Unit-I.4- Alteration In Hepatobiliary System.pptx

This presentation is all about causes & pathophysiology of GIT
Surgical and medical daigonosis
Nursing care plan
And client teaching plan

1. Topic Alteration In Hepatobiliary System UNIT-I GIT Disorders

2. At the end of this presentation the learner will be able to; Discuss the causes, pathophysiology and manifestation of the following GIT disorders. Discuss the diagnostic, medical and surgical management of the below mentioned disorders. Apply nursing process including assessment, planning, implementation and evaluation of care provided to the clients with GIT disorders. Develop a teaching plan for a client experiencing disorders of the GIT . Objectives

3. Disorders of the Gallbladder

4. Anatomy & Physiology of the Gallbladder

5. Several disorders affect the biliary system and interfere with normal drainage of bile into the duodenum. These disorders include inflammation of the biliary system and carcinoma that obstructs the biliary tree. Gallbladder disease with gallstones is the most common disorder of the biliary system. Although not all occurrences of gallbladder inflammation (Cholecystitis) are related to gallstones (Cholilithiasis), more than 90% of patients with acute Cholecystitis have gallstones. Most of the 15 million Americans with gallstones have no pain, however, and are unaware of the presence of stones . Disorders of the Gallbladder

6. Disorders of the Gallbladder Cholecystitis Cholilithiasis Cancer of gallbladder

7. 1 . Cholecystitis Acute inflammation (Cholecystitis) of the gallbladder causes pain.   Cholecystitis can be caused by an obstruction, a gallstone, or a tumor. The exact cause of stone formation in the gallbladder and the common bile duct is unknown.

8. 2 . Cholilithiasis Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition. They are uncommon in children and young adults but become increasingly prevalent after 40 years of age. The incidence of Cholilithiasis increases thereafter to such an extent that up to 50% of those over the age of 70 and over 50% of those over 80 will develop stones in the bile tract.

9. When an obstruction is caused by gallstones or a tumor prevents bile from leaving the gallbladder , the trapped bile acts as an irritant, causing inflammatory cells to infiltrate the gallbladder wall after 3 to 4 days. A typical inflammatory response occurs, and the gallbladder becomes enlarged and edematous. The vascular occlusion along with bile stasis causes the mucosal lining of the gallbladder to become necrotic. At first, the bile in the gallbladder is sterile. Within a few days bacteria infiltrate and begin to grow. When the disease is severe enough, the gallbladder may become gangrenous, rupture, and spread infection to the hepatic duct and liver. Pathophysiology

10. Epigastric distress, such as fullness, abdominal distention, and vague pain in the right upper quadrant of the abdomen, may occur. Fever and may have a palpable abdominal mass . U pper right abdominal pain that radiates to the back or right shoulder associated with nausea and vomiting. Jaundice Clay colored stool Vitamin (A, D, E & K) deficiency Clinical Manifestations

11. A bdominal x-ray R adionuclide imaging or cholescintigraphy C holecystography E ndoscopic retrograde cholangiopancreatography Diagnostic Test

12. Bed rest is prescribed. An NG tube is inserted and connected to low suction, and the patient is placed on NPO status. This allows the GI tract, including the gallbladder, to rest . IV fluids are given to rehydrate the patient and to replace drainage from the NG tube. Antispasmodic and analgesic drugs may be given to decrease pain . Medical Management

13. Antibiotics may be given (1) prophylactically to prevent infection, (2) to treat an existing infection and (3) after perforation, should it occur. A diet that is low in fat and cholesterol may be prescribed. Avoidance of spicy foods is also suggested. Extracorporeal shock wave lithotripsy is used to treat a patient who has mild or moderate symptoms caused by a few stones, that breaks the stones into fragments . Cont…

