Interventions for clients with liver, gallbladder and pancreas disorders

download Interventions for clients with liver, gallbladder and pancreas disorders

of 32

Embed Size (px)

description

Disorders in patients with liver, biliary and pancreatic problems

Transcript of Interventions for clients with liver, gallbladder and pancreas disorders

  • 1.Interventions forInterventions for clients with liver,clients with liver, galdbladder andgaldbladder and pancreaspancreas disorders. Clientsdisorders. Clients with malnutritionwith malnutrition and obesity.and obesity. ..

2. HepatitisHepatitis Widespread viral inflammation of liver cellsWidespread viral inflammation of liver cells Hepatitis AHepatitis A Hepatitis BHepatitis B Hepatitis CHepatitis C Hepatitis DHepatitis D Hepatitis EHepatitis E Hepatitis F and G are uncommonHepatitis F and G are uncommon 3. Clinical ManifestationsClinical Manifestations Abdominal painAbdominal pain Changes in skin or eye colorChanges in skin or eye color Arthralgia (joint pain)Arthralgia (joint pain) Myalgia (muscle pain)Myalgia (muscle pain) Diarrhea/constipationDiarrhea/constipation FeverFever LethargyLethargy MalaiseMalaise Nausea/vomitingNausea/vomiting PruritusPruritus 4. Fatty LiverFatty Liver (Steatohepatitis)(Steatohepatitis) Fatty liver is caused by the accumulation of fats in andFatty liver is caused by the accumulation of fats in and around the hepatic cells.around the hepatic cells. Causes include:Causes include: Diabetes mellitusDiabetes mellitus ObesityObesity Elevated lipid profileElevated lipid profile Many clients are asymptomaticMany clients are asymptomatic 5. Hepatic AbscessHepatic Abscess Liver invaded by bacteria or protozoa causing abscessLiver invaded by bacteria or protozoa causing abscess Pyrogenic liver abscess; amebic hepatic abscessPyrogenic liver abscess; amebic hepatic abscess Treatment usually involves:Treatment usually involves: Drainage with ultrasound guidanceDrainage with ultrasound guidance Antibiotic therapyAntibiotic therapy 6. Liver TraumaLiver Trauma The liver is the most common organ injured in clients withThe liver is the most common organ injured in clients with penetrating trauma of the abdomen, such as gunshot woundspenetrating trauma of the abdomen, such as gunshot wounds and stab wounds.and stab wounds. Clinical manifestations include abdominal tenderness,Clinical manifestations include abdominal tenderness, distention, guarding, rigidity.distention, guarding, rigidity. Treatment involves surgery, multiple blood products.Treatment involves surgery, multiple blood products. 7. CirrhosisCirrhosis Cirrhosis is extensive scarring of the liver, usually caused byCirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction to hepatic inflammation anda chronic irreversible reaction to hepatic inflammation and necrosis.necrosis. Complications depend on the amount of damage sustainedComplications depend on the amount of damage sustained by the liver.by the liver. In compensated cirrhosis, liver has significant scarring butIn compensated cirrhosis, liver has significant scarring but performs essential functions without causing significantperforms essential functions without causing significant symptoms.symptoms. 8. ComplicationsComplications Portal hypertensionPortal hypertension AscitesAscites Bleeding esophageal varicesBleeding esophageal varices Coagulation defectsCoagulation defects JaundiceJaundice Portal-systemic encephalopathy withPortal-systemic encephalopathy with hepatic comahepatic coma Hepatorenal syndromeHepatorenal syndrome Spontaneous bacterial peritonitisSpontaneous bacterial peritonitis 9. EtiologyEtiology Known causes of liver disease include:Known causes of liver disease include: AlcoholAlcohol Viral hepatitisViral hepatitis Autoimmune hepatitisAutoimmune hepatitis SteatohepatitisSteatohepatitis Drugs and toxinsDrugs and toxins Biliary diseaseBiliary disease Metabolic/genetic causesMetabolic/genetic causes Cardiovascular diseaseCardiovascular disease 10. Clinical ManifestationsClinical Manifestations In early stages, signs of liver diseaseIn early stages, signs of liver disease include:include: FatigueFatigue Significant change in weightSignificant change in weight Gastrointestinal symptomsGastrointestinal symptoms Abdominal pain and liver tendernessAbdominal pain and liver tenderness PruritusPruritus 11. Clinical ManifestationsClinical Manifestations 12. Abdominal AssessmentAbdominal Assessment Massive ascitesMassive ascites Umbilicus protrusionUmbilicus protrusion Caput medusae (dilated abdominal veins)Caput medusae (dilated abdominal veins) Hepatomegaly (liver enlargementHepatomegaly (liver enlargement 13. Cancer of the LiverCancer of the Liver One of the most common tumors inOne of the most common tumors in the worldthe world Most common complaint: abdominalMost common complaint: abdominal discomfortdiscomfort Treatment includes:Treatment includes: ChemotherapyChemotherapy SurgerySurgery 14. Liver TransplantationLiver Transplantation Used in the treatment of end-stage liver disease,Used