Nutritional Disorders InflammatoryLiver Pancreas and Gall Bladder Iowa

Nutritional Disorders: Inflammatory-Liver, Pancreas and Gall. Bladder Iowa Western Community College Stacia Thompson, MSN, RN

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Cirrhosis Chronic Liver Failure

Cirrhosis n Etiology ¡ ¡ Chronic alcohol ingestion Postnecrotic Biliary Cardiac

Pathophysiology n n n Inflammation of the liver cells Infiltration with fat and WBC Fibrotic scar tissue replaces liver tissue

Prevention n n Abstinence from Alcohol Balanced diet- adequate protein Avoid hepatotoxic chemicals Avoid hepatitis

Signs and Symptoms n n n n Malaise Anorexia Indigestion Nausea Weight loss Diarrhea Constipation n n n RUQ pain Liver enlargement Bleeding Jaundice Itching Loss of liver function

Complications of Cirrhosis n n n Clotting defects Hepatorenal syndrome Encephalopathy ¡ ¡ ¡ Early Stuporous Comatose n Ascites Portal hypertension n think ‘CHEAP’ n

Asterixis

Ascites

Diagnostic Tests n Lab ¡ n n n Liver enzymes, bilirubin, ammonia, PT Abdominal x-ray Upper GI series Liver scan EGD Liver biopsy

Treatment n n n Support liver regeneration Treat complications Ascites TIPS

Treatment n Esophageal varices

Treatment n Hepatic encephalopathy

Nursing Diagnosis n n n n Excess Fluid volume R/T… Imbalanced Nutrition: < body requirements R/T Pain R/T… Risk for disturbed thought processes R/T… Risk for ineffective breathing pattern R/T… Risk for deficient fluid volume R/T… Risk for infection R/T. .

Nursing Interventions n n n n Daily weight Measure abd girth daily VS q 4 hr- esp. Resp. Diet restrictions Monitor albumin infusion Administer diuretics Monitor for bleeding

Nursing Intervensions n n n n Frequent mouth care Administer vitamins/ supplements as ordered Pain relief Assess LOC/ reorient Administer lactulose Respiratory interventions Monitor for S/S infection

Liver, liver woe is me Gross hepatomegaly Pain just north of my umbilicus My yellow face is so ridiculous Upon my back and on my chest Those spider angiomas nest My serum G. O. T. is raised And so's my alkaline phosphatase So set 'em up don't make a sound We've still got time for one more round.

Acute Liver Failure

Acute Liver Failure n Etiology ¡ ¡ Drug toxicity HBV in presence of HDV

Signs and Symptoms n Hepatic encephalopathy n Confusion which can lead to coma n Reduction in liver size n Increase in lab values

Treatment n n n Rest Dialysis Diet restrictions Medication to rid ammonia Supportive care

Nutritional Disorders: Inflammatory Pancreas/ Gallbladder Iowa Western Community College Stacia Thompson, MSN, RN

Normal Pancreas n Normal A & P?

Acute Pancreatitis n Pathophysiology/Etiology n Inflammation n Auto digestion n Elevated enzymes n Fluid loss n Can result in: n Shock n DIC n Chronic pancreatitis

Etiology n Alcohol n Biliary disease n Trauma n Some drugs

Signs and Symptoms n Abdominal pain n Guarding n Hypotension or shock n Respiratory distress n Low-grade fever n Nausea and vomiting n Jaundice

Complications n Cardiovascular failure n ARDS n Renal failure n Hemorrhage n Turner’s sign n Cullen’s sign n Infection

Turner’s sign Cullen’s Sign

Diagnostic Tests n Serum amylase n Serum lipase n X-ray examination n CT n Ultrasound

Treatment n IV fluids/TPN n Blood products PRN n Oxygen n Analgesics, antianxiety agents n NPO n NG suction n Histamine antagonists n Antiemetics n Strict I&O

Nursing Diagnoses n Pain n Imbalanced nutrition n Risk for ineffective breathing pattern n Risk for injury

Chronic Pancreatitis n Progressive disease n Continued cellular damage n Decreased pancreatic enzyme functioning n Pancreas becomes smaller and hardened

Etiology and Prevention n Alcohol n Biliary disease n Prolonged malnutrition n Cancer of pancreas or duodenum n Prolonged enteral feedings n Treat the cause

Signs and Symptoms n Less severe than - more prolonged n Epigastric or LUQ pain n Weight loss, anorexia Later occuring symptoms: n Malabsorption and fat intolerance n Diabetes mellitus

Complications of Chronic Pancreatitis n Abcesses or fistulas n Malabsorption syndrome n Diabetes mellitus

Diagnostic Tests n Amylase and lipase n Fecal fat analysis n CT/US n ERCP

Nursing Process n Nursing Diagnoses n Pain n Impaired Nutrition < body requirements n Interventions ? ? ?

Gall Bladder Disorders n Cholecystitis n Cholelithiasis n Choledocholithiasis

Etiology n Stasis n High cholesterol intake n Sedentary lifestyle n Family history n More common in women n Risk increases with age

Signs and Symptoms n. Objective: n. Subjective n Increased VS n Epigastric pain n Vomiting Biliary colic n RUQ tenderness n Nausea n Indigestion n Jaundice n Positive Murphy’s sign n

Complications n Cholangitis n Necrosis/perforation of GB n Empyema n Fistulas n Adenocarcinoma of GB n Acute Pancreatitis

Diagnostic Tests n WBC n X-ray examination n Nuclear scan n Ultrasound n ERCP n Labs

Treatment- Cholecystitis n Analgesics- Demerol n Antispasmodics n Antiemetics n Diet

Cholelithiasis Treatment n Surgery n Laparoscopic n Traditional n Choledochoscopy n ESWL n Drugs to dissolve

Nursing Diagnosis n Pain r/t … n Altered nutrition: less than body requirements r/t … n Risk for deficient fluid volume r/t … n Risk for impaired skin integrity r/t n Risk for ineffective breathing pattern r/t… n Altered health maintenance r/t … n Interventions? ? ?