1
Q
What is the glisson capsule?
A
capsule around the liver that contains nerves
2
Q
Does the liver or the glisson capsule cause pain when there is injury?
A
glisson capsule
3
Q
What is the ligamentum teres
A
separates right and left lobes of liver
4
Q
Blood flow through liver
A
- blood flows from hepatic artery and hepatic portal vein (from digestive tract/pancreas/spleen)
- blood flows through liver
- leaves the liver through hepatic veins
- blood then is flowed into inferior vena cava
5
Q
purpose of spleen
A
breakdown of RBCs
6
Q
Functional units of liver:
Lobules
(what do they contain and what does it do)
A
- central vein of lobule
- empties into hepatic veins then into inferior vena cava
7
Q
functional units of liver:
Hepatocytes
A
produces bile & must have blood flow by them to actually do their job
8
Q
Are lobules inside hepatocytes or are hepatocytes inside lobules?
A
hepatocytes are inside lobules
9
Q
what are sinusoids lined with?
A
kupffer cells
10
Q
what are kupffer cells?
A
type of macrophage in liver that removes old/defective blood cells & gets rid of bacteria/toxins
11
Q
Flow of duct system in liver:
A
- R and L hepatic ducts
- common hepatic duct
- combines with cystic duct from gallbladder to form common bile duct
- common bile duct and pancreatic duct combine and enters descending duodenum (ampulla of vater)
- sphincter of oddi regulates bile flow into duodenum
12
Q
Secretory functions of the liver
A
bile production and excretion
bilirubin conjugation
13
Q
Storage functions of the liver
A
glucose/glycogen
vitamins A, D, E, K, B1, B2, cobalamin, folic acid
fatty
minerals - iron, copper
amino acids - albumin, beta globulins
14
Q
vascular functions of the liver
A
- mononuclear phagocyte system
- kupffer cells
- breakdown of HGB to bilirubin
- blood reservoir/storage
15
Q
what does unconjugated bilirubin bind to?
A
albumin
16
Q
is albumin water soluble?
A
yes
17
Q
metabolic functions of the liver
A
- blood clotting
- carb metabolism
- detoxification
- fat metabolism
- protein metabolism
- bile production
18
Q
What does the liver synthesize? (proteins)
A
- non-essential amino acids
- plasma proteins
- clotting factors
- converts ammonia to urea
19
Q
what is bile production essential for?
A
fat emulsification and digestion
20
Q
what does bile contain?
A
water
cholesterol
bile salts
electrolytes
fatty acids
bilirubin
21
Q
3 functions of bilirubin metabolism
A
1 - fat digestion
2 - absorb fats, fat soluble vitamins, minerals
3 - excrete bile pigments, cholesterol, metals, bacteria
22
Q
flow of bilirubin
A
RBC –> Hgb –> unconjugated bili –> insoluble so it attaches to albumin –> then the unconjugated bilirubin combines with glucuronic acid to become conjugated bilirubin (soluble)
23
Q
PMH s&s r/t possible hepatic problems
A
abd pain
n/v/d
jaundice
hematemesis
melena
reflux
indigestion
24
Q
diagnostic tests for the liver
A
abd US
endoscopic US (down throat)
CT/MRI
hepatobiliary scintigraphy
liver biopsy
percutaneous transhepatic cholangiography (PTC)
endoscopic retrograde cholangiopancreatography (ERCP)
25
what to monitor for when a pt gets a liver biopsy
BLEEDING
26
gerontologic considerations - liver
decr size
lower position
decr protein synthesis, regenerate
decr ability to metabolize drugs and hormones
more susceptible to drug-induced liver disease
27
Factors that affect the liver
alcohol
drugs
chemicals
autoimmune
stones in bile duct
heart/vessel disorders
DM
malnutrition
congenital
viruses
hereditary
28
what is considered moderate alcohol consumption for a man v woman?
1 drink/day - women
2 drinks/day - men
29
what is considered binge drinking for men v women?
men - 5+ drinks one day at least once a month
women - 4+ drinks
30
combination of alcohol use with ________ can increase the risk of liver damage
acetaminophen
31
What are some viral causes of inflammation of the liver?
