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

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

Clinical Manifestations  Abdominal pain  Changes in skin or eye color  Arthralgia (joint pain)  Myalgia (muscle pain)  Diarrhea/constipation  Fever  Lethargy  Malaise  Nausea/vomiting  Pruritus

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

Hepatic Abscess  Liver invaded by bacteria or protozoa causing abscess  Pyrogenic liver abscess; amebic hepatic abscess  Treatment usually involves:  Drainage with ultrasound guidance  Antibiotic therapy

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

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

Complications  Portal hypertension  Ascites  Bleeding esophageal varices  Coagulation defects  Jaundice  Portal-systemic encephalopathy with hepatic coma  Hepatorenal syndrome  Spontaneous bacterial peritonitis

Etiology  Known causes of liver disease include:  Alcohol  Viral hepatitis  Autoimmune hepatitis  Steatohepatitis  Drugs and toxins  Biliary disease  Metabolic/genetic causes  Cardiovascular disease

Clinical Manifestations  In early stages, signs of liver disease include:  Fatigue  Significant change in weight  Gastrointestinal symptoms  Abdominal pain and liver tenderness  Pruritus

Clinical Manifestations

Abdominal Assessment  Massive ascites  Umbilicus protrusion  Caput medusae (dilated abdominal veins)  Hepatomegaly (liver enlargement

Cancer of the Liver  One of the most common tumors in the world  Most common complaint: abdominal discomfort  Treatment includes:  Chemotherapy  Surgery

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

Complications  Acute, chronic graft rejection  Infection  Hemorrhage  Hepatic artery thrombosis  Fluid and electrolyte imbalances  Pulmonary atelectasis  Acute renal failure  Psychological maladjustment

Acute Cholecystitis  Acute cholecystitis is the inflammation of the gallbladder.  Cholelithiasis (gallstones) usually accompanies cholecystitis.  Acalculous cholecystitis inflammation can occur in the absence of gallstones.  Calculous cholecystitis is the obstruction of the cystic duct by a stone, which creates an inflammatory response.

Chronic Cholecystitis  Repeated episodes of cystic duct obstruction result in chronic inflammation  Pancreatitis, cholangitis  Jaundice  Icterus  Obstructive jaundice  Pruritus

Clinical Manifestations  Flatulence, dyspepsia, eructation, anorexia, nausea and vomiting, abdominal pain  Biliary colic  Murphy’s sign  Blumberg’s sign  Rebound tenderness  Steatorrhea

Surgical Management  Laparoscopic cholecystectomy  Standard preoperative care  Operative procedure  Postoperative care  Free air pain result of carbon dioxide retention in the abdomen  Ambulation  Return to activities in 1 to 3 weeks

Traditional Cholecystectomy  Standard preoperative care  Operative procedure  Postoperative care  Meperidine hydrochloride via patient-controlled analgesia pump  Antiemetics  Wound care  Care of the T-tube  Nothing by mouth  Diet therapy

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

Acute Pancreatitis  Serious and possibly life-threatening inflammatory process of the pancreas  Necrotizing hemorrhagic pancreatitis  Lipolysis  Proteolysis  Necrosis of blood vessels  Inflammation  Theories of enzyme activation

Complications of Acute Pancreatitis  Hypovolemia  Hemorrhage  Acute renal failure  Paralytic ileus  Hypovolemic or septic shock  Pleural effusion, respiratory distress syndrome,pneumonia  Multisystem organ failure  Disseminated intravascular coagulation  Diabetes mellitus

Clinical Manifestations  Generalized jaundice  Bowel sounds  Abdominal tenderness, rigidity, guarding  Pancreatic ascites  Significant changes in vital signs

Clinical Manifestations  Cullen’s sign Turner’s sign

Chronic Pancreatitis  Progressive destructive disease of the pancreas, characterized by remissions and exacerbations  Nonsurgical management includes:  Drug therapy  Analgesic administration  Enzyme replacement  Insulin therapy  Diet therapy

Pancreatic Abscess  Most serious complication of pancreatitis; always fatal if untreated  High fever  Blood cultures  Drainage via the percutaneous method or laparoscopy  Antibiotic treatment alone does not resolve abscess

Pancreatic Carcinoma  Nonsurgical management  Drug therapy  Radiation therapy  Biliary stent insertion