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Liver Biliary Tract and Pancreas Problems PowerPoint Presentation

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Description : Check out this medical presentation on Gallbladder and Biliary Disease, which is titled "Liver, Biliary Tract, & Pancreas Problems", to know about Jaundice, Hemolytic jaundice, Hepatocellular Jaundice, and Obstructive jaundice.

Tags : Gallbladder, Biliary Disease, Liver, Biliary Tract, Pancreas Problems, Jaundice, Hemolytic jaundice, Hepatocellular Jaundice, Obstructive jaundice

Published on : Jul 10, 2021 | Views : 2314 | Downloads : 3

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Slide 1-

Liver, Biliary Tract, & Pancreas Problems Nur 302 Unit I
Slide 2-

Liver, Biliary Tract & Pancreas Problems Jaundice Hemolytic jaundice Hepatocellular Jaundice Obstructive jaundice
Slide 3-

Viral Hepatitis Inflammation of the liver. Types: A,B,C,D,E,G Epstein-Barr, herpes, cytomegalovirus, coxsackievirus, rubella Presence of antigens & antibodies Outbreaks of hepatitis – type A, 50% type B, 20% type C, 30% type A
Slide 4-

Hepatitis A Fecal-oral route, outbreaks caused by fecal contaminated food or drinking water. Crowded conditions, poor sanitation & hygiene, undeveloped countries, shellfish from contaminated water Most infectious 2 wks before s/s & 1wk after s/s start. No chronic carrier
Slide 5-

Hepatitis B Percutaneous, permucosal, or perinatal exposure, sexually transmitted disease. 100X more infectious than HIV; can live on dry surface for 7 days Carrier state - antigen HBsAg for 6-12 mo. Immunity – antigen anti-HBs-Ag
Slide 6-

Hepatitis C Transmission- pericutaneous At risk: IV drugs, bld transfusion, hemodialysis, tattooing, hi risk sexual behavior, organ transplants, health care workers
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Hepatitis D Delta virus Transmission - percutaneous Can turn mild or chronic hepB into severe, chronic, progressive, active hepatitis & cirrhosis Can occur as coinfection with hepB or as superinfection
Slide 8-

Hepatitis E Transmission – fecal-oral route, esp contaminated drinking water. Enteric non-A, non-B hepatitis Occurs in developing countries, epidemics in India, Asia, Mexico, Africa. In US rarely, only after a person traveled.
Slide 9-

Hepatitis G Recently discovered. Found in blood donors & transmitted by transfusion. Co-exists with other hepatitis viruses. Not associated with chronic hepatitis or cirrhosis.
Slide 10-

Pathophysiology Inflammation of liver -> Cell degeneration & necrosis Proliferation & enlargement of Kupffer cells Interrupted flow of bile & cholestasis If no complications, liver cells regenerate, resume normal appearance & function. Rash, angioedema, arthritis, fever, malaise
Slide 11-

Collaborative Care Rest, well balanced diet Antiemetics, Benadryl, NO phenothiazines Immunoglobulin for hepB or hepA Alpha inferon wks after exposure, hepA vaccine –pre-exposure prophylaxis HepB vaccine prophylaxis, post exposure- hepatitis B immune globulin
Slide 12-

Nursing Care: Hepatitis Health Promotion Assessment of jaundice Adequate nutrition Rest Home Care
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Toxic, Drug-induced & Idiopathic Hepatitis Ingestion, inhalation, parenteral injection of chemicals Systemic poisons- carbon tetrachloride, gold compounds, converted toxic metabolites (acetaminophen) Drugs – Halothane, INH, Diuril, Aldomet Elderly, previous liver diseased Idiopathic - autoimmune
Slide 14-

Cirrhosis of the Liver Degeneration & destruction of liver cells Abnormal bld vessel & bile duct relationships from fibrosis Lobules of irreg size & shape & impeded bld flow from overgrowth of new & fibrous tissue Insidious, progressive, chronic disease
Slide 15-

Types of Cirrhosis Alcoholic, portal or nutritional cirrhosis: fat accumulation in liver cells, scar formation. Post necrotic- re: hepatitis, broad bands scar tissue. Biliary: due to chronic biliary obstruction or infection. Jaundice, diffuse fibrosis. Cardiac: R heart failure, constrictive pericarditis, tricuspid insufficiency Cell necrosis, scar tissue, nodules, decr cellular nutrition, hypoxia-> decreased functioning of liver
Slide 16-

Clinical Manifestations Insidious- anorexia, dyspepsia, n/v, flatulence, diarrhea or constipation, dull, heavy feeling in RUQ, enl liver & spleen Jaundice Skin lesions – spider angiomas, palmer erythema Hematologic – thrombocytopenia, anemia, leukopenia, coagulation disorders Endocrine disturbances – hormone inactivation Peripheral neuropathy – deficiency in folic acid, thiamine, B-12.
Slide 17-

Diagnostic Studies Liver enzymes elevated, PT prolonged Cholesterol & Protein levels decreased Serum & urine bilirubin increased, stool decreased Liver scan,biopsy, analysis of ascitic fluid Esophagogastroduodenoscopy, angiogram Lytes, CBC, ammonia level
Slide 18-

Peripheral Edema & Ascites Peripheral edema @ ankle & presacral area - decr. albumin -> decr colloidal osmotic pressure. Increased portalcaval pressure from portal hypertension. Ascites- hypertension in liver->proteins move bld via capillaries to lymph->leak into peritoneal cavity-> osmotic pres pulls water. Lo albumin & hyperaldosteronism adds to ascites formation. S/S- abd distention, wt gain, distended abd wall veins, dehydration, decr output, hypokalemia.
Slide 19-