Hep A/B/C/D/E
cytomegalovirus (CMV)
Epstein-Barr (EBV)
Herpesvirus
Coxsackievirus
rubella
32
How could someone get Hepatitis A?
fecal/oral route
eating raw shellfish
33
S/S of Hep A
flu-like symptoms
potentially jaundice
self-limiting
acute liver failure (severe)
34
When is someone infectious after getting Hep A?
1-2 weeks after start of symptoms
35
can a person who has had hep A get reinfected?
no
36
How could someone get hepatitis B?
blood-borne
secretions
37
S/S of hep B
acute or chronic hepatitis
inflammation
scarring
liver cancer
38
Who is most at risk for hep B?
healthcare workers, sex workers, drug users, etc
39
How is Hep C transmitted?
blood or secretions
40
S/s of hep c
acute or chronic infection
co infections common
41
how long between infection and clinical s/s occurring of hep b
1-2 weeks in between
42
What actions put someone at an increased risk of getting hep c?
high risk sexual behaviors or IV drug use
43
what is the most common cause of chronic liver disease and liver failure
hep c
44
Which Hepatitis co-exists with hep B?
hep D
45
How does someone get hep D?
if they have been exposed to or have had hep B
46
Does a vaccine for hep B prevent hep D?
yes
47
is hep D common or uncommon in US?
uncommon
48
How could someone get hep E
recal-oral route
contaminated drinking water
- developing countries
49
What happens during an acute hepatitis infection?
virus attacks hepatocytes and destroys them
- can cause liver failure if hepatocytes dont regenerate
50
what happens during a chronic hepatitis infection?
persistant and continual destruction of hepatocytes
51
what is developed from chronic hepatitis?
scar tissue and fibrosis:
- cirrhosis
- liver failure
- irreversible
52
S/S of hepatitis
anorexia
lethargy
malaise
nausea
vomiting
lack of appetite
low fever
abd tenderness
hepatomegaly
jaundiced
rashes
dark urine
pruritus
53
diagnostic labs for acute hepatitis
Increased:
- alk phos
- AST/ALT
- GGT
- serum total bilirubin
- urinary bilrubin
- urinary urobilirubin
prolonged PT
54
serum draws for hepatitis
viral loads
antibodies
55
acute hep tx
nutrition
rest
avoid alc
56
chronic hep tx
antiemetics
antihistamines
Hep B and C have some drug therapies
57
preventative measures for hep a
hand washing
personal hygeine
environmental sanitation
food handling properly
active immunizations
infection control precautions
58
preventative measures for hep b & c
screening donated blood
use of disposable needles & syringes
HBV vaccination
condoms
handwashing
avoid sharing toothbrushes/razors
reduce contact with blood
universal precautions
needle disposal
59
What is cirrhosis?
End stage liver disease characterized by:
- extensive degeneration and destruction of liver cells
- replacement of liver tissue with fibrous, scar tissue and nodules
60
What causes cirrhosis?
any chronic liver disease
nonalcoholic fatty liver disease
nonalcoholic steatohepatitis
excessive alcohol intake
hepatitis C
cardiac cirrhosis
wilsons disease
autoimmune hepatitis
61
what is nonalcoholic steatohepatitis
fatty accumulation w/inflammation
prevalent w metabolic disease and obesity
62
what is cardiac cirrhosis
results from long standing, severe, right sided HF
- ends w non functioning liver tissue
63
What do the fibrotic tissue and nodules from cirrhosis block?
the flow of vasculature in the liver
64
what happens when the flow of vessels in the liver are blocked?
predisposed to portal hypertension
obstruction of biliary channels
bile stasis
continued loss of liver cells
liver failure
65
what does cirrhosis impair?
gluconeogenesis
detoxification of drugs and alcohol
bilirubin metabolism
GI function
steroid & hormone metabolism
66
early s/s of cirrhosis
fatigue
enlarged liver
67
late s/s of cirrhosis
jaundice
skin lesions
hematologic problems
endocrine problems
peripheral neuropathy
GI symptoms
68
what is jaundice
decreased ability to conjugate and excrete bilirubin
69
what hematologic problems occur from cirrhosis
bleeding
decreased vit k absorption
anemia/thrombocytopenia/leukopenia
70
what endocrine problems are caused by cirrhosis?
