Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders

Chapter 27

Liver, Gallbladder and Pancreas

Gallbladder Disorders

Cholelithiasis and Cholecystitis Patho

– gallstones form due to• abnormal bile composition

• biliary statis

• inflammation of gallbladder

Risk factors– age, family hx., females - oral contraceptive

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

Let’s Review

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

Hepatitis Worldwide

Liver Disorders

Disease pattern– incubation– prodromal– icteric– convalescent

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, gynecomastia, jaundice, edema, anemia, pancytopenia

Liver Disorders

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

What are your assessments, interventions?

What are your goals?

How would you chart this?

Systemic effects ofCirrhosis

Liver Disorders

Liver Cancer– usually poor outcomes

Liver Trauma– blunt or penetrating - hemorrhage

Liver Abscess

Hepatitis

Nursing Care?

Teaching needs?

Complications?

Pancreatitis

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– hydration, pain control

and antibiotics

Pancreatic Cancer

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