1. Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders Chapter 27

2. Liver, Gallbladder and Pancreas

3. Gallbladder Disorders 4 Cholelithiasis and Cholecystitis 4 Patho –gallstones form due to abnormal bile composition biliary statis inflammation of gallbladder 4 Risk factors –age, family hx., females - oral contraceptive

4. Gallbladder Disorders Cholelithiasis asymptomatic epigastric fullness after fatty meal biliary colic jaundice Acute cholecystitis RUQ pain - back a/n/v fever with chills

6. Gallbladder Disorders 4 Treatment –laparoscopic cholecystectomy 4 Nursing Diagnoses –Pain –Imbalanced Nutrition –Risk for Infection

7. Let’s Review

8. Liver

9. Hepatitis

11. Liver Disorders 4 Hepatitis –inflammation of the liver due to virus, ETOH, drugs, toxins, may be acute or chronic 4 Viral Hepatitis 4 Hepatitis A - infectious hepatitis –fecal-oral route –benign, self-limiting

12. Liver Disorders 4 Hepatitis B –transmission - infected blood and body fluids at risk - healthcare workers, drug users, multiple sexual partners, hemodialysis clients 4 Hepatitis C –transmission - infected blood and body fluids –manifestations - mild, non-specific –world wide cause of chronic hepatitis

13. Hepatitis Worldwide

14. Liver Disorders 4 Disease pattern –incubation –prodromal –icteric –convalescent

15. Liver Disorders 4 Nursing Care –teaching handwashing blood and body fluid precautions vaccines for persons at high risk

16. Advanced Cirrhosis

17. Liver Disorders 4 Cirrhosis –end state of chronic liver disease, progressive and irreversible alcoholic cirrhosis, biliary, or secondary to hepatitis –Manifestations liver enlg. Tender, wt loss, weakness, anorexia ascites, gynecomastia, jaundice, edema, anemia, pancytopenia

18. Liver Disorders 4 Complications –portal hypertension –splenomegaly –ascites –esophageal varices –hepatic encephalopathy –hepatorenal syndrome

19. What are your assessments, interventions? What are your goals? How would you chart this?

20. Systemic effects of Cirrhosis

21. Liver Disorders 4 Liver Cancer –usually poor outcomes 4 Liver Trauma –blunt or penetrating - hemorrhage 4 Liver Abscess

22. Hepatitis Nursing Care? Teaching needs? Complications?

23. Pancreatitis

24. 4 Pancreatitis –inflammation of pancreas characterized by release of pancreatic enzymes into pancreatic tissue itself leading to hemorrhage and necrosis 4 Risk factors –alcoholism, gallstones

25. Pancreatitis 4 Manifestations –abrupt onset of severe epigastric/abdominal pain relieved by leaning forward, sitting up initiated by fatty meal or alcohol intake –n/v –abd. distention and rigidity, decreased b.s. –fever, 24 hours later jaundice

26. Pancreatitis

27. 4 Diagnostic tests –labs - amylase and lipase –Ultra sound, ERCP, C-T scan, needle bx 4 Treatment –hydration, pain control and antibiotics

28. Pancreatic Cancer

29. 4 Very lethal 4 Risk factors –smoking, chemical or environmental toxins 4 Manifestations –non-specific, a/n, wt. loss, dull epigastric pain 4 Treatment –surgery - Whipple, radiation and chemotherapy