gynecomastia (men)
amenorrhea (women)
hyperaldosteronism - Na and water retention, K loss
71
Types of jaundice
hemolytic (pre-hepatic)
Hepatocellular (hepatic)
Obstructive (post-hepatic)
72
hemolytic jaundice cause
caused by increased breakdown of RBC
73
hepatocellular jaundice cause
liver cant take up bilirubin from blood to conjugate or excrete it
74
obstructive jaundice cause
decreased or obstructed blood flow of bile through liver
75
dx of cirrhosis
LIVER BIOPSY ****
labs
ultrasound
ultrasound elastography (fibroscan)
76
complications of cirrhosis
portal hypertension - esophageal or gastric varices
peripheral edema & ascites
hepatic encephalopathy
hepatorenal syndrome
77
what is portal hypertension
obstruction of blood flow through liver
78
what does portal hypertension cause
- increased pressure within livers circulatory system and collateral circulation/channels
- varicosities
79
where all do varicosities happen
lower esophagus, anterior abdominal wall, parietal peritoneum, and rectum
80
Manifestations of esophageal varies (EV)
distended, dilated, fragile
ruptures easily
coughing/projectile vomiting blood
coffee ground emesis
melena
81
treatment of esophageal varices
prevent bleeding and ruptures
beta-blockers (propranolol, nadolol)
82
what to do if patient is actively bleeding from an esophageal varices
MANAGE AIRWAY AND STABILIZE
IV access
stop bleeding at source
blood products
medications (octreotide, vasopressin, vit K, PPI)
83
invasive treatments of EVs
balloon tamponade
banding/ligation
TIPS procedure
84
how should a nurse care for a balloon tamponade for a pt with EV
explain procedure
position must be verified w XRay
secure tubes
deflate balloon for 5 min (q8-12 hr)
label lumens
saline lavage/NG suction to remove blood
monitor for aspiration pneumonia
scissors at bedside
semi fowlers
oral/nasal care
85
What is a TIPS procedure
shunt created between systemic and portal venous systems to redirect some flow from liver directly into hepatic vein and back into inf vena cava
86
what is the pt at increased risk for after TIPS procedure?
hepatic encephalopathy
87
what is ascites
accumulation of serous fluid in the peritoneal or abdominal cavity
88
how does ascited occur from cirrhosis? (4 ways)
1 - proteins shift from vessels into lymph space because of portal hypertension
2 - hypoalbuminemia (can't synthesize proteins to keep fluid in vessels)
3 - hyperaldosteronism (incr Na)
4 - impaired water excretion (increased ADH)
89
Treatment for ascites
sodium restriction
diuretics
albumin infusion
fluid removal/paracentesis
90
why wouldn't diuretics work for a pt with ascites?
wouldnt work if fluid is in third spacing and not kidneys
91
what is hepatic encephalopathy
high ammonia levels from it not being converted into urea, causing neuro changes from ammonia crosses blood-brain barrier (toxicity)
92
s/s of hepatic encephalopathy
asterixis (flapping tremors)
apraxia (cant construct figures)
hyperventilation
hypothermia
fetor hepaticus
93
meds for hepatic encephalopathy
lactulose (traps ammonia in gut)
rifaximin - antibx
neomycin sulfate
94
nursing care for hepatic encephalopathy
maintain safe environment
frequent assessments
neuro assessments
f&e
reflexes
avoid constipation
watch for GI bleeding
95
what is hepatorenal syndrome?
Type of renal failure due to a decrease in arterial blood volume from terminal liver failure
- from portal HTN and ascites
96
Complications due to hepatorenal syndrome
- progressive azotemia (incr in nitrogen waste products)
- increased serum creatinine levels
- oliguria
97
How could hepatorenal syndrome potentially be reversed?
with liver transplant
98
Would dialysis help hepatorenal syndrome? why?
No because it is due to liver failure, and dialysis wont help liver failure
99
How does a superimposed liver failure contribute to hepatic encephalopathy and coma from hepatorenal syndrome?
inability to clear both hepatic and renal waste leads to buildup of neurotoxins (especially ammonia) directly causes hepatic encephalopathy, which can progress to coma
100
indications for a liver transplant include...
chronic viral hep
congential abnormalities
acute liver failure
end-stage liver disease
101
contraindications for liver transplant
hepatocellular cancer
ongoing drug and alcohol use
102
Why can someone receive a portion of a liver for transplantation?
