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Laboratory and Diagnostic Examinations
Serum bilirubin test
Liver enzyme tests
Serum protein test
Oral cholecystography (gallbladder series)
Intravenous cholangiography (IV cholangiogram)
Operative cholangiography
T-tube cholangiogram
Ultrasound of the liver, gallbladder, and biliary system
Gallbladder scanning
Liver biopsy
Liver scanning
Laboratory and Diagnostic Examinations
(continued)
Blood ammonia
Hepatitis virus studies
Serum amylase test
Urine amylase test
Ultrasound of pancreas
Computerized tomography of the abdomen
Endoscopic retrograde cholangiopancreatography of the pancreatic duct (ERCP)
•
•
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis
Etiology/pathophysiology
•
•
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Scar tissue restricts the flow of blood to the liver
Types of cirrhosis
Laennec’s cirrhosis
Postnecrotic cirrhosis
Primary biliary cirrhosis
Secondary biliary cirrhosis
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Etiology/pathophysiology (continued)
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Chronic, degenerative disease of the liver
Alteration of liver function
Reduced ability to metabolize albumin
Obstruction of portal vein
Increased pressure in veins that drain GI tract
Complications
Portal hypertension
Ascites
Esophageal varices
Hepatic encephalopathy
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Clinical manifestations/assessment
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•
Early stages
Abdominal pain
Liver is firm and easy to palpate
Late stages
Dyspepsia
Changes in bowel habits
Nausea and vomiting
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•
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Clinical manifestations/assessment (continued)
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Late stages (continued)
Ascites
Enlarged spleen
Spider angiomas
Anemia
Bleeding tendencies
Epistaxis
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Clinical manifestations/assessment (continued)
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Gradual weight loss
Late stages (continued)
Purpura
Hematuria
Bleeding gums
Jaundice
Disorientation
Figure 46-2
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Medical management/nursing interventions
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•
Pharmacological management
Antiemetics
o Benadryl and Dramamine
o Contraindicated: Vistaril, Compazine, and Atarax
Eliminate the cause
Alcohol
Hepatotoxins
Environmental exposure to harmful chemicals
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•
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Medical management/nursing interventions (continued)
•
Diet
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Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Medical management/nursing interventions (continued)
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Well-balanced
High in calories
Moderate in protein
Low in fat
Low in sodium
Supplemental vitamins and folic acid
Treatment of complications
Ascites
o Bed rest
o Strict I&O
o Restrict fluids and sodium
o Diuretics: Aldactone, Lasix, HCTZ
o Vitamins K, C, and folic acid supplements
o LeVeen peritoneal-jugular shunt
o Paracentesis
Figure 46-3
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Medical management/nursing interventions (continued)
•
Treatment of complications (continued)
Ruptured esophageal varices
o Maintain airway; establish IV
o Vasopressin drip to control bleeding
o Sengstaken-Blakemore tube
o Endoscopic sclerotherapy
o Portacaval shunt
o Blood transfusion
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•
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cirrhosis (continued)
Medical management/nursing interventions (continued)
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Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Liver cancer
Etiology and pathology
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Hepatocellular carcinoma most commonly seen
Cirrhosis of the liver and hepatitis C and B are also elevated risk factors
In the United States liver cancer is seen more in people over age 40
Metastatic carcinoma of the liver is seen more than primary liver cancer
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Liver cancer
Clinical manifestations
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Treatment of complications (continued)
Hepatic encephalopathy
o Decrease protein in diet
o Avoid drugs that are detoxified by the liver
o Lactulose
o Neomycin
Hepatomegaly
Weight loss
Peripheral edema
Ascites
Portal hypertension
Dull epigastric pain
Jaundice
Anorexia
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
•
Liver cancer
Diagnostic tests
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CT scan
Magnetic resonance imaging
ERCP
Liver biopsy
Liver cancer
Medical management/nursing interventions
Palliative care
Surgery
Chemotherapy
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Hepatitis
Etiology/pathophysiology
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Ultrasound
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
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Liver scan
Inflammation of the liver resulting from several types of viral agents or
exposure to toxic substances
Hepatitis A
Most common
Oral-fecal transmission
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Hepatitis (continued)
Etiology/pathophysiology (continued)
•
Hepatitis B
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•
Hepatitis (continued)
Etiology/pathophysiology (continued)
•
Hepatitis D
Co-infection with hepatitis B
Hepatitis E
Fecal contamination of water
Rare in the United States; usually in developing countries
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Hepatitis (continued)
Clinical manifestations/assessment
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Hepatitis C
Transmitted through contaminated needles and blood transfusions
