1. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Chapter 44 Nursing Management Liver, Pancreas, and Biliary Tract Problems

2. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Jaundice  Hemolytic jaundice  Hepatocellular jaundice  Obstructive jaundice

3. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-1

4. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Disorders of the Liver

5. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis  Etiology  Hepatitis A virus  Hepatitis B virus  Hepatitis C virus  Hepatitis D virus  Hepatitis E virus  Hepatitis G virus

6. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-2

7. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-3

8. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (cont’d)  Pathophysiology  Liver  Systemic effects  Clinical manifestations  General considerations  Complications  Fulminant hepatitis

9. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (cont’d)  Diagnostic studies  Collaborative care  Drug therapy Chronic hepatitis B Chronic hepatitis B  α-Interferon  Nucleoside analogs Chronic hepatitis C Chronic hepatitis C  Prevention Hepatitis A Hepatitis A Hepatitis B Hepatitis B Hepatitis C Hepatitis C  Nutritional therapy

10. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Hepatitis  Nursing assessment  Nursing diagnoses  Planning

11. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Hepatitis (cont’d)  Nursing implementation  Health promotion Hepatitis A Hepatitis A Hepatitis B Hepatitis B Hepatitis C Hepatitis C  Acute intervention Jaundice Jaundice Rest Rest  Ambulatory and home care  Evaluation

12. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (cont’d)  Control of hepatitis in health care personnel  Hepatitis A  Hepatitis B  Hepatitis C

13. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Toxic and Drug-Induced Hepatitis

14. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Autoimmune/Metabolic/Genetic Liver Diseases  Autoimmune hepatitis  Wilson’s disease  Hemochromatosis  Primary biliary cirrhosis  Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis  Clinical manifestations and diagnostic studies  Collaborative care

15. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Cirrhosis  Etiology and pathophysiology  Clinical manifestations  Early manifestations  Later manifestations Jaundice Jaundice Skin lesions Skin lesions Hematologic problems Hematologic problems Endocrine problems Endocrine problems Peripheral neuropathy Peripheral neuropathy

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18. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-6

19. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Cirrhosis (cont’d)  Complications  Portal hypertension and esophageal and gastric varices  Peripheral edema and ascites  Hepatic encephalopathy  Hepatorenal syndrome

20. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-7

21. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-8

22. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Cirrhosis (cont’d)  Diagnostic studies  Collaborative care  Ascites Peritoneovenous shunt Peritoneovenous shunt  Esophageal and gastric varices Long-term management Long-term management Shunting procedures Shunting procedures  Hepatic encephalopathy  Drug therapy  Nutritional therapy

23. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-9

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26. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-12

27. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Cirrhosis  Nursing assessment  Nursing diagnoses  Planning

28. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Cirrhosis (cont’d)  Nursing implementation  Health promotion  Acute intervention Bleeding varices Bleeding varices Hepatic encephalopathy Hepatic encephalopathy  Ambulatory and home care  Evaluation

29. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fulminant Hepatic Failure  Clinical manifestations and diagnostic studies  Collaborative care  Nursing management: Fulminant hepatic failure

30. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Liver Cancer  Clinical manifestations and diagnostic studies  Nursing and collaborative management: Liver cancer

31. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-13

32. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Liver Transplantation

33. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Gerontologic Considerations Liver Disease in the Older Adult

34. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Disorders of the Pancreas

35. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Acute Pancreatitis  Etiology and pathophysiology  Clinical manifestations  Complications  Diagnostic studies

36. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-14

37. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-15

38. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Acute Pancreatitis (cont’d)  Collaborative care  Conservative therapy  Surgical therapy  Drug therapy  Nutritional therapy

39. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Acute Pancreatitis  Nursing assessment  Nursing diagnoses  Planning  Nursing implementation  Health promotion  Acute intervention  Ambulatory and home care  Evaluation

40. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Chronic Pancreatitis  Etiology and pathophysiology  Clinical manifestations  Diagnostic studies  Collaborative care

41. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Chronic Pancreatitis

42. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pancreatic Cancer  Etiology and pathophysiology  Clinical manifestations  Diagnostic studies  Collaborative care  Nursing management: Pancreatic cancer

43. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 44-16

44. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Disorders of the Biliary Tract

45. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Cholelithiasis and Cholecystitis  Etiology and pathophysiology  Cholecystitis  Cholelithiasis  Clinical manifestations  Complications  Diagnostic studies

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48. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Cholelithiasis and Cholecystitis (cont’d)  Collaborative care  Conservative therapy Cholecystitis Cholecystitis Cholelithiasis Cholelithiasis  Surgical therapy  Transhepatic biliary catheter  Drug therapy  Nutritional therapy

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51. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Gallbladder Disease  Nursing assessment  Nursing diagnoses  Planning

52. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Gallbladder Disease (cont’d)  Nursing implementation  Health promotion  Acute intervention Postoperative care Postoperative care  Ambulatory and home care  Evaluation

53. Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Gallbladder Cancer