The liver can regenerate
103
How are cadaver liver transplants given to patients?
The liver can be split into two parts and given to two different patients
104
post op complications for liver transplants
bleeding
infection
rejection
105
Nursing care plan for cirrhosis
oral hygiene
nutrition
assessments - skin, outputs, wt, edema, etc
dyspnea
labs
bleeding monitoring
hypokalemia
NO ALCOHOL
106
why should a nurse watch for hypokalemia in patients with liver cirrhosis?
they have more aldosterone buildup trying to get rid of potassium
107
S/S of hypokalemia
cardiac dysrhythmias
hypotension
tachycardia
muscle weakness
108
What is fulminant liver failure?
Acute
severe impairment of the liver from sudden insult
109
most common causes of fulminant liver failure
chemicals
drugs
alcohol
hep b
110
What labs should a nurse monitor for fulminant liver failure?
ammonia
liver enzymes
CMP
CBC
PT
bilirubin
111
Tx for fulminant liver failure
liver transplant*
nutrition
rest
vitamin K/FFP
albumin
acetylcysteine
112
What is acetylcysteine used for?
Reverse effects of acetaminophen toxicity and prevent further liver damage
113
What is the most common cause of hepatocellular cancer?
Hep C
114
symptoms of liver cancer
upper gastric pain
n/v
anorexia
* s/s arent always a direct indicator of cancer because of how common these symptoms are
115
Dx for liver cancer
PERCUTANEOUS BIOPSY
ultrasound
CT/MRI
116
tx for liver cancer
prevent hepatitis
surgical excision
radiofrequency ablation
embolization
systemic chemo
117
nursing focus for patients with liver cancer
keep comfortable
118
What do hospice nurses focus on?
coordination of hospice team
pain control
symptom management
spiritual assessment
family assessment and needs
119
Overall nursing assessment of the liver
Abdominal girth/distention
- measure at same spot everytime
n/v
mentation
RUQ pain
abnormal labs
nutritional assessment
skin color/integrity
120
Manifestations of impaired liver function
jaundice
hematologic problems
inability to maintain intravascular volume
hepatic encephalopathy
hepatorenal syndrome
121
WBC range
5,000-10,000
122
direct bilirubin range
0.1-0.3
123
indirect bilirubin range
0.2-0.3
124
total bilirubin range
0.3-1
125
Alk phosphate range
30-120
126
AST range
0-35
127
ALT range
4-36
128
GGT for men and women > 45y
8-38
129
GGT for women <45y
5-27
130
What vitamins are fat soluble?
A D E K
131
what are the two bile acids
ursodeoxycholic acid
chenodeoxycholic acid
132
What is cholelithiasis?
gallstones
133
What is cholecystitis?
inflammation of biliary system (usually d/t stones)
134
risk factors for gallbladder diseases?
sedentary lifestyle
familial tendencies
obesity
culture
hormones
135
Causes of gallstones
stasis of bile
abnormalities
136
what is choledocholithiasis?
stones stuck in the duct
137
Where might stones migrate to?
cystic or common bile duct
138
s/s of gallstone obstruction
cholecystitis
jaundice (post hepatic)
clay-colored stool
dark amber urine
n/v
steatorrhea
abdominal guarding
pruritis
139
why might a patient have clay colored stools with gallstones?
bile creates the brown color of poop, so when the stool is clay colored, that means bile is not being produced/moved into GI
140
sign of movement of gallstones
biliary colic (pain in RUQ)
141
what is pruritis
itching from bile buildup
142
what are the main causes of cholecystitis?
stones or biliary sludge
143
Risk factors for acalculous cholecystitis
prolonged immobility, fasting, TPN
DM
bile stasis
adhesions
neoplasms - tumors
anesthesia
opioids
144
What happens when a gallbladder perforates?
Bile leaks into peritoneal cavity
145
manifestations of cholecystitis
edematous gallbladder
hyperemic (too much blood)
distended
occlusion of cystic duct
possible decrease in function
146
Why would someone be intolerant to dietary fats with cholecystitis?
