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IV drug users
HCV (hep C)
HDV (hep D)
HEV (hep E)
Standard precautions
Immune globulin after exposure
Contains antibodies that help prevent the illness
Hepatitis Signs and Symptoms
Prodromal stage (preicteric, prejaundice)
Can occur 2 weeks after exposure
Lasts for about 1 week
Flu-like symptoms, RUQ pain, n/v, diarrhea or
constipation
Icteric stage (appearance of jaundice)
Occurs 5-10 days after prodromal and lasts 2 to 6 weeks
Jaundice, worsening of symptoms, enlarged liver
Convalescent stage
Begins when patient starts feeling better
2 to 6 weeks
Full recovery can take up to 1 year
Hepatitis
Complications
Liver failure
Acute
chronic
Chronic infection
Carrier some become asymptomatic carriers and never
have an active disease, can infect others
Risk of liver cancer
Diagnostic tests (table 35.2, page 782)
Liver enzymes
Serum bilirubin
Prothrombin
Liver biopsy
Hepatitis
Therapeutic interventions
Identify cause
Monitor liver status
Symptom relief
Rest
Avoidance of alcohol and liver toxic drugs
Nursing diagnoses
Pain
Imbalanced nutrition
Risk for ineffective self-health maintenance
Knowledge deficient
Acute Liver Failure (ALF)
Bleeding
Abdominal distention
Liver shows rapid reduction in size on xray (in
matter of hours)
Acute Liver Failure
Diagnostic tests (table 35.2, page 782)
ALT
AST
Serum bilirubin
PT
Potassium-decrease
Glucose- decrease
Acute Liver Failure
Therapeutic Interventions
Aimed at stopping and reversing the damage
Bedrest
Eliminate all drugs
Possible dialysis (if from overdose of a toxic
substance)
High calorie, low sodium, low protein
Lactulose, neomycin, magnesium citrate,
sorbitolmay be given to decrease ammonia
level
transplant
Cirrhosis
Progressive, irreversible replacement of
healthy liver tissue with scar tissue
Chronic alcohol use most common cause
Pathophysiology
Inflammation of liver cells
Liver cells infiltrated with fat and WBC and
replaced by fibrotic tissue
Abnormal regeneration
Impaired liver blood flow
Impaired liver function
Cirrhosis
Signs and Symptoms
Cirrhosis
Complications
Clotting defects
Impaired PT and fibrinogen production
Portal hypertension
Varices (most serious result is bleeding esophageal
varices)
Ascites-accumulation of fluid in the abdominal cavity
Encephalopathy
Caused by elevated ammonia
Hepatorenal syndrome (omnious sign)
Secondary failure of the kidneys
Cirrhosis
Therapeutic Interventions
Ascites
Diuretics
Sodium and fluid restriction
Paracentesis
Albumin infusion
TIPS (transjugular intrahepatic portosystemic shunt
Stent is placed to connect the portal vein to the hepatic vein
Esophageal varices
Stop bleeding immediately
Vasoconstrictors
Sandostatin IV
Banding
Sclerotherapy
Vit K
Therapeutic Interventions
Encephalopathy
Lactulose
Neomycin
Intestinal antibiotic
Restrict dietary protein
dialysis
Cirrhosis
Patient education
Disease process
Signs and symptoms to report
Adequate rest
Diet
Avoid narcotics, sedatives, tranquilizers, alcohol
Follow up care
Liver Transplant
Candidates
Liver failure
No cancer
No complications
Otherwise stable
Anti rejection meds
Cyclosporin A
Protopic
Imuran
Prednisone
cellCept
Liver Transplant
Signs of rejections
Usually will develop between 4th and 10th post
op day
Pulse greater than 100
Temp greater than 101
RUQ pain
Increase in jaundice
Decrease in bile from T-tube, or change in color
Facilitates drainage of bile, usually inserted into the
common bile duct
Elevated liver enzymes
Liver Cancer
Usually metastasized from another site
Usually die within 6 months of diagnosis
Risk factors
Chronic hepatitis B and C
Nutritional deficiencies
Exposure to hepatotoxins
Heavy alcohol use
smoking
Liver Cancer
Signs and symptoms
Encephalopathy
Bleeding
Jaundice
ascites
Diagnosis
Serum alkaline phosphatase (ALP)
Abdominal Xray
Liver scan
Ultrasound
Biopsy (definitive dx)
Acute Pancreatitis
Pathophysiology
Inflammation of the pancreas appears to be caused
by autodigestion
Reasons unknown the pancreas will excrete enzymes
while still in pancreas and begin to digest the
pancreas
Large amounts of enzymes are released by
inflammed cells
Trypsin destroys pancreatic tissue and causes
vasodilation
Fluid loss to the retroperitoneal space, causing shock
Conversion of prothrombin to thrombin, clots form
Acute Pancreatitis
Complications
Shock
DIC
Chronic pancreatitis
Etiology
Alcohol use
Biliary disease
Trauma
Certain drugs
Thiazide diuretics
Estrogen
Opioids
Steroids
Excessive calcium
Acute Pancreatitis
Signs and symptoms
Abdominal pain
Guarding
Rigid abdomen
Hypotension or shock
Respiratory distress
Low grade fever
Nausea and vomiting
jaundice
Acute Pancreatitis
Complications
Cardiovascular failure
Acute respiratory distress
Acute renal injury
Hemorrhage
Infection
Turners sign
Cullens sign
Acute Pancreatitis
Diagnostic tests
Serum amylase
Elevated 5 to 40 times normal
X-ray
CT scan
ultrasound
Chronic Pancreatitis
Pathophysiology
Progressive fibrosis
Obstructed ducts
Ulceration
Becomes smaller and hardened
Etiology
Major cause in men is excessive alcohol ingestion
In women- biliary disease that leads to persistent
inflammation of the pancreatic ducts
Prevention
Alcohol abstinence
Biliary disease treatment
Nutritional intake monitoring
Chronic Pancreatitis
Signs and symptoms
Remissions and exacerbations
LUQ pain
Anorexia and weight loss
Malabsorption and fat intolerance
Diabetes mellitus late occuring
Diagnostic tests
Pancreatic enzymes are normal
High fecal fat level
Changes on CT scan or ultrasound
Chronic Pancreatitis
Therapeutic interventions
Analgesics
Pancreatic enzyme replacement
surgery
Cancer of the Pancreas
Ductal adenocarcinoma and occur in the
exocrine part of the pancreas
Cause unknown
Risk factors
Chemical carcinogens
High fat diets
Smoking
Diabetes mellitus
Alcohol
Chronic pancreatitis
Cancer of the Pancreas
Signs and symptoms
Vague symptoms early
Weight loss and anorexia
Pain
Nausea and vomiting
Weakness
Abdominal pain, worse at night
Jaundice if obstruction of bile duct
Pancreatic Cancer
Diagnostic tests
Pancreatic enzymes elevated
Bilirubin
Coagulation studies
CEA
CT, ERCP
Biopsy
Pancreatic Cancer
Therapeutic Interventions (depends on
staging)
Surgery
Whipple procedure
pancreatectomy
ESWL
Done less frequently, uses shock waves to destroy
stones
Medication to dissolve
May take months to years and stones can come back
Gallbladder disorders
Patient education
High protein, low fat diet
Encourage obese patients to lose weight
Fat should be slowly reintroduced into the diet
Yea!! You are done with
the GI system.
Good luck with your
exam!