1. Hepatitis Inflammation of the liver Caused by viruses, toxins, or chemicals. Drugs can cause hepatitis.

2. Jaundice A yellow pigmentation of the sclerae, skin, and deeper tissues caused by excessive accumulation of bile pigments in the blood. Bilirubin (bile pigment), a breakdown of Hemoglobin of the red blood cell. (RBC) deposited in the skin and excreted in the urine when high level are noted in the blood. Etiology : Unconjugated Conjugated

3. Clinical Manifestations Yellow sclerae Yellow orange skin Clay colored feces Tea colored urine Puritis Fatigue anorexia

4. Outcome Management MedicalSurgical Determine the cause: LFT’s, CBC, CMP and additional diagnostic studies such as ultra sound, ERCP Common Bile duct exploration Nursing diagnosisTumor removal Impaired skin integrity Ineffective health maintenance Disturbed body image

5. Hepatitis-Pathophysiology Inflammation of the Liver Multiple types A, B, C, D Viral, toxic, chronic or alcoholic

6. Hepatitis A Infectious Hepatitis-RNA virus Caused by: Infected water Milk Food Raw shell fish

7. Hepatitis B Viral Adults and Babies Transmitted via body fluids Can survive on environmental surfaces for at a least a week

8. Hepatitis C Viral Usually identified when going to donate blood IV drug abusers account for 60%/Blood transfusion Tattoo and body piercing

9. Clinical Manifestations Vary from client to client-abrupt to insidious ProdromalMiddleFulminant Jaundice, lethargy, irritability, myalgia, anorexia, N/V, abdominal pain, diarrhea, fever, flu like symptoms, pruritus Encephalopathy, liver flap, mild depression, bleeding tendency, liver enlargement, palmar erythema, gynecomastia, acitis Acute liver failure, encephalopathy, GI bleeding, DIC,

10. Hepatitis: Medical Management Reduce fatigue Maintain nutritional and fluid balance Reduce effects of hepatitis Antiemetics, antihistamines, vitamin K, glucocorticoids, estrogens, bile acid sequestrants, immune globulin, vaccines Medications to avoid ASA Tylenol Sedative-because of hepatoxic effects

11. Hepatitis: Nursing Diagnoses Fatigue Imbalanced Nutrition: Less Than Body Requirements Anxiety Ineffective Health Maintenance

12. Complications of Hepatitis Fulminant hepatitis- massive hepatic necrosis. Chronic hepatitis- inflammation> 3-6 months. Chronic hepatitis B- common among male Chronic hepatitis. Autoimmune hepatitis Chronic carrier state Aplastic anemia

13. Nonviral Hepatitis Toxic hepatitis and alcoholic hepatitis Etiology and risk factors Chemicals, alcohol, medications Pathophysiology Liver necrosis Clinical manifestations same a viral hepatitis Medical and surgical management Folic acid, thiamine, high carb diet, high vitamin, parenteral fluids Nursing management

14. Hepatic Disorders: Cirrhosis Cirrhosis overview Etiology and risk factors- associated with alcohol ingestion. Pathophysiology – final stage of many liver insults. Clinical manifestations- slow progression, usually found during routine medical care. (Enlarged liver, abnormal labs) Medical management- Monitor for complications Maximize liver function Treat the underlying causes and prevent infection

15. Cirrhosis: see concept map 1342-43 Nursing Diagnoses Ineffective Tissue Perfusion Imbalanced Nutrition: Less Than Body Requirements Activity Intolerance Risk for Injury Ineffective Protection Ineffective Health Maintenance

16. Complications of Cirrhosis Portal hypertension Etiology and risk factors Pathophysiology 70% inflow portal vein 30% inflow hepatic artery Clinical manifestations Acites, enlarged spleen, esophageal varices

17. Portal Hypertension Hepatic encephalopathy Hemorrhage Sclerotherapy Transjugular intrahepatic Porto systemic shunt (TIPS) Vasopressin Beta-adrenergic– blocking agents Balloon tamponade

19. Ascites: Management Correct fluid and electrolyte imbalance Paracentesis Albumin Diet modifications Peritoneovenous shunt TIPS

20. Hepatic Encephalopathy: Medical Management Identify and treat cause Reduce nitrogenous/ammonia waste in blood Reduce bacteria in colon Maintain fluid volume balance