Hepatobiliary- Chap 44
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- DNA virus transmitted from mother to baby, IV drug use, accidental needle stick, mucosal exposure to infectious blood, blood products, & other bodily fluids. There is no evidence that urine, feces (without GI bleeding), breastmilk, tears, & sweat are infective. It is a sexually transmitted disease. It can live on a dry surface for up to 7 days. It is more infectious than HIV. Impacts nutrition.
- Pt needs a high calorie diet, vitamin supplements (Vit B & Vit K). Fluid & electrolyte balance must be maintained.
- Vaccine is given in a series of 3 doses. The 2nd dose is given 1 month after the initial dose & the 3rd dose is given 6 months after the initial dose.
- RNA virus that is primarily transmitted through the fecal-oral route (by ingesting food or liquid contaminated with the virus), bodily fluids, & IV drug use.
- Bed rest, activity, nutrition, & sanitation
Preventative measures: personal & environmental hygeine, good health education. Vaccination should be given to children over the age of 1. HAV vaccine contains an inactivated form of Hep A & it is primarily a single dose given IM in the deltoid. A booster may be given 6-12 months after the initial dose.
Inflammation of the liver. Viral hepatitis is the most common. Types of viral hep are A,B,C,D,E, & G
Types of Jaundice
- Hemolytic- Due to an increased breakdown of RBC's, which produces an increased amount of unconjugated bilirubin in the blood.
- Hepatocellular- Altered ability in the liver to take up bilirubin from the blood or to conjugate (excrete) it. In hepatocellular disease, hepatocytes are damaged and leak bilirubiin thus increasing levels of conjugated bilirubin. Mostly caused by cirrhosis, hepatitis, & hepatocellular carcinoma.
- Obstructive- Due to decreased/obstructed flow of bile through the liver or biliary tract system. May occur in intrahepatic or extrahepatic bile ducts
- RNA virus transmitted percutaneously (IV drug use), blood, bodily fluids, sexual activity with infected partners.
- No vaccine available
Single stranded RNA virus that cant survive on its own. Hep D needs Hep B to replicate. It can be acquired at the same time as Hep B. There is no vaccine for Hep D, but the Hep B vaccine reduces the risk of Hep D co-infection.
RNA virus transmitted through the fecal-oral route. Usual mode of transmission is drinking contaminated water. Hep E is a co-infection of Hep A.
Poorly characterized parenterally & sexually transmitted virus. It can coexist with other viral infections (HBV, HCV, & HIV), but it doesn't appear to cause liver damage on its own.
No specific tx or therapy. Adequate nutrients, rest, well balanced diet, bed rest, vitamin supplements ( B & K), & avoid alcohol & drugs detoxified by the liver. Fluid & electrolyte balance must be maintained. For severe n/v IV solutions of glucose or supplemental enteral nutrition may be used.
Comfort measures to relieve pruritus (if present), HA, & arthralgias. Anorexia & distaste for food can cause nutritional problems, so give pt small frequent meals, avoid carbonated drinks, & avoid very hot or very cold foods. Fluid intake should be 2500-3000ml/day. Rest is essential.
Fulminant Hepatic Failure (Acute liver failure)
Characterized by severe impairment of liver function associated with encephalopathy. Most common cause is drugs (acetaminophen), in combination with alcohol. Drugs can cause liver cell failure by disrupting essential intracellular processes leading to an accumulation of toxic substances in the body. It's characterized by rapid onset of liver dysfunction in someone with no prior hx of liver disease.
Liver Failure Manifestations
Jaundice, coagulation abnormalities, & encephalopathy. First sign is change in mentation. There is an elevation in bilirubin levels & PTT is prolonged. AST & ALT levels are elevated.Hypoglycemia may be present.
Liver Failure Diagnostics
Liver Function tests, CBGs, serum bilirubin, acetaminophen levels, other drug screening, screening for HAV & HBV, serum ceruloplasmin, iron levels, autoantibodies, & amonia levels
Liver Failure Tx
Liver Failure Management
Frequent LOC checks, provide quiet environment, monitor I&O, CBGs, elevate HOB 30 degrees, avoid pt stimulation, electrolyte & fluid balance,avoid use of sedatives, ICP should be maintained below 20-25 mm Hg, support of systemic BP may be required, padding on bed rails in case of seizure activity, provide good skin & oral care.
Common site for metastasis due to high rate of blood flow & extensive capillary network. Primary liver tumors commonly metastasize to the lungs.
Liver Cancer Manifestations
- Early stages: hepatomegaly, splenomegaly, jaundice,wt loss, peripheral edema, ascites, portal hypertension.
- Other S/S: dull abd pain in RUQ, n/v, anorexia, increased abd girth, pulmonary emboli & portal vein thrombosis.
Liver Cancer Diagnostics
U/S, CT, MRI, resonance angiography, hepatic angiography, percutaneous biopsy, & endoscopic retrograde cholangiopancreatography.
Risks of biopsy are bleeding & potential tumor cell spread.
Liver Cancer Management
- Sx excision if there is no evidence of portal HTN, normal liver function, & no evidence of invasion of hepatic blood vessels.
- Radiofrequency albation
- Alcohol injection
- Chemotherapy/ chemoemobilization
An acute inflammation of the pancreas. It affects men and women equally. Its primarily caused by a biliary tract disease
Acute Pancreatitis Manifestations
abd pain (ULQ) that can radiate to the back, pain is sudden, severe, deep, piercing, & continuous/steady, n/v, low grade fever, leukocytosis, hypotension, tachycardia, & jaundice. pain is made worse with eating and is not alleviated with vomiting. pain may be accompanied by flushing, cyanosis, & dyspnea.
Yellowish discoloration of body tissues, resulting from an alteration in normal bilirubin metabolism or flow of bile. Jaundice results when the concentration in bilirubin in the blood becomes abnormally increase.
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