Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders

Chapter 27

Liver, Gallbladder and Pancreas

Gallbladder Disorders

Cholelithiasis- Formation of stonesCholecystitis-Inflammation of thegallbladderPatho&risk- age, hx, gender, OC

– gallstones form due to• abnormal bile composition• biliary statis • inflammation of gallbladder

Gallbladder Disorders

Cholelithiasis

asymptomatic

epigastric fullness after fatty meal

biliary colic

jaundice

Acute cholecystitis

RUQ pain - back

a/n/v

fever with chills

Gallbladder Disorders

Treatment– laparoscopic cholecystectomy

Nursing Diagnoses– Pain– Imbalanced Nutrition– Risk for Infection

Liver

Hepatitis

Liver Disorders

Hepatitis– inflammation of the liver due to virus, ETOH,

drugs, toxins, may be acute or chronic Viral Hepatitis Hepatitis A - infectious hepatitis

– fecal-oral route– benign, self-limiting

Liver Disorders

Hepatitis B – transmission - infected blood and body fluids

• at risk - healthcare workers, drug users, multiple sexual partners, hemodialysis clients

Hepatitis C– transmission - infected blood and body fluids– manifestations - mild, non-specific– world wide cause of chronic hepatitis

Liver Disorders

Disease pattern– Onset– Transmission– Carrier– Prevent– Treatment

Hepatitis

Course of acute viral hepatitis follows three phases:Preicteric- abruptly before jaundiceIcteric- after 5-10 days of exposureConvalescent- well being improves, energy increases, jaundice resolves.See book.

Liver Disorders

Nursing Care– teaching

• handwashing• blood and body fluid precautions• vaccines for persons at high risk

Advanced Cirrhosis

Liver Disorders

Cirrhosis– end state of chronic liver disease, progressive

and irreversible• alcoholic cirrhosis, biliary, or secondary to hepatitis

– Manifestations• liver enlg. Tender, wt loss, weakness, anorexia• ascites, jaundice, edema, anemia,

Cirrhosis of the Liver

Functional liver tissue is gradually destroyed and replaced with fibrous scar tissue, thus metobolic functions of the liver are lost. The scar tissue forms constrictive bands in the liver and disrupts blood and bile flow within the liver.Impaired blood flow through the liver increases pressure in the portal venous system, thus leading to many problems including esophageal varices.Discussion see book.

Cirrhosis of the Liver

As the liver is destroyed it’s ability to metabolize proteins is impaired!!! Ammonia and toxic wastes accumulate in the blood, these substances affect the CNS!!!Hepatic Encephalopathy is the result of accumulated ammonia and toxic wastes(protein). CM are altered levels of consciousness, cognition and motor function.Asterixis or liver flap is an early CM of hepatic encephalopathy. This is a muscle tremor that causes involuntary jerking movements that make it difficult to keep the extremities still

Liver Disorders

Complications– portal hypertension– splenomegaly– ascites– esophageal varices– hepatic encephalopathy– hepatorenal syndrome

HepatitisNursing Care- Supportive care. Prevent transmission of disease!!

Teaching needs- If at risk, need vaccine!!!!!

Complications- Cirrhosis!

Pancreatitis

Pancreatitis– inflammation of pancreas characterized by

release of pancreatic enzymes into pancreatic tissue itself leading to hemorrhage and necrosis

Risk factors– alcoholism, gallstones

Pancreatitis

Manifestations– abrupt onset of severe epigastric/abdominal

pain• relieved by leaning forward, sitting up• initiated by fatty meal or alcohol intake

– n/v– abd. distention and rigidity, decreased b.s.– fever, 24 hours later jaundice

Pancreatitis

Pancreatitis

Diagnostic tests– labs - amylase and lipase– Ultra sound, ERCP, C-T

scan, needle bx Treatment

– NPO,hydration, pain control and antibiotics

Pancreatitis

Can be acute or chronicAcute- middle life from gallstones and alcoholism which are the primary risk factors Chronic- Alcoholism is the primary risk factor.Pancreatic duct obstruction by a gallstone or spasm of the sphincter of oddi can obstruct the outflow of pancreatic enzymes then auto digestion begins.See text

Pancreatic Cancer

Very lethal Risk factors

– smoking, chemical or environmental toxins Manifestations

– non-specific, a/n, wt. loss, dull epigastric pain Treatment

– surgery - Whipple, radiation and chemotherapy

NCLEX

A client diagnosed with cholelithiasis requests medication for pain relief. Which of the following medications is the provider most likely to prescribe?

A. Acetaminophen (Tylenol) D. ibuprofenB. Meperidine (Demerol) (Motrin)C. Morphine Sulfate

NCLEXA client who was diagnosed with hepatitis A state he was told by the

nursing assistant that his disease could be transmitted only through blood contact. The appropriate action by the nurse would be to:

A. Provide the correct information to the client and nursing assistant.B. Take no further action because the information is correct.C. Remove all precautions because hepatitis A cannot be transmittedD. Place a sign on the client’s door stating “blood precautions.”

NCLEX

A client is diagnosed with hepatitis B. Which of the following information, if obtained during the admission assessment would indicate a risk factor?

A. She ate in a dirty restaurant 2 weeks agoB. She uses barrier protection during sexC. She is an intravenous drug userD. She has never received a blood transfusion

NCLEX

The nurse is caring for a client with acute pancreatitis. Which nursing assessment should receive the highest priority?

A. Assess intake and outputB. Assess cardiovascular status and fluid volume statusC. Assess bowel sounds and fecal outputD. Assess mental status

NCLEX

A client with cirrhosis is scheduled for discharge. The nurse recognized the need for further teaching if the client states

A. I will use a soft toothbrush for oral hygieneB. I will maintain a low-protein dietC. I will report increased difficulty breathing to my providerD. I will limit alcohol intake to two servings per day

NCLEX

A 45 –year old client with liver disease is prescribed lactulose (Chronulac) 30 ML every 6 hours. Recognizing the action of this medication in the treatment of liver disease, the nurse would expect to assess which positive response to the medication?

A. Increased urine outputB. Reduced serum ammonia levelsC. Reduced steatorrheaD. Increased serum potassium levels

NCLEX

A patient tells the nurse that his bowel movements are weird in that they look soapy and smell really bad. The nurse realizes that this client might be experiencing:A.A. an obstructed gallbladderB.B. turner’s signC.C .cullen’s sign D.D. steatorrhea

Ammonia Levels and liver failure

Ammonia levels are elevated because of inability of the liver to metabolize protein products. The medication Lactulose increases the absorption of ammonia from the bowel, thus reducing blood ammonia levels.

What do we see clinically in a patient who’s blood ammonia levels are too high from liver cirrhosis?

What is Asterixix?What type of diet should the patient with cirrhosis of the liver

and hepatic encephalopathy be prescribed?

Pancreatitis

Acute- The pancreas is damaged or its duct to the duodenum is blocked, allowing pancreatic enzymes to accumulate within the pancreas.

Pancreatic duct obstruction by a gallstone or spasm of the sphincter of Oddi which is associated with alcohol use can obstruct the outflow of pancreatic enzymes. This creates autodigestion. Steatorrhea- Fatty stool. Alcoholism is the primary risk factor for chronic pancreatitis in the US.

Labs of importance:Serum amylase and lipase will be elevated during pancreatitis.