyDrug therapy Radiation therapyRadiation therapy Biliary stent insertionBiliary stent insertion