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JAUNDICE
• Jaundice, a yellowish discoloration of body tissues, results from an alteration in normal
bilirubin metabolism or flow of bile into the hepatic or biliary duct systems.
HEPATITIS
• Hepatitis is an inflammation of the liver. Viral hepatitis is the most common cause of
hepatitis. The types of viral hepatitis are A, B, C, D, E, and G.
• Hepatitis A
o HAV is an RNA virus that is transmitted through the fecal-oral route.
o The mode of transmission of HAV is mainly transmitted by ingestion of food or
liquid infected with the virus and rarely parenteral.
• Hepatitis B
o HBV is a DNA virus that is transmitted perinatally by mothers infected with HBV;
percutaneously (e.g., IV drug use); or horizontally by mucosal exposure to infectious
blood, blood products, or other body fluids.
o HBV is a complex structure with three distinct antigens: the surface antigen
(HBsAg), the core antigen (HBcAg), and the e antigen (HBeAg).
o Approximately 6% of those infected when older than age 5 develop chronic HBV.
• Hepatitis C
o HCV is an RNA virus that is primarily transmitted percutaneously.
o The most common mode of HCV transmission is the sharing of contaminated
needles and paraphernalia among IV drug users.
o There are 6 genotypes and more than 50 subtypes of HCV.
• Hepatitis D, E, G
o Hepatitis D virus (HDV) is an RNA virus that cannot survive on its own. It requires
HBV to replicate.
o Hepatitis E virus (HEV) is an RNA virus that is transmitted by the fecal-oral route.
o Hepatitis G virus (HGV) is a sexually transmitted virus. HGV coexists with other
viral infections, including HBV, HCV, and HIV.
• Clinical manifestations:
o Many patients with hepatitis have no symptoms.
o Symptoms of the acute phase include malaise, anorexia, fatigue, nausea, occasional
vomiting, and abdominal (right upper quadrant) discomfort. Physical examination
may reveal hepatomegaly, lymphadenopathy, and sometimes splenomegaly.
• Many HBV infections and the majority of HCV infections result in chronic (lifelong) viral
infection.
• Most patients with acute viral hepatitis recover completely with no complications.
• Approximately 75% to 85% of patients who acquire HCV will go on to develop chronic
infection.
• Fulminant viral hepatitis results in severe impairment or necrosis of liver cells and potential
liver failure.
• Drug therapy for chronic HBV and HBC is focused on decreasing the viral load, aspartate
aminotransferase (AST) and aspartate aminotransferase (ALT) levels, and the rate of disease
progression.
o Chronic HBV drugs include interferon, lamivudine (Epivir), adefovir (Hepsera),
entecavir (Baraclude), and telbivudine (Tyzeka).
o Treatment for HCV includes pegylated α -interferon (Peg-Intron, Pegasys) given
with ribavirin (Rebetol, Copegus).
• Both hepatitis A vaccine and immune globulin (IG) are used for prevention of hepatitis A.
• Immunization with HBV vaccine is the most effective method of preventing HBV infection.
For postexposure prophylaxis, the vaccine and hepatitis B immune globulin (HBIG) are
used.
• Most patients with viral hepatitis will be cared for at home, so the nurse must assess the
patient’s knowledge of nutrition and provide the necessary dietary teaching.
AUTOIMMUNE HEPATITIS
• Autoimmune hepatitis is a chronic inflammatory disorder of unknown cause. It is
characterized by the presence of autoantibodies, high levels of serum immunoglobulins, and
frequent association with other autoimmune diseases.
• Autoimmune hepatitis (in which there is evidence of necrosis and cirrhosis) is treated with
corticosteroids or other immunosuppressive agents.
WILSON’S DISEASE
• Wilson’s disease is a progressive, familial, terminal neurologic disease accompanied by
chronic liver disease leading to cirrhosis.
• The risk for developing NAFLD is a major complication of obesity. NAFLD can progress to
liver cirrhosis.