Collaborative Care Na restriction: 250-500mg Na/day Salt poor albumin Diuretics: Aldactone, Dyrenium, Midamor, Lasix Fluid removal via paracentesis or retroperitoneal shunt Monitor lytes and fluid balance
Slide 20-

Portal Hypertension & Esophageal Varices Compression, destruction of hepatic & portal veins & sinusoids-> obstruction portal bld flow-> portal hypertension. Collateral circulation – lower esophagus, parietal peritoneum, rectum-> varices where collateral & systemic circulation meet. Esophageal varices, fragile, tolerate hi pressure poorly, tortuous, bleed easily. Life threatening complication.
Slide 21-

Hepatic Encephalopathy Ammonia in systemic circulation without liver detoxification. Ammonia from metabolism of P shunted past liver or liver unable to convert ammonia to urea-> lg amt ammonia-> crosses blood-brain barrier->neuro s/s S/S: LOC changes from lethargy to coma, disorientation, asterixis, writing impairments, hyperventilation, hypothermia, grimacing, grasping, fetor hepaticus
Slide 22-

Collaborative Care Protein restriction Neomycin po or enemas Lactulose (Cephalac) Control GI blding, remove bld from intestinal tract, treat lyte & acid/base imbalance Liver transplant
Slide 23-

Nursing Care: Encephalopathy Neuro assessment q2h - LOC, reflexes, pupils, sensory & motor Check lytes, acid/base balance, ammonia Decrease ammonia with lactulose, enemas Possible tube feeding- lo-no protein, hi CHO & flds
Slide 24-

Hepatorenal Syndrome Renal failure- possibly due to redistribution of blood flow from kidneys or hypovolemia Follows diuretic therapy, GI hemorrhage or paracentesis Tx: salt poor albumin, salt & water restrictions, diuretic therapy
Slide 25-

Nursing Care: Cirrhosis Health Promotion Bed rest & prevent complications Nutrition- oral hygiene, supplements Assess: jaundice, edema, ascites, bleeding, LOC, dyspnea Skin care Altered body image Monitor lytes, liver & coag studies, ammonia, CBC
Slide 26-

Home Care Written instructions- fluid & diet restrictions Teach pt & family- s/s complications, meds & side effects, observe for bleeding, skin care, protection from infection Counseling & referral to community health nurse
Slide 27-

Liver Cancer Metastasis, h/o cirrhosis, chronic hepB or C Malignant cells enlarge & mis-shape liver Hemorrhage or necrosis common Dx: hard to differentiate bet cirrhosis & Ca Rx: palliative, lobectomy, chemo, poor prognosis, death in 4-7 months Nsg care: same as advanced liver disease
Slide 28-

Endoscopic Retrograde Cholangiopancreatography ERCP The scope is brought in through the esophagus, the stomach and into the bile ducts. A contrast fluid is injected. The gallbladder does not become visible. The hepatopancreatic duct does not show signs of obstruction. Conclusion: No signs of obstruction of the hepatopancreatic duct, obstruction in the gallbladder or the cystic duct cannot be excluded. Nursing Care???
Slide 29-

ERCP Nursing Care Explain procedure & get consent NPO 8 hours before ERCP Sedation before & during ERCP Antibiotics if ordered Post ERCP – check perforation, infection, s/s pancreatitis, VS, check gag reflex
Slide 30-

Cholecystitis & Cholelithiasis S/S cholecystitis: indigestion, moderate-> severe pain, URQ tenderness, referred to R shoulder & scapula, n/v, restless, diaphoretic S/S cholelithiasis: none, s/s depend if stones are moving or not, spasms can be severe, tachycardia, diaphoresis, 3-6 hr after meal, when lie down, s/s bile blockage Dx: ultrasound, cholangiogram, cholecystogram
Slide 31-

Collaborative Care Cholecystitis: control pain, antibiotics, flds Cholelithiasis: cholesterol solvents, lithotripsy, endoscopic sphincterotomy, surgery Surgery: cholecystectomy, laparoscopic cholecystectomy Transhepatic biliary catheter Meds: anticholinergics, analgesics, fat soluble vitamins, bile salts, Demerol, Questran, diet
Slide 32-

Nursing Care: GB Disease Health promotion Acute GB attack: relieve pain, n/v, assessment of progression of s/s & s/s obstruction bile duct, observe s/s bleeding at mucous membranes, assess for infection Post endoscopy; assess s/s pancreatitis, perforation, bleeding Post-op: referred pain to shoulder, place in Simm’s position, prevent resp complications, care of T-tube
Slide 33-

Cancer of the Gallbladder Uncommon Relationship bet Ca GB & chronic cholelithiasis or cholecystitis S/S: insidious, same as GB disease, later s/s biliary obstruction Rx: surgery, symptomatic, supportive Nursing care: supportive, pain relief, skin care, hydration, comfort
Slide 34-

Chronic Pancreatitis Progressive destruction & fibrotic replacement of tissue Chronic obstructive pancreatitis Chronic calcifying pancreatitis S/S: pain, malabsorption with wt loss, jaundice, dark urine, steatorrhea, DM Dx: secretin stimulation test
Slide 35-

Collaborative Care Diet, pancreatic enzyme replacement, control of diabetes Antacids, anticholinergic meds, H2 blockers, bile salts, insulin Surgery if obstruction Nursing Care: health promotion: diet, pancreatic enzymes, diabetic teaching, avoid alcohol, referrals for narcotic or alcohol dependence
Slide 36-

Pancreatic Cancer Over 50% tumors @ head of pancreas-> obstruction of common bile duct->jaundice S/S: pain, rapid wt loss, anorexia, nausea, jaundice Dx: CEA, CA19-9, ultrasound, CT, ERCP-> samples for cytology & biopsy Rx: Whipple’s procedure, radiation, chemo Nursing Care: supportive, comfort, help pt & family grieve