in the treatment of end-stage liver disease, primary malignant neoplasm of the liverprimary malignant neoplasm of the liver Donor livers obtained primarily from trauma victimsDonor livers obtained primarily from trauma victims who have not had liver damagewho have not had liver damage Donor liver transported to the surgery center in aDonor liver transported to the surgery center in a cooled saline solution that preserves the organ for up tocooled saline solution that preserves the organ for up to 8 hours8 hours 15. ComplicationsComplications Acute, chronic graft rejectionAcute, chronic graft rejection InfectionInfection HemorrhageHemorrhage Hepatic artery thrombosisHepatic artery thrombosis Fluid and electrolyte imbalancesFluid and electrolyte imbalances Pulmonary atelectasisPulmonary atelectasis Acute renal failureAcute renal failure Psychological maladjustmentPsychological maladjustment 16. Acute CholecystitisAcute Cholecystitis Acute cholecystitis isAcute cholecystitis is the inflammation of thethe inflammation of the gallbladder.gallbladder. CholelithiasisCholelithiasis (gallstones) usually(gallstones) usually accompaniesaccompanies cholecystitis.cholecystitis. AcalculousAcalculous cholecystitischolecystitis inflammation can occurinflammation can occur in the absence ofin the absence of gallstones.gallstones. Calculous cholecystitisCalculous cholecystitis is the obstruction of theis the obstruction of the cystic duct by a stone,cystic duct by a stone, which creates anwhich creates an inflammatory response.inflammatory response. 17. Chronic CholecystitisChronic Cholecystitis Repeated episodes of cystic ductRepeated episodes of cystic duct obstruction result in chronicobstruction result in chronic inflammationinflammation Pancreatitis, cholangitisPancreatitis, cholangitis JaundiceJaundice IcterusIcterus Obstructive jaundiceObstructive jaundice PruritusPruritus 18. Clinical ManifestationsClinical Manifestations Flatulence, dyspepsia, eructation,Flatulence, dyspepsia, eructation, anorexia, nausea and vomiting,anorexia, nausea and vomiting, abdominal painabdominal pain Biliary colicBiliary colic Murphys signMurphys sign Blumbergs signBlumbergs sign Rebound tendernessRebound tenderness SteatorrheaSteatorrhea 19. Surgical ManagementSurgical Management Laparoscopic cholecystectomyLaparoscopic cholecystectomy Standard preoperative careStandard preoperative care Operative procedureOperative procedure Postoperative carePostoperative care Free air pain result of carbon dioxide retention in theFree air pain result of carbon dioxide retention in the abdomenabdomen AmbulationAmbulation Return to activities in 1 to 3 weeksReturn to activities in 1 to 3 weeks 20. TraditionalTraditional CholecystectomyCholecystectomy Standard preoperative careStandard preoperative care Operative procedureOperative procedure Postoperative carePostoperative care Meperidine hydrochloride via patient-controlledMeperidine hydrochloride via patient-controlled analgesia pumpanalgesia pump AntiemeticsAntiemetics Wound careWound care Care of the T-tubeCare of the T-tube Nothing by mouthNothing by mouth Diet therapyDiet therapy 21. Cancer of the GallbladderCancer of the Gallbladder Anorexia, weight loss, nausea, vomiting, general malaise,Anorexia, weight loss, nausea, vomiting, general malaise, jaundice, hepatosplenomegaly, chronic, progressively severejaundice, hepatosplenomegaly, chronic, progressively severe epigastric or right upper quadrant painepigastric or right upper quadrant pain Poor prognosisPoor prognosis Surgery, radiation, chemotherapySurgery, radiation, chemotherapy 22. Acute PancreatitisAcute Pancreatitis Serious and possibly life-threatening inflammatory processSerious and possibly life-threatening inflammatory process of the pancreasof the pancreas Necrotizing hemorrhagic pancreatitisNecrotizing hemorrhagic pancreatitis LipolysisLipolysis ProteolysisProteolysis Necrosis of blood vesselsNecrosis of blood vessels InflammationInflammation Theories of enzyme activationTheories of enzyme activation 23. Complications of AcuteComplications of Acute PancreatitisPancreatitis HypovolemiaHypovolemia HemorrhageHemorrhage Acute renal failureAcute renal failure Paralytic ileusParalytic ileus Hypovolemic or septic shockHypovolemic or septic shock Pleural effusion, respiratory distressPleural effusion, respiratory distress syndrome,pneumoniasyndrome,pneumonia Multisystem organ failureMultisystem organ failure Disseminated intravascular coagulationDisseminated intravascular coagulation Diabetes mellitusDiabetes mellitus 24. Clinical ManifestationsClinical Manifestations Generalized jaundiceGeneralized jaundice Bowel soundsBowel sounds Abdominal tenderness, rigidity, guardingAbdominal tenderness, rigidity, guarding Pancreatic ascitesPancreatic ascites Significant changes in vital signsSignificant changes in vital signs 25. Clinical ManifestationsClinical Manifestations Cullens signCullens sign Turners signTurners sign 26. Chronic PancreatitisChronic Pancreatitis Progressive destructive disease of theProgressive