Download Pancreatic and Liver Maladaptations

Pancreatic and Liver
Maladaptations
M. DuBois Fennal, PhD, RN, CNS
Associate Professor
Florida A&M University
School of Nursing
Cirrhosis
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Definition: A type of chronic liver disease that
result in extensive hepatocellular damage. An
irreversible inflammatory disease.
Incidence
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A leading cause of death in the United States ,
higher in men than in women, higher in
alcoholics than in non-alcoholics
Etiology
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Classified by cause:
1. Laennec Cirrhosis
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Caused by alcoholism
Most common type
Manifest by fatty deposits that lead to full blown
cirrhosis. If not corrected it will progress to
alcoholic hepatitis.
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Biliary Cirrhosis
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Cause unknown
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Secondary Biliary
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Caused by obstruction
Neoplasms
Strictures
Gallstones
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Postnecrotic
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Hepatitis B
HAV
Hepatitis C
Drugs or other toxins
Autoimmune destruction
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Cardiac Cirrhosis
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Right sided heart failure
Prolonged elevated venous pressure
Liver congestion
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Metabolic Cirrhosis
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Defects and storage diseased, such as alpha1antitrypsin deficiency, glycogen storage disease,
hemochromatosis, Wilson disease, glactosemia
Pathophysiology
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Disorganization of hepatic tissue caused by
diffuse fibrosis and nodular regeneration. The
process creates a rough nodular appearance of
the liver.
The inability to detoxify substances, the
inability to produce essential proteins such as
clotting factor and albumin, The inability to
regulate glucose and bilirubin metabolism.
Signs and Symptoms
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Portal Hypertension
Splenomegaly
Acites
Esophageal Varices
Hepatic Encephalopathy
Clinical Manifestations
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Parotid enlargement
Esophageal varicies (bleeding)
Altered coagulation
Anemia
Leukopenia
Asterixix
Peripheral edema
Pounding pulse
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Ascites
Dyspnea Spider angiomata
Gynecomastia
Potassium deficiency
Medical Management
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Electrolytes
CBC
Bilirubin
Total Protein
Coagulation Studies
Enzyme studies
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Diuretics
Lactulose
Neomycin
Vitamin K
Antacids
Sedation
Surgery
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Scleotherapy
Paracentisis
Leveen Shunt
Portacaval Shunt
Liver Transplant
Nursing Management
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Assessment
Safety
Interpretation of lab data
Management of medication regime
Provision of comfort
Fluid and electrolyte balance
Nursing Diagnosis
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Fluid volume excess
Altered thought processes
Risk for injury; bleeding
Risk for impaired gas exchange
Impaired skin integrity
Cancer of the Liver
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Definition:
Malignant neoplasms of the liver
Etiology
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Usually caused by metabolic spread from
primary site elsewhere in the body
Primary Liver Cancer may be caused by
exposure to mycotoxins (aspergillums flatus) a
mold found in corn, wheat and peanuts
May also occur because of chronic liver
disease especially cirrhosis
May occur from infection of Hepatitis B,C,D
Incidence
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More common in men than in women
Higher in Blacks than in Whites
Most Common during the six decade
Accounts for 2% of deaths in US
18,920 new cases in 2004
14,270 deaths in 2004
Pathophysiology
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Hepatocellular: arise from the liver cells.
Hepatocytes are damaged by invasion of DNA
from most often HBV & HDV
Cholangiocelluar develops in the cells of the
bile duct, as a result of long standing
inflammation or injury to the duct.
Signs and Symptoms
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Nausea and vomiting
Jaundice
Abdominal Distention
Clinical Manifestations
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Portal Hypertension
Loss of appetite
Pain
Weight loss
Elevated Alkaline phosphatase (ALP),
Aminotransferase (ALT or SGPT),
transaminase (AST or SGOT)
Diagnosis
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Based on symptomatology
Laboratory findings
X-rays
Liver Scan
Exploratory Surgery
Medical Management
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Management of pain
Hospice Care
Nursing Management
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Pallative
Provide comfort
Management of pain medication
Appropriate Referrals, i.e. Hospice
Pancreatitis
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Definition: Inflammation of the Pancreas
Etiology
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Associated with several diseases including
alcoholism, obstructive biliary tract disease
(particularly choleithiasis), peptic ulcer,
trauma, hyperlipidemia, and certain drugs
Incidence
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Most common during the 5th decade of life
May be acute or chronic
Occurs equally in men and women (pathology,
McCance & Huether), Occurs more frequently
in men than in women (Lemone & Burke
Pathophysiology
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Acute:
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Also called hemorrhagic pancreatitis. The
triggering event may not be known. Most
commonly it is believed that some sort of injury
occurs or there is a disruption in the pancreatic
ducts o Acini, with leakage of pancreatic enzymes
into pancreatic tissue, initiating autodigestion and
acute pancreatitis
Signs and Symptoms
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Epigastric and midabdominal pain
Fever
Leukocytosis
Inflammatory response
Nausea and vomiting
Paralytic ileus
Peritonitis
Clinical Manifestation
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Complaints of abdominal pain
Abdominal distention
Ascites
Hypotension
Hypovolemia
Complications
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Shock
Myocardial Insufficiency
Tachypnea
Hypoxemia
Decrease renal blood flow
Pulmonary edema
Atelectasis
Pleural effusion
Tetany
Diagnosis
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Based on clinical findings
Identification of associated disorders and
laboratory findings
Elevated amylase*****
Medical Management
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Narcotics such as morphine
NPO
Nasogastric suctioning
IV Fluids
Nursing Management
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Pain control
NPO
Bedrest
Nutrition
Management of fluid volume
Chronic Pancreatitis
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May be structural or functional impairment
Etiology: Alcohol abuse
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Idiopathic
Cystic fibrosis
Clinical Manifestations
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Pancreatic cyst
Pancreatic enzyme deficiency
Mal-absorption syndrome
Medical Management
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Pain management (avoid narcotics if possible)
Diet
Insulin
Surgery
Nursing Management
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Pain control
Education
Monitor dietary intake
Pancreatic Cancer
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Definition:
Proliferation of abnormal cell growth in the
pancreas
Etiology
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Smoking
Exposure to industrial chemicals
Environmental toxins
High fat diet
Pancreatitis
Diabetes
Incidence
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More prevalent in men than women
More common in blacks than in whites
Occurs most often after the fifth decade
Pathophysiology
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Most cancers of the pancreas are
adenocarcinomas that cause death in one to
two years.
As with any cancer cells that do not contribute
to livelihood of the host act as a parasite that
takes from the host and eventually depletes the
host of nutrients
Cancer cells do not die on time and continue to
multiply
Signs and Symptoms
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Anorexia
Weight loss
Flatulence
Dull epigastric pain
Clinical Manifestations
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Obstruction of bile flow
Jaundice
Clay colored stools
Dark Urine
Puritis
Medical Management
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Whipple Procedure
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Removal of the head of the pancreas, the entire
duodenum, the distal third of the stomach, a
portion of the jejunum, and the lower half of the
common bile duct.
The common bile duct is sutured to the end of the
jejunum and the remaining pancreas and stomach
are sutured to the side of the jejunum (p 606 or p
501)
Nursing Management
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Care of the post-operative patient
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Airway
Pain
Nasogastric suctioning (drainage)
Positioning (semi-fowlers)
Signs and Symptoms
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Abdominal Pain continuous or intermittent
Loss of islet cell function