Chapter 47 learning objectives

pathophysiology of esophageal varices

As the normal pathway for the blood is obstructed the collateral veins become distended and engorged with blood. These distended collateral vessels develop primarily in the esophagus. Esophageal varices overfill as a result of portal hypertension. They are especially vulnerable to bleeding because they lie superficially in the mucosa, contain little protective elastic tissue and are easily traumatized by rough food or chemical irritation.

pathophysiology of portal hypertension

In the scarred cirrhotic liver, intrahepatic veins may be compressed. Consequently blood backs up into the portal system which is the venous pathway through the liver. This congestion and increased fluid pressure in the portal system care called portal hypertension.

Nutritional aspects of medical treatment for cholecystitis

Low fat diet before surgery, after surgery you can return to your normal diet as tolerated.

Identify the etiology, outcomes and prognosis of viral hepatitis A

Mode of transmission is oral route from feces and salvia of infected persons; water, food and equipment that is contaminated with the virus. Outcome usually mild with a full recovery fatality rate is <1%; no carrier states or increased risk of chronic hepatitis, cirrhosis or hepatic cancer. incubates; 3-5 weeks

dietary management for cirrhosis

Only used when it is believed to help with symptoms. Fat is restricted for clients with steatorrhea, medium chain triglyceride oil may be given when fat is limited. Sodium is restricted to 2g per day when ascites is present. A high calorie diet is recommended for clients with malnutrition, weight loss and infection. A high protein diet is used to prevent muscle wasting. Carb controlled for diabetic patients. Small, frequent meals for N/V and fatigue.

pathophysiology of ascites

Portal hypertension is a major underlying factor. Portal hypertension leads to a cascade of events called the hepatorenal syndrome, this ultimately alters fluid distribution and interferes with fluid excretion. Portal hypertension pushes albumin into the peritoneal cavity. Albumin creates osmotic pressure, and will create it even when it is forced into the peritoneal cavity. This will pull fluid towards the albumin in the peritoneal cavity resulting in ascites.

Dietary management for hepatitis

Small frequent meals. supplemental fat soluble vitamins Depends on symptoms- some will not need modifications. others will need a high protein diet of 1.5-2.0 g/kg to promote liver cell regeneration.

pathophysiology of hepatic encephalopathy

This is the CNS manifestation of liver failure it can lead to coma and death. This occurs when ammonia builds up in the blood stream and passes the blood brain barrier resulting in toxicity. Fetor hepaticus is a sign as well as disorientation, asterixis, and a positive babinski reflex.

Contributing factors and medical management of cholecystitis

cholelithiasis refers to stones that form in the gallbladder. Gallstones are the most common abnormality of the biliary system. If the stones are located in the common bile duct that condition is referred to as choledocholithiasis. The formation of stones often leads to an inflammation or infection of the gallbladder which is called cholecystitis. This can be acute or chronic. NPO, NG tube is inserted and fluids are prescribed until the inflammation subsides. To relieve pain and discomfort analgesics, anticholinergics, and nitroglycerin may be given. Lithotrispy may be done (shock waves to break up stones) or the gallbladder may be removed.

What are the different phases for hepatitis?

incubation phase; the virus replicates in the liver, client is asympotamatic. Late in this phase the cirus can be found in blood, bile, and stools (for hep A). At this point the client is considered infectious. preicteric phase or prodomal phase N/V, anorexia, fever, malaise, arthralgia, headache, RUQ discomfort, enlargement of the spleen, liver and lymphnodes, weight loss, rash, urticaria Icteric phase: jaundice, pruritus, clay colored or light stools, dark urine, fatigue, anorexia, RUQ discomfort, symptoms from prodomal phase will continue posticteric phase liver enlargement, malaise, fatigue, other symptoms begin to subside, liver function tests begin to return to normal.

Nursing management for clients undergoing gallbladder surgery

low fat diet. the nurse completes the preoperative skin preparation, inserts an IV line and administers sedation. The nurse will provide instructions on self care.

Functions of the liver

metabolizes: glucose, proteins, and fats; drugs, chemicals, bacteria, and foreign elements. converts: glucose to glycogen regulates: blood glucose Stores vitamins forms and excretes bile and bilirubin synthesizes factors for blood coagulation.

Identify the etiology, outcomes and prognosis of viral hepatitis C

mode of transmission infected blood or blood products, sexual contact outcomes frequent occurence of chronic carrier state and chronic liver diseasel increased risk of hepatic cancer incubates: 2-20 weeks

Identify the etiology, outcomes and prognosis of viral hepatitis B

mode of transmission infected blood or plasma, needles, syringes, surgical or dental equipment contaminated with infected blood. also sexually transmitted through vaginal secretions and semen of carries or those actively infected. outcomes may be severe; fatality rate 1%-10%, carrier state possible, increased risk of chronic hepatitis, cirrhosis and hepatic cancer, some infected people become carriers. incubates; 2-5 months

What are the most common complications associated with cirrhosis

portal hypertension esophageal varices ascites hepatic encephalopathy

Describe the treatment of pancreatic carcinoma

radical pancrearoduodenectomy- removes the head of the pancreas; resects the duodenum and stomach; redirects flow of secretions from stomach, gallbladder and pancreas. cholecystojejunostomy; rerouting of pancreatic and biliary drainage inoperable tumors: radiation therapy or chemotherapy with 5-fluorouracil.

Explain the pathophysiology of jaundice

results from abnormally high bilirubin in the blood. It is a yellowish discoloration of tissue that is sign of an underlying disease that is directly or indirectly connected to the liver. Bilirubin increases for 2 reasons (1) excessive destruction of the red blood cells. (2) The liver cannot excrete it so it leaks into the blood stream. Hemolytic jaundice- excessive destruction of red blood cells hepatocellular jaundice- caused by liver disease. obstructive jaundice- Caused by a block of the passage of bile between the liver and the intestinal tract.

Describe the treatment and management of pancreatitis

tx: abstinence from alcohol, fat-free diet and correction of associated biliary tract disease. drug therapy includes: meperidine, narcotics, non opioid medications and pancrelipase. A total or partial pancreatectomy may be performed but remember that they will lose all or partial function of the pancreas and will require insulin and pancrealipase for life.

Describe common assessment findings associated with cirrhosis

weight loss chronic fatigue weakness diarrhea or constipation white or clay colored stools (indicates bilirubin excess) "tea" colored urine (indicates bilirubin excess) Abdominal discomfort and shortness of breath distended abd with ascites peripheral edema Later assessment findings (signs of liver failure) distended abd jaundice caput medusa pruritis gynecomastia palmar erythema cutaneous spider angiomata continuous mild fever bleeding