Disorders Of The Liver, Biliary Tract, Gallbladder, And Exocrine Pancreas

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Cirrhosis

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Cirrhosis is a chronic, degenerative disease of the liver in which the lobes become covered with fibrous or scar tissue, the parenchyma, degenerates, and the lobules are infiltrated with fat.

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There are several forms of cirrhosis, caused by different factors

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. Alcohol-related liver disease may occur with heavy alcohol consumption.

Postnecrotic cirrhosis, found worldwide, is caused by viral hepatitis (especially hepatitis C, but also hepatitis and D).

Primary biliary cirrhosis occurs more often in women and results from destruction of the bile ducts due to inflammation

Secondary biliary cirrhosis is caused by chronic biliary tree obstruction from gallstones, chronic pancreatitis, a tumor, cystic fibrosis, or biliary atresia.

Cardiac cirrhosis results from longstanding, severe right-sided heart failure in patients with cor pulmonale, constrictive pericarditis, and tricuspid insufficiency.

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Clinical Manifestations of cirrhosis

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In the early stages the liver is firm and therefore easier to palpate, and abdominal pain . Generalized weaknesses, malaise, vague flulike symptoms.

Later stages: dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen, malaise, nausea, jaundice, ecchymoses, and spider telangiectases.

Spider telangiectases occur on the nose, cheeks, upper trunk, neck, and shoulders.

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Medical Management

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decrease the buildup of fluids in the body, prevent further damage to the liver, and provide individual supportive care. Eliminating alcohol, hepatotoxins e.g., acetaminophen Tylenol, or environmental exposure to harmful chemicals is essential to prevent further damage to the liver

A diet that is well balanced, high in calories 2500 to 3000 calories/day, moderately high in protein low in fat, low in sodium. with additional vitamins and folic acid will usually meet the needs of the patient with cirrhosis and improve deficiencies. A protein-restricted diet may be prescribed for a patient recovering from an acute episode of hepatic encephalopathy.

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Medication for cirrhosis

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Antiemetics may be prescribed to control nausea or vomiting.

Monitor the patient closely for toxicity,

Diphenhydramine: Benadryl

dimenhydrinate: Dramamine. may be given, whereas prochlorperazine maleate: Compazine, hydroxyzine pamoate :Vistaril, or hydroxyzine hydrochloride: Atarax are contraindicated in severe liver dysfunction.

Later manifestations may be severe and result from liver failure and portal hypertension. Jaundice, peripheral edema, esophageal varices, hepatic encephalopathy, and ascites develop gradually

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Hepatic encephalopathy

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is a type of brain damage caused by liver disease and consequent ammonia intoxication

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Asterixis

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is a hand-flapping tremor in which the patient stretches out an arm and hyperextends the wrist with the fingers separated, relaxed, and extende

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Nursing Interventions and Patient Teaching

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Check vital signs every 4 hours, or more often if evidence of hemorrhage is present. Observe the patient for GI hemorrhage as evidenced by hematemesis, melena, anxiety, and restlessness.Most patients require a well-balanced, moderate, high-protein, high-carbohydrate diet with adequate vitamins. With impending liver failure, protein and fluids are restricted. Sodium restriction is frequently necessary, which can make providing a palatable diet more difficult. Provide frequent oral hygiene and a pleasant environment to help the patient increase food intake.

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Complications of cirrhosis

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Fluid retention

Diuretics are commonly used to decrease fluid retention

Albumin may be given to increase osmotic pull into vascular space

LeVeen peritoneal shunt

Paracentesis may performed

Esophageal varices: veins in the esophagus became enlarged and engorged

Susceptible to ulcerations and hemorrhage

Prophylactic treatment includes beta blockers

Varices can rupture as a result anything that increases abdominal venous pressure such coughing sneezing, vomiting or the Valsalva meneuver.

Rupture of a varix is an emergency and should be should be treated as such

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Pancreatitis

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Pancreatitis is an inflammatory condition of the pancreas that may be acute or chronic. The degree of inflammation varies from mild edema to severe hemorrhagic necrosis.

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factors

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Alcoholism and biliary tract disease are the two factors most commonly associated with pancreatitis. Pancreatitis can develop as a postoperative complication in patients who have had surgery of the pancreas, stomach, duodenum, or biliary tract. Pancreatitis can also occur after undergoing ERCP

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Clinical Manifestations

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Manifestations include severe abdominal pain radiating to the back. The pain is usually located in the left upper quadrant. The pain is sometimes relieved by leaning forward, taking the stomach weight off the pancreas. Jaundice may be noted if the common bile duct is obstructed.

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Assessment

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Pain in is the most common subjective data associated with pancreatitis. Pain may be gradual or have a sudden onset, and is often severe. The pain is caused by the enlargement of the pancreatic capsule, an obstruction, or chemical irritation from enzymes. The pain is usually decreased by flexing the trunk, leaning forward from a sitting position, or by assuming the fetal position. It is increased by eating or lying down. Other complaints include nausea, anorexia, malaise, and restlessness.

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Diagnostic Tests

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Both acute and chronic pancreatitis are diagnosed by radiologic studies an abdominal CT scan and ultrasound of the pancreas, endoscopy, and laboratory analysis of the pancreatic enzymes in the serum and urine. Laboratory tests reveal an increased level of serum amylase and lipase during the first few days and increased urine amylase thereafter. Amylase and lipase levels that are three times above normal are considered most definitive for pancreatitis.