14. Cholecystectomy: (removal of the gallbladder) with ligation of the cystic duct , vein, and artery. A laparoscopic cholecystectomy : A  laparoscope, a narrow tube with a camera, is inserted through one incision, to remove the gallbladder. Open cholecystectomy: O ne large incision may be used to remove the gallbladder.   Surgical Management

15. Administer Oral analgesics or anti-inflammatory agents relieve symptoms. Oral liquids and a light meal are given the first night after surgery. The patient has four bandages at the puncture sites on the abdomen, check wound for oozing. Assess vital signs routinely. The patient should be ambulatory by the first postoperative night . Nursing Interventions

16. Patients are usually able to resume moderate activity within 48 to 72 hours . Before discharge, patients should be able to eat without difficulty and walk, and should have no abdominal distention, evidence of bleeding, or bile leakage. Instruct them to immediately report to the health care provider any severe pain, tenderness, increase in abdominal girth, leakage of bile-colored drainage from the puncture site, increase in pulse or blood pressure. Asses of characteristics of pain. Observe signs of jaundice of the skin, sclera, and mucous membranes . Cont…

17. Observe the patient's urine and stool for alterations in the presence of bilirubin. keep the patient comfortable and provide hygiene care. The patient is kept on NPO status or on clear liquids. Administer antiemetic. Measure I &O carefully . Cont…

18. 3 . Cancer Of Gallbladder Gallbladder cancer  is a disease in which malignant (cancer) cells form in the tissues of the  gallbladder. Causes: Gallbladder cancer is more common in women. Old age . history of gallstones gallbladder polyps chronic gallbladder infection.

19. Abdominal pain, particularly in the upper right portion of the abdomen Abdominal bloating Fever Weight loss Nausea Yellowing of the skin and whites of the eyes (jaundice ) Manifestation of gallbladder cancer

20. gallbladder carcinoma  begins with gallstones giving rise to a condition called chronic Cholecystitis, which increases to risk to gallbladder cancer formation. More than 90% of patients with gallbladder carcinoma show dysplasia. Pathophysiology of gallbladder

21. CT scan MRI Endoscopic ultrasound Fine needle aspiration Cholangiography (is the imaging of the bile duct by x-rays and an injection of contrast medium.) Medical management of gallbladder cancer: Chemotherapy Radiation Symptomatic treatment Diagnostic test for gallbladder

22. T he optimal  treatment is simple cholecystectomy, which can be carried out as either a laparotomy or a laparoscopic  surgery. Surgical Management Of Gallbladder Cancer

23. Relive pain by giving analgesics. Improve patient’s respiratory status. Provide skin care and biliary drainage. Provide proper nutrition to the patient. Provide education related diseases to patient and family. Observe urine output, and monitor intake & output. Provide physical and emotional support. Nursing intervention of gallbladder cancer

24. Disorders of the Pancreas

25. Disorders of the Pancreas Pancreatitis Pancreatic abscess Pancreatic carcinoma

26. 1. Pancreatitis Pancreatitis is an inflammatory condition of the pancreas that may be acute or chronic. The degree of inflammation varies from mild edema to severe hemorrhagic necrosis.

27. Causes of Pancreatitis Although the exact cause of pancreatitis remains unknown, A lcohol consumption Trauma I nfectious disease D rugs B iliary tract disease P ostoperative complication in patients who have had surgery of the pancreas, stomach, duodenum, or biliary tract.

28. T he enzymes cannot flow out of the pancreas because of occlusion (an obstruction) of the pancreatic duct by edema, stones, or scar tissue. The pancreatic enzymes build up and increase pressure within the duct. The duct ruptures, releasing enzymes that begin digesting the pancreas ( autodigestion ). In chronic pancreatitis, the enzyme-producing tissue atrophies, resulting in the pancreas becoming necrotic due decrease blood supply. Pathophysiology

29. S evere abdominal pain radiating to the back. Pain is usually located in the left upper quadrant. Jaundice may be noted if the common bile duct is obstructed. Manifestation of pancreatitis

