Cirrhosis, Hepatitis, Pancreatitis, and Cholecystitis

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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?

Test for:
Blood Urea Nitrogen Levels (BUN)
Serum Protein Levels
Hematocrit (Hct) Levels
Electrolytes

What are some surgical interventions in a patient with a liver disease?

Peritoneovenous SHUNT
Portocaval SHUNT
Transjugular Intrahepatic Portosystemic SHUNT

What are some interventions to prevent a potential Hemorrhage?

Beta Blocker (keeps BP down)
Gastric Intubation
Esophagogastric Balloon Tamponade

How is Hepatitis A contracted and spread by?

The Fecal-Oral Route via ingestion of:
Fecal Contaminants
Contaminated Water
Shellfish from Contaminated Water
Food Contaminated by handlers infected with HVA
Oral-Anal Sexual Activity,

Is HVA life threatening?

NO

How is Hepatitis B contracted and spread by?

Unprotected Sexual Intercourse with an infected partner
Sharing Needles
Accidental Needle Sticks
Blood Transfusions
Hemodialysis
Maternal-Fetal Route
Promiscuous COTC Nursing Students

What are some symptoms that occur in a 25 to 180 days after exposure to HVB?

Anorexia
Nausea
Vomiting
Fever
Fatigue
RUQ Pain
Dark Urine
Light Stool
Joint Pain
Jaundice

What are some ways of contracting and spreading Hepatitis C?

Sharing Needles
Blood
Blood Products
Organ Transplants
Needle Stick Injury
Tattoos
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?

Hepatitis C

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.
Resembles HVA.

What are some Nonsurgical Managements for a patient with Hepatitis?

Physical Rest
Psychological Rest
Diet Therapy
Drug Therapy

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?

Pancreastitis
Cholangitis
Jaundice
Icterus
Obstructive Jaundice
Pruritus

What are some clinical manifestations of Cholecystitis?

Flatulence
Dyspepsia
Eructation
Anorexia
Nausea
Vomiting
Abdominal Pain
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?

LOW fat
Fat Soluable Vitamins
Bile Salts

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?

Hypovolemia
Hemorrhage
Acute Renal Failure
Paralytic Ileus
Septic Shock
Pleural Effusion
Respiratory Distress Syndrome
Pneumonia
Multisystem Organ Failure
Disseminated Intravascular Coagulation (DIC)
Diabetes Mellitus

What are some clinical manifestations of an Acute Pancreatitis patient?

Generalized Jaundice
Cullen's Sign (Grey, Blue Abdomen)
Turner's Sign (Grey, Blue Flank)
Abdominal Tenderness
Rigidity
Guarding
Pancreatic Ascites
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?

Drug Therapy
Comfort Measures
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
HIGH Protein
LOW-Fat meals
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?

High Triglycerides
Alcohol
High Cholesterol

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?

Blood Cultures
Drainage via the percutaneous method
Laparoscopy

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!)

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