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Metabolic and Endocrine Function. Larry Santiago, MSN, RN. Assessment and Management of Patients With Hepatic Disorders. Assessment. Health History Exposure to hepatotoxins Alcohol and drug use Lifestyle behaviors Physical Examination Skin inspection Abdominal assessment Liver palpation.
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Metabolic and Endocrine Function Larry Santiago, MSN, RN
Assessment and Management of Patients With Hepatic Disorders
Assessment • Health History • Exposure to hepatotoxins • Alcohol and drug use • Lifestyle behaviors • Physical Examination • Skin inspection • Abdominal assessment • Liver palpation
Diagnostic Evaluation • Liver Function Tests – page 1079 • Liver Biopsy -removal of a small amount of liver tissue through needle aspiration
Diagnostic Evaluation 2 • Ultrasonography • Computed Tomography
Diagnostic Evaluation 3 • Magnetic resonance imaging (MRI) • Laparoscopy
Hepatic Dysfunction • Jaundice- hemolytic, hepatocellular, obstructive, and hereditary hyperbilirubinemia
Hepatic Dysfunction 2 • Portal Hypertension • Ascites
Ascites • Pathophysiology • Clinical manifestations
Ascites 2 • Medical/Nursing management • Dietary Modification – strict sodium restriction • Diuretics
Ascites 3 • Bed Rest • Paracentesis
Esophageal Varices • - dilated, tortuous veins found in the submucosa of the esophagus or even the stomach
Hepatic Encephalopathy and Coma • Results from accumulation of ammonia and other toxic metabolites in the blood • Hepatic coma represents most advanced stage of hepatic encephalopathy • Clinical manifestations include: mental changes, motor disturbances, asterixis and constructional apraxia
Hepatic Encephalopathy • RN is responsible for maintaining a safe environment to prevent injury, bleeding, and infection • Assess neuro status frequently • Strict I & O • Assess for symptoms of infection • Monitor serum ammonia level and electrolytes
Management of Patients With Viral Hepatic Disorders • Viral Hepatitis • Systemic viral infection in which necrosis and inflammation of the liver cells produce a cluster of changes • Includes Hepatitis A,B,C,D, and E
Hepatitis A • Mode of transmission • fecal/oral Signs & Symptoms: Headache, malaise, fatigue, later on dark urine, jaundice, tender liver
Hepatitis B • Mode of transmission: • sex, either by intercourse or oral contact • Perinatal tranmission • Health care personnel • Long incubation period (70-80 days) • Signs/symptoms insidious and variable
Hepatitis B 2 • Active Immunization: Hepatitis B Vaccine • Passive Immunity: Hepatitis B Immune Globulin
Hepatitis B 3 • Medical/Nursing management • Antiviral agents – Epvir and Hepsera • Bed rest, activity restriction • Adequate nutrition
Hepatitis C • Mode of transmission: • Blood transfusion • Risk increased with STD Signs and Symptoms: Similar to HBV, but less severe and anicteric • Increased risk of chronic liver disease and hepatic cancer • Hepatitis G risk factors similar to HCV
Hepatitis D • Mode of transmission: • same as HBV Signs and Symptoms: Similar to HBV Outcome: Greater likelihood of carrier state, chronic active hepatitis, and cirrhosis
Hepatitis E Mode of transmission: Fecal-oral Signs and Symptoms: Similar to HAV Very severe in PG women Outcome: Similar to HAV except very severe in PG women
Management of Patients With Nonviral Hepatic Disorders • Toxic Hepatitis • Exposure to hepatotoxic chemicals or meds - Symptoms include vomiting, abnormal clotting, delirium, coma, seizures, death
Hepatic Cirrhosis • Types of cirrhosis: • Alcoholic cirrhosis – most common • Postnecrotic cirrhosis – broad bands of scar tissue from previous acute viral hepatitis • Biliary cirrhosis – result of chronic biliary obstruction and infection – much less common
Hepatic Cirrhosis 2 • Pathophysiology • Alcohol consumption major causative factor • Characterized by episodes of necrosis involving the liver cells • Destroyed liver cells are replaced by scar tissue
Hepatic Cirrhosis 3 • Clinical manifestations • Hepatomegaly • Portal Obstruction and Ascites • Infection and Peritonitis • Gastrointestinal varices • Edema • Vitamin deficiency and anemia • Mental deterioration
Hepatic Cirrhosis 4 • Assessment and Diagnostic Findings • Medical Management
Assessment and Management of Patients With Biliary Disorders
Diseases of the Gallbladder • Cholecystitis- acute inflammation, calculous cholecystitis • Cholelithiasis- gallstones
Cholelithiasis • Medical Management- lithotripsy, UDCA and CDCA, MTBE, ERCP
Cholelithiasis 2 • Surgical Management- cholecystectomy
Cholelithiasis 3 • Nursing Management- relieve pain, promote biliary drainage, improve nutritional status
Diseases of the Pancreas • Acute Pancreatitis- mild, self- limiting to fatal, self-digestion of pancreas by proteolytic enzymes
Acute Pancreatitis Gerontologic considerations – mortality increases with advancing age
Acute Pancreatitis 2 • Pathophysiology • Caused by self-digestion of the pancreas • Long-term use of alcohol is commonly associated • Mortality rate is high (10%)
Acute Pancreatitis 3 • Clinical Manifestations • Severe abdominal pain • Nausea/vomiting • Hypotension • Respiratory distress • Tachycardia • Cyanosis
Acute Pancreatitis 4 • Medical Management directed at relief of symptoms, prevention and treatment of complications, and managing exocrine and endocrine insufficiency of pancreatitis
Chronic Pancreatitis • Characterized by progressive anatomic and functional destruction of the pancreas • End result is mechanical obstruction of the pancreatic and common bile ducts and the duodenum • Major causes are alcoholism and malnutrition
Chronic Pancreatitis 2 • Clinical Manifestations • Recurring attacks of severe abdominal and back pain • Vomiting • Opioids often do not provide relief • Weight loss • Steatorrhea
Chronic Pancreatitis 3 • Medical Management • Pain management • Diabetes Mellitus • Pancreatico- jejunostomy
Assessment and Management of Patients With Diabetes Mellitus
Diabetes Mellitus • Type 1- destruction of pancreatic beta cells • Combined genetic, immunologic, and environmental factors contribute to beta cell destruction