What is Cirrhosis?
It is an extensive scarring of the liver, usually caused by a chronic reaction to a hepatic inflammation and necrosis.
What are some EARLY stages of a liver disease?
Fatigue, Significant change in weight, GI symptoms, Abdominal pain, Liver tenderness, and Pruritus.
What are some LATE stages of a liver disease?
Jaundice, icterus, dry skin, rashes, petechiae, ecchymoses (lesions), warm, bright red palms of the hands, spider angiomas, and peripheral dependent edema of the extremities and sacrum.
What would you expect to find in the abdominal assessment of a patient with a liver disease?
Massive ascities, umbilicus protusion, caput medusae (dilated abdominal veins), and Hepatomegaly (liver enlargement).
What are some other "late" physical assessments of a patient with a liver disease?
Assess the NG drainage, vomitus, and stool for presence of blood, fector hepaticus (breath odor), amenorrhea, gynecomastia, testicular atrophy, impotence, brusing, petchiae, enlarged spleen, neurologic changes, and asterixis (quiver of the liver)!
What are some lab assessments you would look for in a patient with a liver disease?
Aminotransferase Serum Levels may be ELEVATED!
Lectate Dehydrogenase may be ELEVATED!
Alkaline Phosphatase levels may be INCREASED!
Total Serum Bilirubin and Urobilinogen levels may RISE!
Ammonia levels are ELEVATED!
Serum Creatinine level is possibly ELEVATED!
Prothromin Time is PROLONGED
Platelet Count is LOW
Total Serum Protein and Albumin Levels DECREASED!
How should the nutrition of a patient with liver disease consists of?
LOW Na+, Limited fluid intake, and Vitamin Supplements.
What are some comfort measures used on a patient with liver disease?
ELEVATE the head of bed at least 30 degrees, or as high as the patient wishes to help minimize SOB.
Patient is ENCOURAGED to sit in chair.
WEIGH patient in STANDING position because SUPINE position can aggravate dyspnea.
What are some fluid and electrolyte managements for a patient with a liver disease?
Blood Urea Nitrogen Levels (BUN)
Serum Protein Levels
Hematocrit (Hct) Levels
What are some surgical interventions in a patient with a liver disease?
Transjugular Intrahepatic Portosystemic SHUNT
What are some interventions to prevent a potential Hemorrhage?
Beta Blocker (keeps BP down)
Esophagogastric Balloon Tamponade
How is Hepatitis A contracted and spread by?
The Fecal-Oral Route via ingestion of:
Shellfish from Contaminated Water
Food Contaminated by handlers infected with HVA
Oral-Anal Sexual Activity,
Is HVA life threatening?
How is Hepatitis B contracted and spread by?
Unprotected Sexual Intercourse with an infected partner
Accidental Needle Sticks
Promiscuous COTC Nursing Students
What are some symptoms that occur in a 25 to 180 days after exposure to HVB?
What are some ways of contracting and spreading Hepatitis C?
Needle Stick Injury
Intranasal Cocaine Use with a $100 Bill
What are some symptoms after 21 to 140 days after having HCV?
Most are asymptomatic and damage occurs over DECADES!
Which Hepatitis is the leading indication for liver transplantation in the US?
How is Hepatitis D primarily transmitted?
Parenteral Routes, any hole in your freakin' BODY!
How is Hepatitis E contracted or spread by?
Present in Endemic areas where waterborne epidemics occur and in travelers to those areas.
Transmitted via fecal-oral route.
What are some Nonsurgical Managements for a patient with Hepatitis?
What is Acute Cholecystitis?
An inflammation of the Gallbladder.
What is Acalculous Cholecystitis?
An inflammation that can occur in the absence of gallstones.
What is Chronic Cholecystitis?
Repeated Episodes of cystic duct obstruction result in chronic inflammation
What are some symptoms of a person who has Chronic Cholecystitis?
What are some clinical manifestations of Cholecystitis?
Biliary Colic (cramping near RUQ)
Murphy's Sign (Pain on inspiration)
Blumberg's Sign (Rebound Tenderness)
Steatorrhea (Fatty Stools)
What kind of nutrition should a person with Cholecystitis?
Fat Soluable Vitamins
What are some Nonsurgical Management for a person with Cholecystitis?
Extracorporeal Shock Wave Lithotripsy (Kidney Stone Shocker, like a Jackhammer!)
Percutaneous Transhepatic Biliary Catherter Insertion (snags gallstones out!)
What is Acute Pancreatitis?
Serious and possibly life-threatening inflammation process of the pancreas!
What are some complications of an Acute Pancreatitis?
Acute Renal Failure
Respiratory Distress Syndrome
Multisystem Organ Failure
Disseminated Intravascular Coagulation (DIC)
What are some clinical manifestations of an Acute Pancreatitis patient?
Cullen's Sign (Grey, Blue Abdomen)
Turner's Sign (Grey, Blue Flank)
Significant changes in vital signs (everything's up because of the pain process!)
What are some Lab Assessments on a person with Acute Pancreatitis?
Lipase is INCREASED
Trypsin is INCREASE
Alanine Aminotransferase is INCREASED
WBC are INCREASED
Glucose is INCREASED
Alkaline Phosphatase is DECREASED
Calcium is DECREASED
What is the #1 way to decrease pain for an Acute pancreatitis patient?
NPO!!!!! Fasting (pancreatic rest)
What are some other ways of nonsurgical management in an Acute pancreatitis patient?
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What kind of diet should an Acute Pancreatic patient be on?
NPO in early stages
Total Parenteral Nutrition (TPN) if N/V goes for too long!
Small, Frequent, Moderate-to-High-Carb
Avoid foods that cause GI stimulation
What is Chronic Pancreatitis?
Progressive Destructive Disease of the pancreas, characterized by remissions and exacerbations
What are some causes of Chronic Pancreatitis?
What is the process of giving the pancreatic enzyme to a Chronic Pancreatic patient?
Administer with a FULL glass of WATER
With EACH meal
WIPE their mouth because this stuff is ACIDIC!
What is Pancreatic Abscess?
The MOST serious complication of pancreatitis!
ALWAYS FATAL if untreated!!!!!
What are some ways to find out if you have a Pancreatic Abscess?
Drainage via the percutaneous method
What is Insulinoma?
The MOST common type of Neuroendocrine pancreatic TUMOR!
How is the Insulinoma caused?
The benign tumor of the islets of Langerhans causes excessive insulin secretion and subsequent hypoglycemia!
What is the only way to rid of an Insulinoma?
Removal of Tumor via the Whipple Procedure (LAST DITCH!)