30. Abdominal CT scan, MRI U ltrasound Endoscopy L aboratory analysis of the pancreatic enzymes Diagnostic test for pancreatitis

31. Kept patient is on NPO status, and an NG tube is inserted to decrease pancreatic stimulation, to treat or prevent nausea and vomiting, and to decrease abdominal distention. Administer i/v fluid to fulfill body requirements. Analgesics, antispasmodics prescribed to control the pain associated with pancreatitis. A Enteral feeding (tube feeding) is begun 24 to 48 hours after the onset of acute pancreatitis and is administered via the jejunum to prevent the release of pancreatic enzymes. Medical Management Of Pancreatitis

32. A clear liquid diet with gradual progression. The diet should be low in fat and protein. The diet should also be free of caffeinated beverages since caffeine acts as a gastric stimulant. Oral hypoglycemic agents or insulin may be needed. Cont…

33. Determine the presence and location of pain, as well as what aggravates or relieves the pain. Keep the patient as comfortable as possible through proper administration of analgesic and antispasmodic medications. The patient is usually on bed rest with bathroom privileges to decrease the flow of pancreatic enzymes. Nutritional needs are met by enteral feeding via the jejunum as long as necessary. Nursing Intervention Of Pancreatitis

34. Carefully monitor all replacement fluids and medications for proper administration. The patient remains on a low-fat, high-calorie, high-carbohydrate diet after discharge. Alcohol and beverages or foods containing caffeine are not allowed. Cont…

35. 2. Pancreatic Abscess A pancreatic abscess is a collection of pus resulting from tissue necrosis and infection .

36. Causes Of Pancreatic Abscesses Alcohol consumption Trauma I nfectious disease D rugs B iliary tract disease P ostoperative complication in patients who have had surgery of the pancreas, stomach, duodenum, or biliary tract.

37. U sually develop in patients with pancreatitis. They may also form as a result of fibrous wall formation around fluid collections or penetrating peptic ulcers. Pathophysiology

38. A bdominal pain C hills and fever I nability to eat A bdominal mass Nausea and vomiting Manifestations of pancreatic abscess

39. Ultrasound MRI Blood test Ct scan-guided fine needle fluid aspiration of the fluid collection can be used to confirm narcosis.   Diagnostic test for pancreatic abscess

40. E ndoscopic ultrasound ( EUS): guided puncture and drainage has become recognized as a safer and more effective alternative to surgery. Antibiotics, analgesics medication as ordered by doctor. Medical Management Of Pancreatic Abscess

41. Surgical drainage and debridement of necrotic pancreatic debris and external drainage is required. ERCP (Endoscopic retrograde cholangiopancreatography : is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Surgical Management Of Pancreatic Abscess

42. Administer analgesic, antibiotics. Maintain fluid and electrolytes balance. Perform aseptic techniques while providing care to patient. Provide education to patient and family about diseases. Promote position of comfort on one side with knees flexed, sitting up and leaning forward . Nursing Intervention Of Pancreatic Abscess

43. Pancreatic carcinoma Cancer (abnormal growth of cells) may arise in any portion of the pancreas(in the head, the body, or the tail). It depends on the location of the lesion, functioning , insulin secreting (pancreatic islet cells) are involved. Approximately 75% of pancreatic cancers originate in the head of the pancreas.

44. The most common environmental risk factor for pancreatic cancer is cigarette smoking. E xposure to chemical carcinogens C hronic pancreatitis Diets high in red meat and pork Obesity Genetics Causes of pancreatic cancer

45. The cancer may originate in the pancreas or be the result of metastasis from cancer of the lung, the stomach, the duodenum, or the common bile duct. The head of the pancreas is involved and causes jaundice by compressing and obstructing the common bile duct. Biliary obstruction and gallbladder dilation are subsequent complications. Pathophysiology

