Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders

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

• Chapter 27

2
Liver, Gallbladder and Pancreas
3
Gallbladder Disorders

• Cholelithiasis and Cholecystitis
• Patho
• gallstones form due to
• abnormal bile composition
• biliary statis
• inflammation of gallbladder
• 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
5
(No Transcript)
6
Gallbladder Disorders

• Treatment
• laparoscopic cholecystectomy
• Nursing Diagnoses
• Pain
• Imbalanced Nutrition
• Risk for Infection

7
Lets Review
8
Liver
9
Hepatitis
10
(No Transcript)
11
Liver Disorders

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

12
Liver Disorders

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

13
Hepatitis Worldwide
14
Liver Disorders

• Disease pattern
• incubation
• prodromal
• icteric
• convalescent

15
Liver Disorders

• Nursing Care
• teaching
• handwashing
• blood and body fluid precautions
• vaccines for persons at high risk

16
Advanced Cirrhosis
17
Liver Disorders

• 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

• 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

• Liver Cancer
• usually poor outcomes
• Liver Trauma
• blunt or penetrating - hemorrhage
• Liver Abscess

22
Hepatitis
Nursing Care? Teaching needs? Complications?
23
Pancreatitis
24
Pancreatitis

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

25
Pancreatitis

• 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
Pancreatitis

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

28
Pancreatic Cancer
29
Pancreatic Cancer

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