Liver cancer.pptx

AHN, nursing, disease

1. Khyber Medical University Cancer of liver

2. Objectives At the end of this presentation the student will be able to: Define liver cancer. Describe Pathophysiology of liver cancer. Enlist signs, symptoms and causes of liver cancer. Discuss medical diagnosis and treatment of liver cancer. Make nursing diagnosis and nursing intervention for liver cancer.

3. Liver cancer Liver cancer  or  hepatic cancer  (from the Greek  hēpar , meaning liver) is a cancer that originates in the liver. Liver cancers are malignant tumors that grow on the surface or inside the liver.   Liver cancers should not be confused with liver  metastases, which are cancers that originate from organs elsewhere in the body and migrate to the liver.

4. Causes of liver cancer Liver cancer is often caused by damage to the liver due to: Cirrhosis (scarring of the liver tissue from alcohol) Hepatitis B or C. Inflammation of the liver that is long-term (chronic) Iron overload in the body (hemochromatosis)

5. Pathophysiology Hepatic carcinoma, like any other cancer, develops when there is a mutation to the cellular machinery that causes the cell to replicate at a higher rate. In particular, chronic infections of hepatitis B and/or C can aid the development of hepatic carcinoma by repeatedly causing the body's own immune system to attack the liver cells, some of which are infected by the virus.

6. Cont…. While this constant cycle of damage followed by repair can lead to mistakes during repair which in turn lead to carcinogenesis, this hypothesis is more applicable, at present, to hepatitis C. Chronic hepatitis C causes liver cancer through the stage of cirrhosis.

7. Signs & Symptoms Abdominal pain or tenderness, especially in the upper-right part Easy bruising or bleeding Enlarged abdomen Yellow skin or eyes (jaundice)

8. Diagnosis Physical examination may show an enlarged, tender liver. Tests include: Abdominal CT scan Abdominal ultrasound Liver biopsy Liver enzymes (liver function tests) Liver  MRI.

9. Treatment Surgery or a liver transplant can successfully treat small or slow-growing tumors if they are diagnosed early. Chemotherapy delivered straight into the liver with a catheter can help, but it will not cure the disease. Radiation therapy in the area of the cancer may also be helpful.

10. Complications Gastrointestinal bleeding. Liver failure. Spread to nearby organs. Tumor rupture. Bone marrow damage. Constipation. Diarrhea. Hair loss. Increased risk of infection.

11. Nursing Diagnoses Activity intolerance R/T fatigue, lethargy, and malaise. Imbalanced nutrition R/T abdominal distention and anorexia. Impaired skin integrity R/T jaundice and edema. High risk for injury R/T altered clotting mechanisms. Disturbed body image R/T changes in appearance, sexual dysfunction, and role function.

12. Cont… Chronic pain R/T enlarged tender liver and ascites Ineffective breathing pattern R/T restriction of thoracic excursion secondary to ascites and abdominal distention

13. Nursing interventions Give analgesics as ordered to relieve pain. Provide patient with a special diet that restricts sodium, fluids, and protein and that prohibits alcohol. To increase venous return and prevent edema, elevate the patient’s legs whenever possible. Keep the patient’s fever down. Turn the patient frequently and keep his skin clean to prevent pressure ulcers. Prepare the patient for surgery, if indicated.

14. Cont… Provide comprehensive care and emotional assistance. Monitor the patient for fluid retention and ascites. Monitor respiratory function. Explain the treatments to the patient and his family, including adverse reactions the patient may experience.

15. References Garcia-Tsao G, Lim JK; Members of Veterans Affairs Hepatitis C Resource Center Program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program.  Am J Gastroenterol . 2009;104:1802-1829. Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Ausiello D, eds.  Cecil Medicine . 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156. Mehta G, Rothstein KD. Health maintenance issues in cirrhosis.  Med Clin North Am . 2009;93:901-915

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