Their gallbladder is struggling to break down fats into fatty acids to be used during digestion, causing digestive issues and heartburn
147
Characteristics of pain from cholecystisis or gallstones
acute pain and RUQ tenderness
3-6 hrs after fatty meal
intolerant to fatty foods
indigestion
fever, diaphoresis
148
What complications can gallstones cause?
cholecystitis
gangrenous cholecystitis
subphrenic abscess
pancreatitis
cholangitis
biliary cirrhosis
fistulas
rupture of gallbladder
choledocholithiasis (stone in duct)
149
Diagnostics for cholecystitis & cholelithiasis
H&P
US
CT
ERCP
HIDA scan
liver labs
WBC
150
Post-ERCP care
VS
s/s of pancreatitis
best rest for several hours
NPO until gag returns
151
medications for cholecystitis & cholelithiasis
IV fluid
antiemetics
analgesics
fat soluble vitamins (ADEK)
anticholenergic/antispasmotics
antibiotics (secondary infection)
152
Other tx (non-med) for cholecystitis & cholelithiasis
NG
ERCP
lithotripsy
transhepatic biliary catheter
surgery (laproscopic or incisional)
153
What is a lapraroscopic cholecystectomy
removal of gallbladder using only 4-5 small punctures
- abdomen is inflated with CO2
- dissect with laser then remove with forceps
154
What might a patient experience after a lapraroscopic cholecystectomy that is due to air in the abdomen?
right shoulder referred pain
155
contraindications of a lapraroscopic cholecystectomy
peritonitis
bleeding disorder
perforated gallbladder
156
post op care for lapraroscopic cholecystectomy
manage pain and nausea
bleeding
turn/cough/deep breathe
movement
SIMS POSITION
diet -- no/low fat
157
what is sims position and why may a pt need to lay in it?
- lay on side with one leg up
- after lap chole procedure to help with shoulder pain
158
post op care for open cholecystectomy
more pain - management
RUQ incision - infection
focus on ventilation & pneumonia prevention
T-tube care
decreased activity for 4-6 weeks
general post op care
159
general post-op nursing care
pain
VS
s/s shock
labs
patency of tubes
abdomen assessment
diet
n/v
I&O
IV lines
voiding and foley care
160
How should someone cough after they've had an open procedure?
place pillow over incision site and splint it while coughing
161
What is a T-tube
used to keep common bile duct open after surgery and to treat an obstruction
162
Can a patient be discharged with t-tube and drainage in place?
yes, but it is temporary
163
Nutritional therapy for pt after cholecystectomy
smaller, more freq meals
eat some fat
avoid rapid weight loss
164
What is gallbladder cancer related to?
chronic cholecystitis and cholelithiasis
165
diagnostics of gallbladder cancer
abdominal ultrasound
endoscopic ultrasound
CT/MRI
MRCP
166
nursing implications of biliary cancer
care may be palliative (supportive)
nutrition
hydration
oral/skin care
pain control
surgically treated
radiation and chemo may not be effective
167
conservative therapy for biliary tract problems
treat pain
manage n/v
comfort
F&E
nutrition
assessments
NG prn
SE of meds
168
when would a T tube be removed
once the drainage slows down
169
Where should the T-tube drainage bag be placed?
lower than site of incision
170
What could happen if bile is leaked onto the skin?
redness and irritation
171
where does gallbladder cancer usually metastasize to?
the liver
172
Where does the pancreas sit
behind the stomach, LUQ, and kind of wraps around to side of the body
173
What is the pancreas innervated by?
parasympathetic nerves - rest and digest
174
Pancreas: amylase function
digest starch and sugar
175
pancreas: lipase function
digests fats
176
pancreas: trypsinogen & chymotrypsin function
digests proteins
177
pancreas: bicarbonate function
neutralizes contents of duodenum
178
Are enzymes in the pancreas active or inactive until they leave the pancreas?
inactive
179
Factors that affect the pancreas
biliary tract diseases (gallstones)
chronic alc intake
drug interactions
pancreatic cancer
hypertriglyceridemia
smoking/trauma/surgeries
viruses
180
Does the pancreas get smaller as you get older?
no
181
What all changes in pancreatic function as someone gets older?
increased fibrosis
deposits of fatty acids
some atrophy
lipase production decr
182
what is pancreatitis & how severe can it get
acute inflammation of pancreas -- mild edema to severe hemorrhagic necrosis
183
How does pancreatitis occur?
premature activation of pancreatic enzymes & causes injury to the cells
184
what is autodigestion?
injury to pancreatic cells d/t premature activation
185
what percent of patients with pancreatitis are because of alcohol abuse?
