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
Acute cholecystitis
asymptomatic
RUQ pain - back
epigastric
fullness after
fatty meal
a/n/v
biliary colic
jaundice
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 of
Cirrhosis
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