46. Anorexia Malaise Nausea & vomiting fatigue are common Abdominal pain in the epigastric region or back occurs in many of the patients. About half the patients develop diabetes mellitus if islet cells are involved . Manifestations of pancreatic carcinoma

47. Patient's history, signs and symptoms Trans-abdominal ultrasound and CT Scan E ndoscopic ultrasound (EUS ) with fine needle biopsy to obtain specimens for cytological examination. ERCP allows for visualization of the pancreatic duct and biliary system. P ancreatic secretions and tissues can be collected for analysis of various tumor. Diagnostic Test For Pancreatic Cancer

48. Chemotherapy Radiation Treatment of pancreatic cancer is primarily surgical. Medical management of pancreatic cancer

49. Cancer of the head of the pancreas is usually treated by pancreatoduodenectomy, (the procedure involves resection of the antrum of the stomach, the gallbladder, the duodenum, Anastomoses are constructed between the stomach, the common bile duct.) Another procedure is total pancreatectomy with resection of parts of the GI tract. Surgical management of pancreatic cancer

50. M aintain fluid and electrolyte balance. Observe & prevent hemorrhage , preventing respiratory complications. The patient may receive long-acting narcotic analgesics for chronic Pain. Administer antiemetic's. Nurse should provide physical and emotional assistance to patient. Check skin for impaired skin integrity, related to drainage from wound. Provide education to patient and family about diet. Nursing intervention of pancreatic cancer

51. Hepatic Disorders

52. Liver disorders are common and may result from a virus or exposure to toxic substances such as alcohol. Another liver disorder is cancer: hepatocellular carcinoma is a highly malignant tumor that is difficult to treat and often fatal. In the United States, hepatocellular cancer accounts for less than 1% of all cancers, but in other parts of the world, it accounts for up to 50% of cancer cases. The difference is thought to be due to the percentage of the population who are carriers of the hepatitis B virus, which predisposes individuals to hepatocellular cancer. Liver cancer can originate in the liver or can metastasize to the liver from other sites . Hepatic Disorders

53. Hepatic Disorders Hepatic abscess Cancer of liver Liver Cirrhosis

54. Hepatic abscess A n infection develops in the liver or travels through the biliary system, portal venous system, or hepatic arterial or lymphatic systems , and creating an abscess (a collection of pus). If an abscess is allowed to progress it can become life-threatening.

55. Causes of hepatic abscess A bdominal infections such as appendicitis, diverticulitis, and perforated colon. Other causes include any infection in the blood or bile ducts, and trauma to the liver.

56. If the body is not successful in destroying bacteria, the bacterial toxins attack neighboring liver cells, and the necrotic tissue produced serves as a protective wall for the organism. Meanwhile, leukocytes migrate into the infected area. The result is an abscess a cavity full of a liquid containing living and dead leukocytes and bacteria. Pyogenic (pus-producing) abscesses of this type may be single or multiple. Pathophysiology

57. Fever chills abdominal pain and tenderness in the right upper quadrant of the abdomen. Unintentional weight loss Jaundice Weakness Manifestations of hepatic abscess

58. R adiograph , ultrasound, CT, and liver scan. Liver biopsy may be performed to determine the presence of an abscess and a culture may be initiated to determine the infective agent . Common laboratory testing include bilirubin levels, liver enzymes, blood cultures for bacteria, and a complete blood count (CBC). Diagnostic test for hepatic abscess

59. Medical Management Of Hepatic Abscess Usually liver abscesses are managed by medical therapy. Treatment includes IV antibiotic therapy that is specific to the organism identified. Antibiotic therapy is often continued for 4 to 6 weeks. Percutaneous drainage of a liver abscess is reserved for patients who do not respond to medical therapy or are at high risk for rupture. Medical Management

60. The patient's response to drug therapy is determined by a decrease in fever, tenderness and rigidity of the abdomen, chills, and discomfort. If percutaneous or open surgical drainage is initiated, observe the drainage for amount, color, and consistency . Provide proper nutrition. Provide education to patient and family related diseases. Provide emotion and physical support to patient. Nursing intervention of hepatic abscess

61. Liver cancer Liver cancer  is  abnormal growth of cells   in the liver (hepatocellular carcinoma), which begins in the  liver cell (hepatocyte ).