70-80%
186
Trypsin actions
- initiates pancreatic digestion
- activates other enzymes
- can activate prothrombin and plasminogen
187
symptoms of premature trypsin activation
edema, necrosis, hemorrhage, intravascular thrombi, pulmonary emboli, DIC
188
Elastase actions
- dissolves elastic fibers of blood vessels within the pancreas
189
symptom of premature elastase activation
hemorrhage
190
Activated kinins (kallikrein) actions
systemic vasodilation and increased vascular permeability
191
symptoms of activated kinins (kallikrein)
edema, shock, low BP
192
phospholipase A & lipase actions & symptoms (they're the same)
necrosis of pancreas and surrounding fatty tissue
193
clinical manifestations of pancreatitis
pain
n/v/bloating
fever
hypotention
jaundice
tachycardia
abdominal distention & guarding
decr bowel sounds
lung crackles
steatorrhea
194
two signs to check for pancreatitis
cullens sign
grey-turners sign
195
why might a pt with pancreatitis have crackles in their lungs?
they have increased vascular permeability, leading to more fluid buildup
196
What is Grey-Turners sign?
ecchymotic spots on FLANK (sides) without being due to injury
- from intravascular damage
197
what enzyme causes grey-turners sign
trypsin
198
what is cullens sign?
discoloration or appearance of bruising around UMBILICUS without being due to injury
199
Labs for pancreatitis
amylase (reg and urinary) & lipase
blood glucose
serum calcium
serum triglycerides
liver enzymes
WBCs
200
Why may a pt have increased amounts of fat in stool?
indicates pancreatic insufficiency caused by decreased lipase secretion when biliary function is normal
201
diagnostics for pancreatitis
abd US, Xray, CT w contrast
ERCP
EUS
MRCP
angiography
chest xray
202
complications of acute pancreatitis
pseudocyst
pancreatic abscess
systemic complications
203
What is a pseudocyst?
accumulation of fluid and pancreatic enzymes
204
s/s of pseusocyst
abd pain/mass
n/v
anorexia
205
what is a pancreatic abscess
an infected pseudocyst
- collection of pus & extensive necrosis in pancreas
206
s/s of pancreatic abscess
pain & mass
high fever
leukocytosis
207
treatment for pseudocyst and pancreatic abscess
sometimes spontaneous resolution
surgical drainage
perc catheter
prompt surgery to prevent sepsis
208
If a pseudocyst ruptures/perforates, what can it cause
peritonitis
209
Systemic complications of pancreatitis
pleural effusion, atelactasis, pneumonia
hypotension, hypovolemia, shock, myocardial insufficiency
hypocalcemia
thrombi and emboli
abdominal compartment syndrome
210
what is compartment syndrome?
inter-abdominal hypertension and edema
211
what is a sign of severe pancreatitis that causes tetany?
hypocalcemia
212
Positive Trousseau's sign is...
When a patients hand makes a claw when the blood pressure cuff is inflating
213
A positive Chvostek's sign is...
When a patients lip starts twitching everytime the nurse taps their cheek
214
serum total calcium - normal value
9 - 10.5
215
ionized calcium - normal value
4.5 - 5.6
216
Nursing goals for a patient with acute pancreatitis
relieve pain
prevention of shock
reduction in pancreatic secretions
correct F&E balance
prevent infections/ or tx
removal of cause (ex gallstones)
217
Conservative treatment for Pancreatitis
supportive care:
- hydration
- pain
- manage metabolic complications
- minimize pancreatic stim
- O2
- infection prevention and sepsis
- accuchecks
218
Why may a patient with pancreatitis need an NG suction?