• NAFLD should be considered in patients with risk factors such as obesity, diabetes,
hypertriglyceridemia, severe weight loss (especially in those whose weight loss was recent),
and syndromes associated with insulin resistance.
CIRRHOSIS
• Cirrhosis is a chronic progressive disease characterized by extensive degeneration and
destruction of the liver parenchymal cells.
• Common causes of cirrhosis include alcohol, malnutrition, hepatitis, biliary obstruction, and
right-sided heart failure. Excessive alcohol ingestion is the single most common cause of
cirrhosis followed by chronic hepatitis (B and C).
• Diagnostic tests for cirrhosis include elevations in liver enzymes, decreased total protein, fat
metabolism abnormalities, and liver biopsy.
• If the patient has esophageal and/or gastric varices in addition to cirrhosis, the nurse
observes for any signs of bleeding from the varices (e.g., hematemesis, melena).
• The focus of nursing care of the patient with hepatic encephalopathy is on maintaining a
safe environment, sustaining life, and assisting with measures to reduce the formation of
ammonia.
LIVER TRANSPLANTATION
• Indications for liver transplant include chronic viral hepatitis, congenital biliary
abnormalities (biliary atresia), inborn errors of metabolism, hepatic malignancy (confined to
the liver), sclerosing cholangitis, fulminant hepatic failure, and chronic end-stage liver
disease.
• The patient who has had a liver transplant requires highly skilled nursing care.
ACUTE PANCREATITIS
• Acute pancreatitis is an acute inflammatory process of the pancreas. The primary etiologic
factors are biliary tract disease (most common cause in women) and alcoholism (most
common cause in men).
• Abdominal pain usually located in the left upper quadrant is the predominant symptom of
acute pancreatitis. Other manifestations include nausea, vomiting, hypotension, tachycardia,
and jaundice.
• Two significant local complications of acute pancreatitis are pseudocyst and abscess. A
pancreatic pseudocyst is a cavity continuous with or surrounding the outside of the
pancreas.
• The primary diagnostic tests for acute pancreatitis are serum amylase and lipase.
• Objectives of collaborative care for acute pancreatitis include relief of pain; prevention or
alleviation of shock; reduction of pancreatic secretions; control of fluid and electrolyte
imbalances; prevention or treatment of infections; and removal of the precipitating cause.
• Because hypocalcemia can also occur, the nurse must observe for symptoms of tetany, such
as jerking, irritability, and muscular twitching.
CHRONIC PANCREATITIS
• Chronic pancreatitis is a continuous, prolonged, inflammatory, and fibrosing process of the
pancreas. The pancreas becomes progressively destroyed as it is replaced with fibrotic
tissue. Strictures and calcifications may also occur in the pancreas.
• Measures used to control the pancreatic insufficiency include diet, pancreatic enzyme
replacement, and control of the diabetes.
PANCREATIC CANCER
• The majority of pancreatic cancers have metastasized at the time of diagnosis. The signs and
symptoms of pancreatic cancer are often similar to those of chronic pancreatitis.
• Transabdominal ultrasound and CT scan are the most commonly used diagnostic imaging
techniques for pancreatic diseases, including cancer.
• Surgery provides the most effective treatment of cancer of the pancreas; however, only 15%
to 20% of patients have resectable tumors.
GALLBLADDER DISORDERS
• The most common disorder of the biliary system is cholelithiasis (stones in the gallbladder).
Cholecystitis (inflammation of the gallbladder) is usually associated with cholelithiasis.
• Medical dissolution therapy is recommended for patients with small radiolucent stones who
are mildly symptomatic and are poor surgical risks.
• Cholelithiasis develops when the balance that keeps cholesterol, bile salts, and calcium in
solution is altered and precipitation occurs. Ultrasonography is commonly used to diagnose
gallstones.
• Initial symptoms of acute cholecystitis include indigestion and pain and tenderness in the
right upper quadrant.