Nursing Care of Patients

with Liver, Pancreatic, and

Gallbladder disorder

Sharon Freeman, MSN, RN

 Hepatitis
Inflammation of the liver caused by a virus, bacteria,
or exposure to medications or hepatotoxins
If complications do not occur, cells regenerate and
normal liver function eventually resumes
Types of hepatitis
HAV (hep A) most common, low mortality rate

HBV (hep B) most common among healthcare workers and

IV drug users
HCV (hep C)

HDV (hep D)

HEV (hep E)

HGV (hep G)not much is known about it, thought to be mild

 Hepatitis
Prevention
Hand hygiene
Vaccines
HAV
HBV

Standard precautions
Immune globulin after exposure
Contains antibodies that help prevent the illness
 Hepatitis Signs and Symptoms
Prodromal stage (preicteric, prejaundice)
Can occur 2 weeks after exposure
Lasts for about 1 week
Flu-like symptoms, RUQ pain, n/v, diarrhea or
constipation
Icteric stage (appearance of jaundice)
Occurs 5-10 days after prodromal and lasts 2 to 6 weeks
Jaundice, worsening of symptoms, enlarged liver
Convalescent stage
Begins when patient starts feeling better
2 to 6 weeks
Full recovery can take up to 1 year
 Hepatitis
Complications
Liver failure
Acute

chronic

Chronic infection
Carrier some become asymptomatic carriers and never
have an active disease, can infect others
Risk of liver cancer
Diagnostic tests (table 35.2, page 782)
Liver enzymes
Serum bilirubin
Prothrombin
Liver biopsy
 Hepatitis
Therapeutic interventions
Identify cause
Monitor liver status
Symptom relief
Rest
Avoidance of alcohol and liver toxic drugs
Nursing diagnoses
Pain
Imbalanced nutrition
Risk for ineffective self-health maintenance
Knowledge deficient
 Acute Liver Failure (ALF)

Rare, but serious condition that can develop

rapidly, sometimes in as little as 2 days.
Sudden massive loss of liver tissue
Etiology
Drug toxicity
hepatitis
 Acute Liver Failure

Signs and symptoms

Fatigue, GI upset, diarrheainitially
Jaundice
Hepatic encephalopathy
Confusion
coma

Bleeding
Abdominal distention
Liver shows rapid reduction in size on xray (in
matter of hours)
 Acute Liver Failure
Diagnostic tests (table 35.2, page 782)
ALT
AST
Serum bilirubin
PT
Potassium-decrease
Glucose- decrease
 Acute Liver Failure
Therapeutic Interventions
Aimed at stopping and reversing the damage
Bedrest
Eliminate all drugs
Possible dialysis (if from overdose of a toxic
substance)
High calorie, low sodium, low protein
Lactulose, neomycin, magnesium citrate,
sorbitolmay be given to decrease ammonia
level
transplant
 Cirrhosis
Progressive, irreversible replacement of
healthy liver tissue with scar tissue
Chronic alcohol use most common cause
Pathophysiology
Inflammation of liver cells
Liver cells infiltrated with fat and WBC and
replaced by fibrotic tissue
Abnormal regeneration
Impaired liver blood flow
Impaired liver function
 Cirrhosis
Signs and Symptoms
 Cirrhosis
Complications
Clotting defects
Impaired PT and fibrinogen production
Portal hypertension
Varices (most serious result is bleeding esophageal
varices)
Ascites-accumulation of fluid in the abdominal cavity

Encephalopathy
Caused by elevated ammonia
Hepatorenal syndrome (omnious sign)
Secondary failure of the kidneys
 Cirrhosis
Therapeutic Interventions

Ascites
Diuretics
Sodium and fluid restriction
Paracentesis
Albumin infusion
TIPS (transjugular intrahepatic portosystemic shunt
Stent is placed to connect the portal vein to the hepatic vein

Esophageal varices
Stop bleeding immediately
Vasoconstrictors
Sandostatin IV

Banding

Sclerotherapy

Vit K
 Therapeutic Interventions
Encephalopathy
Lactulose
Neomycin
Intestinal antibiotic
Restrict dietary protein
dialysis
 Cirrhosis

