hepatobiliary

• Hepatitis A

  Most common type of hepatitis
• Spread of Hepatitis A

  Through the oral route from food, water, shellfish, unsanitary conditions, such as not washing hands, not having clean knives or clean workspace, through people that live close together in shelters or daycares
• Hepatitis B

  Spread by blood and body fluids and spread by contact with infected fluids with individuals and can also be passed from mother to baby, and with contaminated needles and instruments
• Everyone everywhere should get vaccinated for Hepatitis B
• Risk factors for Hepatitis B

  • Sexual contact with infected person
  • Having multiple partners and not practicing safe sex
  • Someone in kidney failure and undergoing hemodialysis
  • A patient that might need a blood transfusion
  • Occupational exposure (healthcare workers)
• Hepatitis B incubation period

  1. 4-10 weeks
• Diagnosis of Hepatitis B


  Increased ALT and AST levels
• Hepatitis C

  Spread by blood and body fluids, contaminated needles, and can also be contracted through tattoos and piercing shops
• Treatment for uncontrolled esophageal varices

  1. Use of a Sengstaken-Blakemore tube which will provide traction and compression in the esophagus and in the stomach to stop the hemorrhaging (aka. Balloon tamponade)

  2. Complications may be an occluded airway and lead to aspiration pneumonia
• Treatment for cirrhosis of the liver

  1. Avoiding protein overload

  2. Decreasing production of ammonia

  3. Correcting electrolyte imbalances
• Nursing actions for cirrhosis of the liver


  1. Use diuretics (remember K+ level is going to be low, ammonia level will be elevated, serum albumin is going to be low due to malnutrition, magnesium may be low, phosphate may be low)

  2. Restrict sodium and fluids
• Acute Pancreatitis

  • Increased BUN due to hypovolemia, patient will be dehydrated or may be some impaired kidney function
  • Increased AST and ALT
  • Increased Serum lipase (most specific test for pancreatitis)
  • Decreased Serum albumin due to malnutrition, inadequate intake
• Chronic Pancreatitis


  Most common cause is alcohol use
• Patient education for Chronic Pancreatitis

  1. Avoid alcohol

  2. If taking "PERT" (pancreatic enzyme replacement therapy) they need to take those capsules whole, cannot be chewed or crushed

  3. Limit fats and irritating foods and beverages such as caffeine and coffee

  4. May refer to support groups like AA
• Pancreatic Cancer

  • The stage and the location of the tumor will determine if a surgical intervention will be possible
  • If there is lymph node involvement then a surgical intervention is not an option
  • There may be time with this cancer when surgery may just be palliative
  • Surgical management may include a celiac nerve block that would help decrease abdominal pain
• Surgical management of Pancreatic Cancer

  1. Surgeon may place an NG tube that is NOT TO BE MANIPULATED

  2. If there is problem with the tube, surgeon needs to be called
• Nursing actions for Pancreatic Cancer

  1. IV fluids because patient may be dehydrated and hypovolemic

  2. Leave them NPO if they have gone to surgery until their GI function returns

  3. Because pancreas is not working you may have to administer insulin