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Acute Pancreatitis
Etiology of Pancreatitis
Incidence
Nursing Care
• Abdominal pain; mid or ULQ area; radiates to back, left flank or left shoulder
and aggravated by alcohol, fatty meal, lying in recumbent position; relieved
with fetal position or sitting upright and bending forward
• Weight loss, N&V, jaundice, gray-blue discoloration of abdomen (Cullen’s
sign) and the flanks (Turner’s sign)
• Bowel sounds absent or decreased (paralytic ileus), abdominal tenderness,
rigidity, and guarding (peritonitis); palpable mass
• Elevated temp, tachycardia, decreased BP, decreased or abnormal breath
sounds, dyspnea or orthopnea
• Changes in behavior and sensorium
Diagnostic Assessment
Planning/Expected Outcomes
Non-Surgical Management
Drug Therapy
• Meperidine
• Nitroglycerine
• Antispasmodics
• Carbonic anhydrase inhibitor
• Antacids
• Histamine H2-receptor antagonists
• Calcium gluconate
• Adrenocortical steroids
• Aprotinin
• Glucagon
• Somatostatin
• Albumin (if shock present)
• Chronic Pancreatitis - Pancreatin and Insulin used
Comfort Measures
• Fetal position
• Oral hygiene -NG tube
• Lower anxiety level - explain procedures, diversional activities, encourage
visitors, encourage expression of emotions
Surgical Management
Postoperative Care-Interventions
Continuing Care
Evaluation
Chronic Pancreatitis
Nursing Care/Interventions
BILIARY DISORDERS
Chronic Cholecystitis
Cause of Cholecystitis
INCIDENCE
• Dyspepsia
• Eructation
• Flatulence
• Feeling of abdominal fullness
• Pruritis (itching) or burning sensation of skin
• Rebound tenderness (Blumberg’s sign)
• Fever
• Jaundice, clay-colored stools, dark urine, steatorrhea (most common with
chronic cholecystitis)
Diagnostic Assessment
Interventions
Surgical Management
• Clamp T-tube for 1-2 hours before and after meals as ordered; assess for
tolerance of food
• Observe stools for return of brown color 7-10 days post-op
Laparoscopic Cholecystectomy
CHOLELITHIASIS
Composition of Gallstones
Types of Gallstones
• Cholesterol Stones
• Result of metabolic imbalances of cholesterol and bile salts
• Most common type in U.S.
• Pigment Stones
• Result of metabolic imbalances of unconjugated bilirubin
• Small, brown or black
• Black stones composed of calcium bilirubinate; most common
Etiology
Incidence of Cholelithiasis
Diagnosis
Nonsurgical Interventions
Surgical Intervention
HEPATIC DISORDERS
Jaundice
Types of Jaundice
HEPATITIS
• Primarily viral in origin but can be caused by bacteria, drugs, and chemicals
(toxic)
• Viral Hepatitis - A,B,C,D,E; cytomegalovirus, Epstein-Barr herpes,
coxsackievirus, and rubella
• Many cases asymptomatic - undiagnosed
HEPATITIS A
HEPATITIS C
HEPATITIS D
HEPATITIS E
• Fecal-oral transmission
• Mostly in underdeveloped countries with poor sanitation
• Incubation 15-64 days
• Based on diagnosis of exclusion - no serologic tests
Phases of Hepatitis
• Icteric Phase: 2-4 weeks, jaundice, pruritis, dark urine, bilirubinuria, light
stools, fatigue, liver enlargement, tenderness, and weight loss
Complications
Nursing Diagnoses/Analysis
• Altered nutrition
• Activity intolerance
• Anxiety
• Pain
• Body image disturbance
• Fatigue
• Knowledge deficit
Management
• Usually at home
• Rest
• Adequate diet, high protein and carbohydrate, vitamins
• Avoid alcohol and drugs (detoxified in liver), fatty foods
• Vaccine, gamma globulin, interferon
Nursing Care/Interventions
• UNIVERSAL PRECAUTIONS!
• Comfort measures
• Small frequent feedings; adequate fluid intake;, oral hygiene
• Antiemetics (Tigan, Dramamine)
• Monitor activities; weak, build strength
• Promote return of normal liver function
CIRRHOSIS
TYPES OF CIRRHOSIS
• Alcoholic (Laennec’s) -early changes reversible, fat accumulation; later scar
tissue forms and irreversible; alcohol or malnutrition cause
• Postnecrotic - complication of viral, toxic, idiopathic; scar tissue
• Cardiac - chronic right sided heart failure with cor pulmonale, constrictive
pericarditis, and tricuspid insufficiency
• Biliary - chronic biliary obstruction and infection; scar tissue
Early Manifestations
Late Manifestations
Complications of Cirrhosis
• Portal hypertension
• Ascites
• Bleeding esophageal varices
• Coagulation defects
• Jaundice
• Portal-systemic encephalopathy (PSE) with hepatic coma
• Hepatorenal syndrome
• KNOW WHAT CAUSES EACH ONE!
Diagnosis
• Serum enzymes
• Bilirubin
• Serum Proteins
• Serum Ammonia
• Prothrombin time
• ALL ELEVATED!
• Serum protein & albumin decreased in chronic/severe liver disease
• Abdominal x-ray
• Upper GI series
• CT of abdomen
• Esophagogastroduode-noscopy(EGD)
• Injection sclerotherapy