Patient education
Disease process
Signs and symptoms to report
Adequate rest
Diet
Avoid narcotics, sedatives, tranquilizers, alcohol
Follow up care
 Liver Transplant
Candidates
Liver failure
No cancer
No complications
Otherwise stable
Anti rejection meds
Cyclosporin A
Protopic
Imuran
Prednisone
cellCept
 Liver Transplant
Signs of rejections
Usually will develop between 4th and 10th post
op day
Pulse greater than 100
Temp greater than 101
RUQ pain
Increase in jaundice
Decrease in bile from T-tube, or change in color
Facilitates drainage of bile, usually inserted into the
common bile duct
Elevated liver enzymes
 Liver Cancer
Usually metastasized from another site
Usually die within 6 months of diagnosis
Risk factors
Chronic hepatitis B and C
Nutritional deficiencies
Exposure to hepatotoxins
Heavy alcohol use
smoking
 Liver Cancer
Signs and symptoms
Encephalopathy
Bleeding
Jaundice
ascites
Diagnosis
Serum alkaline phosphatase (ALP)
Abdominal Xray
Liver scan
Ultrasound
Biopsy (definitive dx)
 Acute Pancreatitis
Pathophysiology
Inflammation of the pancreas appears to be caused
by autodigestion
Reasons unknown the pancreas will excrete enzymes
while still in pancreas and begin to digest the
pancreas
Large amounts of enzymes are released by
inflammed cells
Trypsin destroys pancreatic tissue and causes
vasodilation
Fluid loss to the retroperitoneal space, causing shock
Conversion of prothrombin to thrombin, clots form
 Acute Pancreatitis
Complications
Shock
DIC
Chronic pancreatitis
Etiology
Alcohol use
Biliary disease
Trauma
Certain drugs
Thiazide diuretics

Estrogen

Opioids

Steroids

Excessive calcium
 Acute Pancreatitis
Signs and symptoms
Abdominal pain
Guarding
Rigid abdomen
Hypotension or shock
Respiratory distress
Low grade fever
Nausea and vomiting
jaundice
 Acute Pancreatitis
Complications
Cardiovascular failure
Acute respiratory distress
Acute renal injury
Hemorrhage
Infection
Turners sign
Cullens sign
 Acute Pancreatitis
Diagnostic tests
Serum amylase
Elevated 5 to 40 times normal
X-ray
CT scan
ultrasound
 Chronic Pancreatitis
Pathophysiology
Progressive fibrosis
Obstructed ducts
Ulceration
Becomes smaller and hardened
Etiology
Major cause in men is excessive alcohol ingestion
In women- biliary disease that leads to persistent
inflammation of the pancreatic ducts
Prevention
Alcohol abstinence
Biliary disease treatment
Nutritional intake monitoring
 Chronic Pancreatitis
Signs and symptoms
Remissions and exacerbations
LUQ pain
Anorexia and weight loss
Malabsorption and fat intolerance
Diabetes mellitus late occuring
Diagnostic tests
Pancreatic enzymes are normal
High fecal fat level
Changes on CT scan or ultrasound
 Chronic Pancreatitis
Therapeutic interventions
Analgesics
Pancreatic enzyme replacement
surgery
 Cancer of the Pancreas
Ductal adenocarcinoma and occur in the
exocrine part of the pancreas
Cause unknown
Risk factors
Chemical carcinogens
High fat diets
Smoking
Diabetes mellitus
Alcohol
Chronic pancreatitis
 Cancer of the Pancreas
Signs and symptoms
Vague symptoms early
Weight loss and anorexia
Pain
Nausea and vomiting
Weakness
Abdominal pain, worse at night
Jaundice if obstruction of bile duct
 Pancreatic Cancer
Diagnostic tests
Pancreatic enzymes elevated
Bilirubin
Coagulation studies
CEA
CT, ERCP
Biopsy
 Pancreatic Cancer
Therapeutic Interventions (depends on
staging)
Surgery
Whipple procedure
pancreatectomy

Stent to relieve biliary obstruction

Chemotherapy
radiation
 Pancreatic Cancer
Patient education
Management of hyperglycemia
Pancreatic enzyme replacement
Dressing/drain care
Complications to report
Hospice referral
 Acute Pancreatitis
Therapeutic measures
NPO- resting the pancreas is essential
Histamine antagonist
TPN
Analgesics
IV fluids
Possible surgery
 Gallbladder Disorders
Cholecystitis: inflammation, acute or chronic
Cholelithiasis: stones
Choledocholithiasis: stones in common bile duct
Etilogy
bile stasis
High cholesterol intake
Fasting
Sedentary lifestyle
Family history, female
Risk increases with age
 Gallbladder disorders
Signs and symptoms (table 35.6, page 803)
Increased VS
Vomiting
Jaundice
Epigastric pain
RUQ tenderness
Nausea
Indigestion
Positive Murphys sign
Inability to take a deep breath when the examiners fingers
are pressed below the liver margin
Biliary colic
 Gallbladder disorders
Complications
Cholangitis
Necrosis/perforation of gallbladder
Empyema
Fistulas
Adenocarcinoma
pancreatitis
 Gallbladder disorders
Diagnostic tests
Ultrasound
ERCP
HIDA scan
WBC
Bilirubin
Serum amylase
Therapeutic interventions
Analgesics
Bile acid sequestrants
Anti-emetics
diet
 Gallbladder disorders
Cholelithiasis treatment
Cholecystectomy
Laparoscopic
traditional

ESWL
Done less frequently, uses shock waves to destroy
stones
Medication to dissolve
May take months to years and stones can come back
 Gallbladder disorders

Patient education
High protein, low fat diet
Encourage obese patients to lose weight
Fat should be slowly reintroduced into the diet
Yea!! You are done with
the GI system.
Good luck with your
exam!