Liver and Pancreatic Problems

1
Liver and Pancreatic Problems
2
(No Transcript)
3
Cirrhosis of the Liver

• Chronic progressive disease
• Extensive degeneration and destruction of liver
  parenchyma
• Regenerative process is disorganized, resulting
  in fibrosis
• Impeded vascular flow
• Insidious, prolonged course

4
Etiology of Cirrhosis

• Alcoholic-Most common
• Fat accumulation in liver cells
• Unstopped, leads to scarring throughout liver
• Postnecrotic-
• From viral, toxic or autoimmune hepatitis
• Wide bands of scarring
• Biliary-
• From obstruction within biliary system
• Fibrosis
• Cardiac-From Right sided heart failure

5
Pathophysiology of Cirrhosis

• Cell necrosis
• Destroyed liver cells replaced by scar tissue
• Irregular, disorganized regeneration
• Poor cellular nutrition
• Hypoxia caused by inadequate circulation
• Decreased functioning of liver

6
Clinical Manifestations

• Early
• GI disturbances N and V, anorexia, ? Flatulence,
  change in bowel habits
• Pain
• Lassitude
• Organomegaly

7
Clinical Manifestations

• Later
• Jaundice
• Skin lesions spider hemangiomas, palmar
  erythema, pruritis
• Hematological problems
• Endocrine disturbances
• Peripheral neuropathy

8
Jaundice

• Hemolytic-?in breakdown of RBCs which produces
  ?in unconjugated bilirubin
• Blood Tx Reactions, Sickle Cell and/or Hemolytic
  Anemia
• Hepatocellular-altered bilirubin uptake by liver
• Hepatitis, cirrhosis, liver Ca
• Obstructive-obstructed flow of bile
• Liver Ca, hepatitis, cirrhosis

9
Complications of Cirrhosis

• Portal Hypertension and Esophageal Varices
• Structural changes? venous changes ? obstruction
  of blood flow ? Portal Hypertension ? Collateral
  Circulation Development (especially in lower
  esophagus)
• New vessels are fragile, non-elastic ? bleed
  easily

10
Complications of Cirrhosis

• Bleeding Esophageal Varicose-most frequent
  lifethreatening complication
• Mortality rate-30-60
• Can be slow bleed
• Sudden, rapid bleed much more common
• Medical Emergency

11
Complications of Cirrhosis

• Ascites and Peripheral Edema
• Results from decreased osmotic pressure from
  impaired synthesis of albumin and increased
  pressures from Portal Hypertension
• Peripheral Ankle, Sacral
• Ascites-edema in abdominal, peritoneal cavity
• Abdominal distension
• Weight gain

12
Complications of Cirrhosis

• Hepatic Encephalopathy-coma
• In end stages of liver disease
• Ammonia enters circulation because liver has lost
  ability to metabolize-not fully understood
• Gradual or sudden inset
• ? LOC, asterixis (hand flapping)
• Odor-fetor hepaticus
• Musty, ammonia like smell

13
Complications of Cirrhosis

• Hepatorenal syndrome
• Renal function deterioration accompanies liver
  failure
• No structural change in kidneys
• Not fully understood
• Treatment-Strict Fluid, Na restrictions,Diuretics,
  
• Treatments often not successful

14
Therapeutic Management of Cirrhosis/ Liver Failure

• Rest-
• Decrease metabolic demands
• Allow liver cell recovery
• May require complete bed rest
• Issues of total Bed Rest

15
Therapeutic Management

• Ascites Management
• Fluid, Na restrictions
• Diuretics
• Salt poor albumins
• Strict I/O, Weights
• Paracentesis-remove fluid
• Peritoneovenous shunt-surgical procedure which
  shunts ascites fluid into circulatory system
• TIPS Procedure Radiological Procedure

16
Therapeutic Management

• Esophageal varices
• Once presence of varices has been
  detected-PREVENTION of bleeding
• no ASA, no ETOH, no irritating foods
• Bleeding-
• Meds-Vassopressin
• Balloon Tamponade
• Sclerotherapy, Ligation, Shunting
• Supportive therapy
• Blood, FFP, Fluid Replacement
• Vit K

17
Therapeutic Management

• Hepatic encephalopathy
• Goal is to reduce ammonia levels
• Protein Restrictions
• Neomycin, Lactulose
• Given PO, per NG or Per Rectum in suppository or
  enema form
• Diarrhea is desired outcome--is how ammonia is
  excreted from body
• Levadopa use
• Controlling GI bleeding-? old blood in tract

18
Therapeutic Management

• Liver Transplantation
• Lifestyle considerations
• Compliance considerations

19
Nursing Management of Cirrhosis/ Liver Failure

• Alt. Nutrition less than body requirements
• Many restrictions, diminished appetite
• Impaired Skin Integrity
• Ineffective Breathing Pattern
• Risk for Injury
• Activity Intolerance
• Body Image Disturbance
• Risk for Infection

20
Nursing Management PCs

• PC Hepatic encephalopathy
• PC Hepatic Insufficiency/Failure
• PC Hyperbiliruinemia
• PC Hemorrhage
• Where???
• PC Hepatorenal syndrome