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Interventions for clients with liver, gallbladder and pancreas disorders
1. Interventions forInterventions for
clients with liver,clients with liver,
galdbladder andgaldbladder and
pancreaspancreas
disorders. Clientsdisorders. Clients
with malnutritionwith malnutrition
and obesity.and obesity.
..
2. HepatitisHepatitis
Widespread viral inflammation of liver cellsWidespread viral inflammation of liver cells
Hepatitis AHepatitis A
Hepatitis BHepatitis B
Hepatitis CHepatitis C
Hepatitis DHepatitis D
Hepatitis EHepatitis E
Hepatitis F and G are uncommonHepatitis F and G are uncommon
3. 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
4. Fatty LiverFatty Liver
(Steatohepatitis)(Steatohepatitis)
Fatty liver is caused by the accumulation of fats in andFatty 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
5. 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
6. Liver TraumaLiver Trauma
The liver is the most common organ injured in clients withThe liver is the most common organ injured in clients with
penetrating trauma of the abdomen, such as gunshot woundspenetrating 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.
7. CirrhosisCirrhosis
Cirrhosis is extensive scarring of the liver, usually caused byCirrhosis is extensive scarring of the liver, usually caused by
a chronic irreversible reaction to hepatic inflammation anda chronic irreversible reaction to hepatic inflammation and
necrosis.necrosis.
Complications depend on the amount of damage sustainedComplications depend on the amount of damage sustained
by the liver.by the liver.
In compensated cirrhosis, liver has significant scarring butIn compensated cirrhosis, liver has significant scarring but
performs essential functions without causing significantperforms essential functions without causing significant
symptoms.symptoms.
9. EtiologyEtiology
Known causes of liver disease include:Known causes of liver disease include:
AlcoholAlcohol
Viral hepatitisViral hepatitis
Autoimmune hepatitisAutoimmune hepatitis
SteatohepatitisSteatohepatitis
Drugs and toxinsDrugs and toxins
Biliary diseaseBiliary disease
Metabolic/genetic causesMetabolic/genetic causes
Cardiovascular diseaseCardiovascular disease
10. Clinical ManifestationsClinical Manifestations
In early stages, signs of liver diseaseIn 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
PruritusPruritus
14. Cancer of the LiverCancer of the Liver
One of the most common tumors inOne of the most common tumors in
the worldthe world
Most common complaint: abdominalMost common complaint: abdominal
discomfortdiscomfort
Treatment includes:Treatment includes:
ChemotherapyChemotherapy
SurgerySurgery
15.
16. 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 victimsDonor 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 aDonor liver transported to the surgery center in a
cooled saline solution that preserves the organ for up tocooled saline solution that preserves the organ for up to
8 hours8 hours
19. Acute CholecystitisAcute Cholecystitis
Acute cholecystitis isAcute cholecystitis is
the inflammation of thethe inflammation of the
gallbladder.gallbladder.
CholelithiasisCholelithiasis
(gallstones) usually(gallstones) usually
accompaniesaccompanies
cholecystitis.cholecystitis.
AcalculousAcalculous
cholecystitischolecystitis
inflammation can occurinflammation can occur
in the absence ofin the absence of
gallstones.gallstones.
Calculous cholecystitisCalculous cholecystitis
is the obstruction of theis the obstruction of the
cystic duct by a stone,cystic duct by a stone,
which creates anwhich creates an
inflammatory response.inflammatory response.
20. Chronic CholecystitisChronic Cholecystitis
Repeated episodes of cystic ductRepeated episodes of cystic duct
obstruction result in chronicobstruction result in chronic
inflammationinflammation
Pancreatitis, cholangitisPancreatitis, cholangitis
JaundiceJaundice
IcterusIcterus
Obstructive jaundiceObstructive jaundice
PruritusPruritus
22. 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 theFree 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
23. TraditionalTraditional
CholecystectomyCholecystectomy
Standard preoperative careStandard preoperative care
Operative procedureOperative procedure
Postoperative carePostoperative care
Meperidine hydrochloride via patient-controlledMeperidine 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
24. 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 severejaundice, hepatosplenomegaly, chronic, progressively severe
epigastric or right upper quadrant painepigastric or right upper quadrant pain
Poor prognosisPoor prognosis
Surgery, radiation, chemotherapySurgery, radiation, chemotherapy
25. Acute PancreatitisAcute Pancreatitis
Serious and possibly life-threatening inflammatory processSerious 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
26.
27. Complications of AcuteComplications of Acute
PancreatitisPancreatitis
HypovolemiaHypovolemia
HemorrhageHemorrhage
Acute renal failureAcute renal failure
Paralytic ileusParalytic ileus
Hypovolemic or septic shockHypovolemic or septic shock
Pleural effusion, respiratory distressPleural effusion, respiratory distress
syndrome,pneumoniasyndrome,pneumonia
Multisystem organ failureMultisystem organ failure
Disseminated intravascular coagulationDisseminated intravascular coagulation
Diabetes mellitusDiabetes mellitus
30. Chronic PancreatitisChronic Pancreatitis
Progressive destructive disease of theProgressive destructive disease of the
pancreas, characterized bypancreas, characterized by
remissions and exacerbationsremissions and exacerbations
Nonsurgical management includes:Nonsurgical management includes:
Drug therapyDrug therapy
Analgesic administrationAnalgesic administration
Enzyme replacementEnzyme replacement
Insulin therapyInsulin therapy
Diet therapyDiet therapy
31. Pancreatic AbscessPancreatic Abscess
Most serious complication ofMost serious complication of
pancreatitis; always fatal if untreatedpancreatitis; always fatal if untreated
High feverHigh fever
Blood culturesBlood cultures
Drainage via the percutaneousDrainage via the percutaneous
method or laparoscopymethod or laparoscopy
Antibiotic treatment alone does notAntibiotic treatment alone does not
resolve abscessresolve abscess