I am a liver, not a fighter
Irreversible scarring of the liver caused by inflammation & necrosis eventually leading to end-stage liver disease.
What is cirrhosis?
Causes:
Alcohol, hepatitis B & C, toxins, gallbladder disease, fatty liver (NAFLD), non-alcoholic steatohepatitis (NASH), severe right-sided heart failure
Most people recover from this type of hepatitis, although some people are chronic carriers. It is transmitted through blood, semen, and other body fluids, and there is a vaccine available.
What is Hepatitis B?
S/sx: Anorexia, N/V, Fever, fatigue, RUQ Pain, dark urine, light stool, join pain, jaundice
This is the dietary recommendation after a cholecystectomy.
What is decreased intake of fatty foods.
The body is unable to break down fat.
These are hallmark lab values of pancreatitis.
What is elevated amylase and lipase?
Other lab abnormalities:
■Elevated bilirubin and alkaline phosphatase if biliary dysfunction is present
■Elevated ALT if biliary obstruction is cause of pancreatitis
■Elevated WBC
■Elevated glucose
■Decreased Calcium and Magnesium-related to fat necrosis
This form of inflammatory bowel disease can have effects in the small and large intestines.
What is Crohn's disease?
Ulcerative colitis is found only in the colon (large intestines)
Both forms of IBD have the following characteristics:
•Inflammatory and autoimmune in nature
•Genetic, immune and environmental factors
•Diarrhea, frequency mucousy bloody stools
•Treatment: Symptomatic, surgical (colectomy or ileostomy), Steroids, immunomodulators, electrolyte replacement, low fiber diet, malnutrition treatment for CD, peritonitis/fistulas with CD
•Increased risk of colorectal cancer
Bonus question: How does IBD differ from IBS?
-Red meat
-Burned/heavily BBQ meat
-Salt fish/meat
-Pickled food
-Alcohol
-Nitrates from processed foods
Bonus question: What are some signs and symptoms of colorectal cancer?
These lab abnormalities are associated with cirrhosis in the acute care setting.
What are:
-elevated liver enzymes : alanine transaminase (ALT) and aspartate transaminase (AST), and alkaline phosphatase (ALP)
-elevated bilirubin
-elevated prothrombin time
-decreased protein
This type of hepatitis is spread through fecal-oral transmission, causing GI symptoms, and recover fully.
What is hepatitis A?
Clay colored feces due to lack of bilirubin is a sign of this condition.
What is Chronic Cholecystitis?
This is the most common cause of pancreatitis.
What is alcohol use disorder/alcohol consumption?
Can also be caused by
–Biliary tract disease
–Biliary obstruction
–Liver disease
-Blunt trauma
What are:
-Inhibition of mucosal defenses from acid/pepsin
-Increased acid secretion
-NSAID use
-Stress
-H.pylori
What are:
-ulcerative colitis
-diet
-Family history
-prostate cancer
Bonus question- what is often the initial diagnostic or screening test for colon cancer?
Prior to their patient getting a paracentesis for cirrhosis-related ascites, the nurse must do these things.
What is:
-ensure that informed consent has been completed
-obtain patient's weight
-take vital signs
The cause for the decline in Hepatitis A & B is a result of…
What are vaccinations?
However Hep B and Hep C are still a concern because of their association with cirrhosis and liver cancer.
What are:
Biliary colic, pain in RUQ, pain associated with ingestion of fatty foods, pain between shoulder blades, N/V, fever, and bloating
These are at least three signs and symptoms of acute pancreatitis.
What are:
Other s/sx:
■Severe and constant abdominal pain
■ETOH consumption and withdrawal symptoms
■Fetal position relieves pain
■Generalized jaundice
■Absent or decreased bowel sounds
–Paralytic ileus
■Tenderness, rigidity, guarding
■Left lung pleural effusions common
■Atelectasis and pneumonia common
■Hypotension and tachycardia common
■Hemorrhage and shock,
What are PPIs and antibiotics?
What is small, frequent meals without water?
Dumping syndrome is the rapid emptying of food into small intestines
S/sx: vertigo, tachycardia, syncope, sweating, pallor, palpitations, and desire to sit and lay down
These are at least two complications of cirrhosis.
What are:
-ascites
-portal hypertension
-esophageal varices
-biliary obstruction and decreased bile production
-splenomegaly
-jaundice
-hepatorenal syndrome
-spontaneous bacterial peritonitis
-hepatopulmonary syndrome
With this type of hepatitis, patients can be asymptomatic for years, it is transmitted through blood exposure, and most patients are chronically infected with the virus.
What is Hepatitis C (HCV)?
Bonus question: how many vaccinations are in the hepatitis C series?
These are three risk factors for chronic cholecystitis.
What are these risk factors:
S/sx:
■Jaundice and icterus
■Clay colored feces because of lack of bilirubin
■Dark foamy urine
These are at least two complications of PUD.
What are:
•Hemorrhage
•Perforation
•Pyloric obstruction
•Intractable disease
This is the top nursing priority for most patients experiencing an emergent upper GI bleed.
What is maintaining a patent airway?
Bonus question: What other interventions can we anticipate?
A client with advanced cirrhosis of the liver is not tolerating protein well, as evidenced by elevated ammonia levels. The nurse anticipates that this medication will be prescribed for this patient.
What is lactulose?
Ammonia is a byproduct of protein digestion in the GI tract. The liver converts ammonia to urea for excretion. Elevated ammonia levels can contribute to the development of hepatic encephalopathy, which can lead to altered mental status, coma, and death.
Lactulose is an osmotic diuretic and decreases intestinal production and absorption of ammonia. It achieves this through stimulating loose stool.
What two groups of drugs are approved for the management of Hepatitis B?
What are Interferon alfa preparations and nucleoside analogs?
These lab abnormalities and signs/symptoms are usually seen in a patient with acute cholecystitis.
What is:
Labs: elevated WBCs and elevated alkaline phosphatase
This type of diet is recommended for a patient with chronic pancreatitis.
What is high calorie, protein, carb and low fat diet (4000-6000 calories/day), and abstaining from alcohol?
Other interventions for chronic pancreatitis:
■Pain management
■Pancreatic enzymes given with meals and snacks
■H2 blockers and PPI to control stomach acid
■TPN or TEN maybe needed with vitamin supplements
■Avoid Alcohol
These are symptoms of this PUD complication:
•Abdominal Pain
•Tenderness
•High fever
•Rigid board-like abdomen (Classic symptom)
•Distended abdomen
What is perforation?
A patient recently had surgery to remove a sizeable GI cancerous tumor. An ostomy was placed and 2 days after surgery the nurse assesses diarrhea-liquid stool output. This type of ostomy is most often with loose, watery stool, instead of formed stool.
What is ileostomy?
New ostomies generally start producing output 2-4 days after surgery.