62. Types of Liver Cancer Hepatocellular carcinoma ( HCC) : is also called hepatoma or HCC. It's the most common type of primary liver cancer. It develops from the main liver cells called hepatocytes. It's more common in people with cirrhosis. Cirrhosis means scarring of the liver due to previous damage, such as from the hepatitis B or C virus or long term alcohol drinking. 2. Fibrolamellar carcinoma: it develops in people with usually have lower levels of alpha fetoprotein (AFP) in their blood. 

63. 3) Cholangiocarcinoma : (bile duct cancer) is cancer of the bile ducts, it starts in the section of ducts outside the liver is called extrahepatic cholangiocarcinoma , Cancer that starts in the section of ducts inside the liver is called intrahepatic cholangiocarcinoma . 4) Angiosarcoma : is also known as haemangiosarcoma . It’s a type of cancer called a soft tissue sarcoma, its begins in the blood vessels of the liver, and is extremely rare.  Cont…

64. Hepatoblastoma : is a very rare type of primary liver cancer that usually affects young children. Cont…

65. L ivers damaged by birth defects A lcohol abuse C hronic infection with diseases such as hepatitis B and C. Causes of liver cancer

66. The high rate of blood flow through the portal vein and its massive capillary structure make the metastasis of cancer cells to the liver more likely than to other organs. The pancreas, colon, stomach, breast, and lung are common primary sites of cancer that metastasizes to the liver. Pathophysiology

67. H epatomegaly , weight loss, peripheral edema, ascites, portal hypertension) are similar to thosen of cirrhosis of the liver. Other common manifestations include dull abdominal pain in the epigastric or right upper quadrant region, jaundice, anorexia, nausea and vomiting, and extreme weakness. Palpation may reveal an enlarged, nodular liver . Manifestation of liver cancer

68. L iver scan, ultrasound, CT scan, magnetic resonance imaging, hepatic A rteriography , ERCP, and needle liver biopsy. The test for alpha-fetoprotein (AFP) may be positive in hepatocellular carcinoma. Diagnostic Tests for liver cancer

69. Chemotherapy & radiation. Surgical management of liver cancer: Surgical excision (lobectomy) is sometimes performed if the tumor is localized to one portion of the liver. Surgical excision or transplantation offers the only chance for cure. Medical management of liver cancer

70. P atient with liver carcinoma focus on keeping the patient as comfortable as possible. Improve nutritional status. Provide skin care. Maintain fluid and electrolytes balance. Nursing Interventions

71. Liver Cirrhosis Cirrhosis is a chronic, degenerative disease of the liver in which the lobes become covered with fibrous (scar) tissue, the parenchyma is a functional tissue of an organ. connective tissue degenerates, the lobules are infiltrated with fat. The overgrowth of new and fibrous tissue restricts the flow of blood to the organ, which contributes to its destruction. Hepatomegaly (enlargement of the liver) and liver contraction (occurs later in the disease) cause loss of the organ's function.

72. Heavy alcohol consumption Exposure to hepatotoxins (e.g., industrial chemicals), or infection. Primary destruction of the bile ducts due to inflammation, it resulting damage to the ducts leads to bile backing up into the liver. Secondary biliary cirrhosis is caused by chronic biliary tree obstruction from gallstones, chronic pancreatitis, a tumor, cystic fibrosis, or biliary atresia (the absence of or underdevelopment of biliary structures that is congenital in nature) in children. Patients with a diagnosis of chronic Patient with chronic hepatitis B and C. Causes of liver cirrhosis

