5. Spleen, Liver and Pancreas, Biliary ducts and Gallbladder (75).pptx
Interventions for clients with liver, gallbladder and pancreas disorders
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Interventions for Interventions for clients with liver, clients with liver, galdbladder and galdbladder and pancreas disorders. pancreas disorders. Clients with Clients with malnutrition and malnutrition and obesity.obesity.
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HepatitisHepatitis Widespread viral inflammation of liver cellsWidespread viral inflammation of liver cells Hepatitis A Hepatitis A Hepatitis B Hepatitis B Hepatitis C Hepatitis C Hepatitis D Hepatitis D Hepatitis E Hepatitis E Hepatitis F and G are uncommonHepatitis F and G are uncommon
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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
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Fatty Liver (Steatohepatitis)Fatty Liver (Steatohepatitis)
Fatty liver is caused by the accumulation of fats in and Fatty 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
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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
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Liver TraumaLiver Trauma The liver is the most common organ injured in clients with The liver is the most common organ injured in clients with
penetrating trauma of the abdomen, such as gunshot wounds penetrating 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.
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CirrhosisCirrhosis Cirrhosis is extensive scarring of the liver, usually caused by Cirrhosis is extensive scarring of the liver, usually caused by
a chronic irreversible reaction to hepatic inflammation and a chronic irreversible reaction to hepatic inflammation and necrosis.necrosis.
Complications depend on the amount of damage sustained Complications depend on the amount of damage sustained by the liver.by the liver.
In compensated cirrhosis, liver has significant scarring but In compensated cirrhosis, liver has significant scarring but performs essential functions without causing significant performs essential functions without causing significant symptoms.symptoms.
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ComplicationsComplications
Portal hypertensionPortal hypertension Ascites Ascites Bleeding esophageal varicesBleeding esophageal varices Coagulation defectsCoagulation defects JaundiceJaundice Portal-systemic encephalopathy with Portal-systemic encephalopathy with
hepatic comahepatic coma Hepatorenal syndromeHepatorenal syndrome Spontaneous bacterial peritonitisSpontaneous bacterial peritonitis
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EtiologyEtiology
Known causes of liver disease include:Known causes of liver disease include: Alcohol Alcohol Viral hepatitisViral hepatitis Autoimmune hepatitisAutoimmune hepatitis SteatohepatitisSteatohepatitis Drugs and toxinsDrugs and toxins Biliary diseaseBiliary disease Metabolic/genetic causesMetabolic/genetic causes Cardiovascular diseaseCardiovascular disease
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Clinical ManifestationsClinical Manifestations
In early stages, signs of liver disease In 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 Pruritus Pruritus
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Clinical ManifestationsClinical Manifestations
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Abdominal AssessmentAbdominal Assessment Massive ascitesMassive ascites Umbilicus protrusionUmbilicus protrusion Caput medusae (dilated abdominal veins)Caput medusae (dilated abdominal veins) Hepatomegaly (liver enlargementHepatomegaly (liver enlargement
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Cancer of the LiverCancer of the Liver
One of the most common tumors in One of the most common tumors in the worldthe world
Most common complaint: abdominal Most common complaint: abdominal discomfortdiscomfort
Treatment includes:Treatment includes: ChemotherapyChemotherapy SurgerySurgery
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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 victims Donor 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 a Donor liver transported to the surgery center in a
cooled saline solution that preserves the organ for up cooled saline solution that preserves the organ for up to 8 hoursto 8 hours
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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
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Acute CholecystitisAcute Cholecystitis Acute cholecystitis is Acute cholecystitis is
the inflammation of the the inflammation of the gallbladder.gallbladder.
Cholelithiasis Cholelithiasis (gallstones) usually (gallstones) usually accompanies accompanies cholecystitis.cholecystitis.
Acalculous cholecystitis Acalculous cholecystitis inflammation can occur inflammation can occur in the absence of in the absence of gallstones.gallstones.
Calculous cholecystitis Calculous cholecystitis is the obstruction of the is the obstruction of the cystic duct by a stone, cystic duct by a stone, which creates an which creates an inflammatory response.inflammatory response.
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Chronic CholecystitisChronic Cholecystitis Repeated episodes of cystic duct Repeated episodes of cystic duct
obstruction result in chronic obstruction result in chronic inflammationinflammation
Pancreatitis, cholangitisPancreatitis, cholangitis JaundiceJaundice IcterusIcterus Obstructive jaundiceObstructive jaundice Pruritus Pruritus
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Clinical ManifestationsClinical Manifestations Flatulence, dyspepsia, eructation, Flatulence, dyspepsia, eructation,
anorexia, nausea and vomiting, anorexia, nausea and vomiting, abdominal pain abdominal pain
Biliary colicBiliary colic Murphy’s signMurphy’s sign Blumberg’s signBlumberg’s sign Rebound tendernessRebound tenderness Steatorrhea Steatorrhea
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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 the Free 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
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Traditional CholecystectomyTraditional Cholecystectomy
Standard preoperative careStandard preoperative care Operative procedureOperative procedure Postoperative carePostoperative care
Meperidine hydrochloride via patient-controlled Meperidine 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
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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 severe jaundice, hepatosplenomegaly, chronic, progressively severe epigastric or right upper quadrant painepigastric or right upper quadrant pain
Poor prognosisPoor prognosis Surgery, radiation, chemotherapySurgery, radiation, chemotherapy
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Acute PancreatitisAcute Pancreatitis Serious and possibly life-threatening inflammatory process Serious 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
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Complications of Acute Complications of Acute PancreatitisPancreatitis
HypovolemiaHypovolemia HemorrhageHemorrhage Acute renal failureAcute renal failure Paralytic ileusParalytic ileus Hypovolemic or septic shockHypovolemic or septic shock Pleural effusion, respiratory distress Pleural effusion, respiratory distress
syndrome,pneumoniasyndrome,pneumonia Multisystem organ failureMultisystem organ failure Disseminated intravascular coagulationDisseminated intravascular coagulation Diabetes mellitusDiabetes mellitus
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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
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Clinical ManifestationsClinical Manifestations
Cullen’s signCullen’s sign
Turner’s signTurner’s sign
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Chronic PancreatitisChronic Pancreatitis Progressive destructive disease of the Progressive destructive disease of the
pancreas, characterized by remissions pancreas, characterized by remissions and exacerbationsand exacerbations
Nonsurgical management includes:Nonsurgical management includes: Drug therapyDrug therapy Analgesic administrationAnalgesic administration Enzyme replacementEnzyme replacement Insulin therapyInsulin therapy Diet therapyDiet therapy
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Pancreatic AbscessPancreatic Abscess Most serious complication of Most serious complication of
pancreatitis; always fatal if untreatedpancreatitis; always fatal if untreated High feverHigh fever Blood culturesBlood cultures Drainage via the percutaneous Drainage via the percutaneous
method or laparoscopymethod or laparoscopy Antibiotic treatment alone does not Antibiotic treatment alone does not
resolve abscessresolve abscess
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Pancreatic CarcinomaPancreatic Carcinoma
Nonsurgical managementNonsurgical management Drug therapyDrug therapy Radiation therapyRadiation therapy Biliary stent insertionBiliary stent insertion