to prevent vomiting and remove gastric secretions
219
surgical therapy for pancreatitis (if d/t gallstones & if not d/t gallstones)
if gallstones:
- ERCP & endoscopic spincterotomy
- lap chole
if not d/t gallstones:
- drain fluid collections r/t necrosis
220
Drug therapy for pancreatitis
morphine - pain
antispasmotics
carbonic anhydrase inhibitor
antacids
PPIs
insulin
pancreatic enzyme products
221
What is the name of a antispasmotic medication used for pancreatitis? And why may someone need this?
dicyclomine
Used to decrease volume and concentration of pancreatic secretion
222
what is the name of a carbonic anhydrase inhibitor used for pancreatitis? And why may a patient need this medication?
acetazolamide
decreases volume and BICARBONATE concentration of pancreatic secretions
223
What do PPIs (omeprazole) do for patients with pancreatitis?
decreases HCL acid secretion (HCL stimulates pancreatic activity) - so this slows pancreatic activity
224
Nutritional therapy for a patient who has pancreatitis
NPO
entero-jejunal feedings
parenteral nutrition
small/freq meals
no alc
fat-soluble vitamins
225
why may a patient need entero-jejunal feedings with pancreatitis?
if they are intolerant to oral feedings, this method results in no stimulation of pancreatic enzymes because it bypasses the pancreas and goes straight into jejunum (bypassing the duodenum)
226
acute nursing interventions for pancreatitis
VS
response to IV fluids
F&E
lungs
s/s hypocalcemia
positioning
oral care
s/s of paralytic ileus, renal failure, AMS, BS
post-surg skincare
227
Ambulatory and home care for patients with pancreatitis
rest
PT
avoid smoking and alc
watch for complications
med adhesion
diet
228
what is chronic pancreatitis
continuous, prolonged, inflammatory and fibrous process of the pancreas
229
most common causes of chronic pancreatitis are ...
chronic alcohol abuse
inflammation d/t gallstones
230
Other (not so common causes) of chronic pancreatitis
tumors
pseudocysts
trauma
systemic diseases
autoimmune
CF
231
what is chronic obstructive pancreatitis
inflammation of sphincter of Oddi with cholelithiasis
or cancer of amopulla of vator, duodenum, or pancreas
232
what is non-obstructive chronic pancreatitis
inflammation of head of pancreas and around pancreatic duct (usually d/t alcohol abuse)
233
clinical manifestations of chronic pancreatitis
abd pain - not relieved w food or antacids
malabsorption
constipation
mild jaundice
dark urine
steatorrhea
DM - s/s hyperglycemia
234
When may a chronic pancreatitis patient need care?
during acute attacks
235
diet for a patient with chronic pancreatitis
pancreatic enzyme replacement
bile salts
low fat
avoid alc and smoking
236
what do bile salts help with for a patient with chronic pancreatitis?
helps with fat soluble vitamin absorption
237
Pancreatic cancer is most likely to occur in...
65-80 yr olds
238
is pancreatic cancer usually detected early or late?
Late - silent growth until well-advanced and metastisized
239
risk factors for pancreatic cancer
chronic pancreatitis
DM
age
cig smoking
fam hx
high fat diet
chemical exposure
AA higher incidence
240
clinical manifestations of pancreatic cancer
dull, aching abd pain (may radiate to back & occurs while eating & nightime)
anorexia
rapid and progressive wt loss
nausea
jaundice
241
How to diagnose pancreatic cancer
CT
abd US
ERCP
MRI
MRCP
tumor markers
242
surgical treatment for pancreatic cancer
whipple procedure (radical pancreaticoduodenectomy)
243
what happens during a whipple procedure?
resection of the proximal pancreas, adjoining duodenum, distal portion of the stomach, and distal segment of the common bile duct
244
Other therapies (besides surg) is done for pancreatic cancer?
radiation - pain relief only
chemotherapy - limited
245
nursing management for pancreatic cancer patients
symptomatic support
pain and comfort
nutrition
bleeding s/s
post-op cares
palliative/EOL care
246
What should a nurse monitor for when a patient is on morphine?
respiratory and constipation
247
Why would a patient take insulin with pancreatitis?
Their pancreas is not working to produce insulin, so their blood sugar is high and needs medication
NUR 408
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