73. Due to causative factor such as hepatitis, alcohol etc Development of scar tissues that replace the normal parenchyma This fibrosis blocks the portal circulation of blood through the organ distributing normal function. Activation of hepatic stellate cells which increase the fibrosis by producing myofibroblast Formation of macro and micro nodules Decreased blood flow Occurs cirrhosis and portal hypertension Pathophysiology

74. Liver easier to palpate and abdominal pain may be present R apid enlargement produces tension on the organ's fibrous covering. Dyspepsia C hanges in bowel habits G radual weight loss A scites , E nlarged spleen Malaise Nausea Jaundice Ecchymosis (a discoloration of the skin resulting from bleeding underneath) Anemia Manifestation of liver cirrhosis

75. Check electrolyte values P rotein and serum albumin L ow blood glucose (hypoglycemia) from impaired ERCP (to detect common bile duct obstruction ) E sophagoscopy with barium to visualize esophageal varices, scans and biopsy of the liver. Ultrasonography are used to diagnose cirrhosis. Paracentesis (a procedure in which fluid is withdrawn from the abdominal cavity) relieves ascites and examination . Diagnostic test for liver cirrhosis

76. D ecrease the buildup of fluids in the body, prevent further damage to the liver, and provide individual supportive care. Eliminating alcohol, hepatotoxins (e.g., acetaminophen [Tylenol]), or environmental exposure to harmful chemicals is essential to prevent further damage to the liver. Diet therapy is aimed at correcting malnutrition, promoting the regeneration of functional liver tissue , and compensating for the liver's inability to store vitamins. Medical management of liver cirrhosis

77. A diet that is well balanced, moderately high in protein, low in fat, low in sodium and with additional vitamins and folic acid will usually meet the needs of the patient with cirrhosis and improve deficiencies. Antiemetic may be prescribed to control nausea or vomiting. Vitamin supplements include vitamin K , vitamin C, and folic acid. Salt-poor albumin may be administered. Medical management of liver cirrhosis

78. Paracentesis : in which fluid is removed from the abdominal cavity by either on gravity or vacuum, provides temporary relief from ascites . H epatic   resection : A  liver resection is the surgical removal of all or a portion of the liver. It is also referred to as a hepatectomy, full or partial. Surgical management of liver cirrhosis

79. S hunt procedures for portal hypertension : the basic surgical choices for diversion of the portal venous flow . Transjugular Intrahepatic Portosystemic Shunt ( TIPS) Liver  transplantation : replacement of a diseased liver with the healthy liver.  Cont…

80. Check vital signs every 4 hours, or more often if evidence of hemorrhage is present. Observe the patient for GI hemorrhage as evidenced by hematemesis, melena, anxiety, and restlessness. Most patients require a well-balanced, moderate, high-protein, high-carbohydrate diet with adequate vitamins. With impending liver failure, protein and fluids are restricted. Provide frequent oral hygiene and a pleasant environment to help the patient increase food intake . Nursing intervention of liver cirrhosis

81. A major nursing focus for many patients is to help them deal with alcoholism. This requires establishing trust that the health team is interested in the patient's well-being . The patient with cirrhosis is prone to skin lesions and pressure sores. Initiate preventive nursing interventions to avoid impairment of skin integrity . Provide pressure air mattress, frequent turning, and back rubs, Apply soothing lotion to relieve pruritus . Cont…

82. Observe the patient's mental status and report changes such as disorientation, headache, or lethargy . Assist in activities of daily living (ADLs) as needed to promote good hygiene. Observe for edema by measuring ankles daily, and observe for ascites by measuring abdominal girth. Record accurate I&O and daily weight. Promote patient’s self-esteem and emotional support. Cont…

83. References Suzanne C. Smeltze , B. G. B. J. Y. J., 2016. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 10th ed. s.l.:Lippincott Williams & Wilkins . Norris, T. L. (2019). Porth's Pathophysiology Concepts of Altered Health States (Tenth Edition ed.). Philadelphia: Wolters Kluwer