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
•
•
•
Transmission by contaminated serum; blood transfusion,
contaminated needles, dialysis, or direct contact with infected body
fluids
General malaise
Aching muscles
Photophobia
Headaches
Chills
Abdominal pain
Dyspepsia
Nausea
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Hepatitis (continued)
Clinical manifestations/assessment (continued)
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•
Diarrhea/constipation
Pruritus
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Weight loss
Jaundice
Dark amber urine
Clay-colored stools
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Hepatitis (continued)
Medical management/nursing interventions
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•
Treat symptoms
Small, frequent meals
Low-fat, high-carbohydrate
IV fluids for dehydration
Vitamin C, vitamin B–complex, vitamin K
Avoid unnecessary medications, especially sedatives
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Hepatitis (continued)
Medical management/nursing interventions (continued)
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Enlarged lymph nodes
Figure 46-5
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Hepatomegaly
Gamma globulin or immune serum globulin
Hepatitis B immune globulin (HBIG)
Should be given to anyone exposed to hepatitis B
Hepatitis B vaccine
Should be given to people identified as high risk for developing
hepatitis B
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Liver abscesses
Etiology/pathophysiology
•
•
•
•
Liver abscesses (continued)
Clinical manifestations/assessment
Fever
Chills
Abdominal pain and tenderness in the right upper quadrant
Hepatomegaly
Jaundice
Anemia
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Liver abscesses (continued)
Diagnostic tests
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Radiograph
Ultrasound
CT scan
Liver scan
Medical management/nursing interventions
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Abscess forms in the liver due to invading bacteria
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
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May be single or multiple
IV antibiotic therapy
Percutaneous drainage of liver abscess
Open surgical drainage
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cholecystitis and cholelithiasis
Etiology/pathophysiology
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•
•
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•
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cholecystitis and cholelithiasis (continued)
Clinical manifestations/assessment
Indigestion after eating foods high in fat
Severe, colicky pain in the right upper quadrant
Anorexia
Nausea and vomiting
Flatulence
Increased heart and respiratory rates
Diaphoresis
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cholecystitis and cholelithiasis (continued)
Clinical manifestations/assessment (continued)
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Risk factors
Female; American Indian or white; obesity; pregnancy; diabetes;
multiparous women; use of birth control
Figure 46-6
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An obstruction, gallstone, or tumor prevents bile from leaving the gallbladder,
and the trapped bile acts as an irritant, causing inflammation
Low-grade fever
Elevated WBC
Mild jaundice
Steatorrhea (fatty stool)
Dark amber urine
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cholecystitis and cholelithiasis (continued)
Medical management/nursing interventions
•
•
•
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cholecystitis and cholelithiasis (continued)
Medical management/nursing interventions (continued)
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•
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•
Lithotripsy
Cholecystectomy
Laparoscopic
Open
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Pancreatitis
Etiology/pathophysiology
•
•
•
•
Mild attacks
Pharmacological management
o Antispasmodic and analgesic medications
o Antibiotics
Bed rest
NG tube to suction
NPO
IV fluids
Dietary recommendations: Avoid spicy foods when allowed PO intake
Inflammation of the pancreas
Acute or chronic
Predisposing factors
Alcohol
Trauma
Infectious disease
Certain drugs
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Pancreatitis (continued)
Clinical manifestations/assessment
•
•
Abdominal pain
Anorexia; nausea and vomiting
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Jaundice
Weight loss
Steatorrhea
Tachycardia
Pancreatitis (continued)
Medical management/nursing interventions
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•
•
•
Pharmacological management
Antiemetics
Analgesics
Anticholinergics
Antacids
NPO
IV fluids
NG tube
Hyperalimentation
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cancer of the pancreas
Etiology/pathophysiology
•
•
•
•
•
Low-grade fever
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
•
•
•
Malaise
Unknown
Risk factors
Cigarette smoking; exposure to chemical carcinogens; diabetes
mellitus; pancreatitis; diet high in meat, fat, and coffee
May be metastasis from the lung, stomach, duodenum, or common bile duct
(CBD)
May live only 4 to 8 months after diagnosis
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
•
Cancer of the pancreas (continued)
Clinical manifestations/assessment
•
•
•
•
•
•
•
•
•
•
Fatigue
Nausea and flatulence
Change in stools
Steady, dull, aching pain in the epigastric area
Weight loss
Jaundice
Onset of diabetes mellitus
Disorders of the Liver, Biliary Tract, Gallbladder, and Pancreas
Cancer of the pancreas (continued)
Medical management/nursing interventions
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•
•
•
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•
Anorexia
Surgery
Whipple procedure
Total pancreatectomy with resection of parts of the GI tract
Chemotherapy
Radiation
Figure 46-9
Nursing Process
Nursing diagnoses