Nursing Care of Clients with
Gallbladder, Liver and
Pancreatic Disorders
Chapter 27
Liver, Gallbladder and Pancreas
Gallbladder Disorders
Cholelithiasis- Formation of stones
Cholecystitis-Inflammation of the
gallbladder
Patho&risk- age, hx, gender, OC
– gallstones form due to
• abnormal bile composition
• biliary statis
• inflammation of gallbladder
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
4 Treatment
– laparoscopic cholecystectomy
4 Nursing Diagnoses
– Pain
– Imbalanced Nutrition
– Risk for Infection
Liver
Hepatitis
Liver Disorders
4 Hepatitis
– inflammation of the liver due to virus, ETOH,
drugs, toxins, may be acute or chronic
4 Viral Hepatitis
4 Hepatitis A - infectious hepatitis
– fecal-oral route
– benign, self-limiting
Liver Disorders
4 Hepatitis B
– transmission - infected blood and body fluids
• at risk - healthcare workers, drug users, multiple
sexual partners, hemodialysis clients
4 Hepatitis C
– transmission - infected blood and body fluids
– manifestations - mild, non-specific
– world wide cause of chronic hepatitis
Liver Disorders
4 Disease pattern
– Onset
– Transmission
– Carrier
– Prevent
– Treatment
Hepatitis
Course of acute viral hepatitis follows three
phases:
Preicteric- abruptly before jaundice
Icteric- after 5-10 days of exposure
Convalescent- well being improves, energy
increases, jaundice resolves.
See book.
Liver Disorders
4 Nursing Care
– teaching
• handwashing
• blood and body fluid precautions
• vaccines for persons at high risk
Advanced Cirrhosis
Liver Disorders
4 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
4 Complications
– portal hypertension
– splenomegaly
– ascites
– esophageal varices
– hepatic encephalopathy
– hepatorenal syndrome
Hepatitis
Nursing CareSupportive care.
Prevent
transmission of
disease!!
Teaching needsIf at risk, need
vaccine!!!!!
ComplicationsCirrhosis!
Pancreatitis
4 Pancreatitis
– inflammation of pancreas characterized by
release of pancreatic enzymes into pancreatic
tissue itself leading to hemorrhage and necrosis
4 Risk factors
– alcoholism, gallstones
Pancreatitis
4 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
4 Diagnostic tests
– labs - amylase and lipase
– Ultra sound, ERCP, C-T
scan, needle bx
4 Treatment
– NPO,hydration, pain
control and antibiotics
Pancreatitis
Can be acute or chronic
Acute- 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
4 Very lethal
4 Risk factors
– smoking, chemical or environmental toxins
4 Manifestations
– non-specific, a/n, wt. loss, dull epigastric pain
4 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. ibuprofen
B. Meperidine (Demerol) (Motrin)
C. Morphine Sulfate
NCLEX
A 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 transmitted
D. 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 ago
B. She uses barrier protection during sex
C. She is an intravenous drug user
D. 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 output
B. Assess cardiovascular status and fluid volume status
C. Assess bowel sounds and fecal output
D. 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 hygiene
B. I will maintain a low-protein diet
C. I will report increased difficulty breathing to my provider
D. 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 output
B. Reduced serum ammonia levels
C. Reduced steatorrhea
D. 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 gallbladder
B. B. turner’s sign
C. 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.