hepatic and pancreatic disorders

• liver normal function: blood storage, detoxifies blood and metabolizes drugs, production of bile (for fat breakdown), synthesis of clotting factors, removal of clotting factors that preventing clotting, metabolism of carbs fats and proteins, storage of vitamins (A, D, E, K) and iron
• hep A is spread by food and water (fecal-oral route)
• Hep B, C, D, E is spread by blood contact
• clinical manifestations of hepatitis: abdominal pain, irritability, pruritus (itching everywhere), malaise, fever, nausea, vomiting, jaundice (d/t build up of bilirubin/bile), ELEVATED liver enzymes (ALT, AST, alkaline)
• medical treatment of hepatitis: oral antiviral agents, pegylated interferon injections, vaccinations for hepatitis A&B, and liver transplant
• complications of hepatitis: untreated can lead to cirrhosis (hardening and scarring of the liver) and death
• physical assessment of hepatitis: elevated temperature associated with inflammation, elevated LFTs, jaundice, fatigue, decreased appetite
• labs for hepatitis: AST (elevated), ALT (elevated), serum albumin (decreased), and serum bilirubin (elevated)
• interventions for hepatitis: vital signs, color of skin (and sclera), nutritional intake, daily weight (watching fluid status AND nutrition), I&Os, signs of organ rejection, provide small frequent meals, administer antiemetics (ONDANSETRON), promote balance between physical activity and rest, and encourage rest periods
• teaching for hepatitis: nutritional teaching (will have issues for rest of life), good hand hygiene, avoid behaviors that contribute to the transmission (IV drug use, sharing needles, safe sex practices), importance of vaccinations, and safe public water supply
• can you take the hep B vaccination once you have hep B?

  NO
• can you take the vaccination once you have hep A and be cured?

  yes
• gallbladder: stores bile produced by the liver
• cholecystitis: inflammation of the gallbladder
• cholelithiasis: gallstones
• cholecystectomy: removal of the gallbladder
• risk factors for cholecystitis: obesity, rapid weight loss, weight loss surgery, high fat diet, genetics, medications
• clinical manifestations of cholecystitis: RUQ pain (and middle of back), rebound tenderness or guarding (Murphys sign), fever, tachycardia
• medical treatment of cholecystitis: NPO status (rest the gut), IV hydration, correct fluid and electrolyte imbalance, pain management (Morphine can make the pain worse but is still given with caution), IV antibiotics, and laparoscopic surgery
• complications of cholecystitis: pancreatitis and rupture (peritonitis ***)
• physical assessment of cholecystitis: pain, vital signs (looking for bleeding or shock), and abdominal
• labs for cholecystitis: elevated liver enzymes (ALT, AST, alkaline), bilirubin (elevated), and WBC (elevated)
• interventions for cholecystitis/cholecystectomy: vital signs, skin turgor, pain, stool (COCA), daily weight, I&Os, administer medications as ordered, promote bedrest in semi-fowlers position (relieves the gallbladder), and NG tube to low suction
• what makes stool brown?

  bilirubin/bile
• teaching for cholecystitis/cholecystectomy: post op instructions, T tube management, avoid diet high in fats, and disease clinical manifestations (nausea, vomiting, pain in back)
• what does the T tube do?

  tube to the common bile duct to drain bile until healing happens
• pancreas: endocrine (insulin and glucagon hormones) and exocrine (secretes into the small intestines)
• pancreas secretes amylase, lipase, and tryptase (enzymes) to break down protein, carbs, and fats
• acute pancreatitis risk factors: alcohol consumption accounts for 1/3 of cases, cholelithiasis, drug use (legal and illegal), or unknown
• chronic pancreatitis risk factors: prolonged alcohol use; typically diagnosed age 30-40
• clinical manifestations of pancreatitis: SEVERE LUQ epigastric pain, deep and sharp pain, more intense when eating fatty foods, abdominal fullness, gas and bloating (hiccups, indigestion), fever, tachycardia, hypotension (d/t enzymes start self digesting pancreas causing necrotizing pancreatitis)
• medical treatment of pancreatitis: NPO status (must rest pancreas; not even ice), IV fluids, ICU level of care if other organs involved, treat cause of pancreatitis (antibiotics, NPO with lots of fluids)
• complications of pancreatitis: necrotizing pancreatitis
• physical assessment of pancreatitis: SUDDEN onset of acute unbearable abdominal pain, elevated HR and RR and low BP, severe abdominal pain, steatorrhea (clay colored stools), hypovolemia (fluid leaving bloodstream to go to inflammation site), hypoxia, pleural effusion, MODs
• labs for pancreatitis: elevated serum lipase, amylase, and glucose values, hypocalcemia
• interventions for pancreatitis: vital signs (looking for infection/shock), oxygen status (pancreas sits right below diaphragm), pain location intensity and duration, abdominal assessment, grey turners and/or cullens signs, monitor serum lipase and amylase, calcium supplements, maintain NPO status, NGT to low suction, promote bedrest in semi-fowlers position or fetal position, encourage coughing and deep breathing
• grey turners sign?

  looks like bruising on the sides; you have to TURN your patient to see it
• cullens sign?

  bruising around umbilical site; C for C around umbilici
• teaching for pancreatitis: appropriate diet and intake of small frequent meals and vitamin supplements (FAT soluble vitamins), abstain from alcohol, abstain from smoking
• what are the fat soluble vitamins?

  A, D, E, K