1. Gastrointestinal & Hepatic- Biliary Systems Chapter 5 Part II

2. Objectives Discuss the common illnesses/ conditions involving the hepatic/biliary organs Discuss the common illnesses/ conditions involving the hepatic/biliary organs  signs & symptoms  etiology  management

3. Hepatic-Biliary Diseases Hepatitis Hepatitis Gallstones & Gallbladder disease Gallstones & Gallbladder disease Acute & chronic pancreatitis Acute & chronic pancreatitis

4. Hepatic-Biliary Diseases Hepatitis Hepatitis AAAA  contracted orally (usually through food)  persons infected with A usually recover fully  B, C, & D  contracted through contact with body fluids  B & C cause the most damage to the liver

5. Hepatic-Biliary Diseases Hepatitis Hepatitis  Signs & Symptoms  Jaundice  Fatigue  Loss of appetite  Dark urine  Light stools  Diarrhea  Fever  Joint pain  Pain in RUQ  Enlarged liver

6. Hepatic-Biliary Diseases Hepatitis Hepatitis  Management  No specific medical treatment  Sometimes antiviral meds are used  Prevention of spread of disease Hand-washingHand-washing Proper protection (gloves, etc.)Proper protection (gloves, etc.) VaccinationVaccination

7. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Cholelithiasis – formation of gallstones within the gallbladder or bile ducts  more common among women than men  gallstones may be present without producing symptoms  symptoms begin when stones obstruct abiliary duct

8. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Cholelithiasis – etiology  obesity  high calorie diets  oral contraceptives  multiple pregnancies  increasing age

9. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Cholelithiasis – signs & symptoms  acute onset of pain in URQ  radiating pain to shoulder and back (shoulder blade)  nausea, vomiting  flatulence, belching, & heartburn  tend to follow large meals or fatty foods

10. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Cholelithiasis – diagnostic procedures  diagnostic ultrasound

11. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Cholelithiasis – management  laparoscopic cholecystectomy to remove gallbladder IF symptoms don’t subside on their own

12. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Acute cholecystitis  Severe inflammation of the interior wall of the gallbladder

13. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Acute cholecystitis – etiology  obstruction of bile ducts by gallstones  pressure from accumulated bile in the gallbladder  chemical changes in the bile  secondary infection from multiplying bacteria

14. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Acute cholecystitis – signs & symptoms  gradual onset of pain in URQ localized over gallbladder  nausea, vomiting  low grade fever

15. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Acute cholecystitis – diagnostic procedures  Blood tests  Diagnostic ultrasound  Abdominal x-ray

16. Hepatic-Biliary Diseases Gallstones & gallbladder disease Gallstones & gallbladder disease  Acute cholecystitis – management  dietary changes  medication to reduce inflammation and/or spasm of gallbladder

17. Hepatic-Biliary Diseases Acute Pancreatitis Acute Pancreatitis  severe, life-threatening inflammation of the pancreas  pancreatic enzymes begin digesting pancreatic tissue producing:  swelling  tissue necrosis  hemorrhage

18. Hepatic-Biliary Diseases Acute Pancreatitis – etiology Acute Pancreatitis – etiology  alcoholism  gallstones  trauma to abdomen  viral infections  drug reations  pancreatic cancer  complications from a duodenal ulcer

19. Hepatic-Biliary Diseases Acute Pancreatitis – signs & symptoms Acute Pancreatitis – signs & symptoms  sudden onset of severe, persistent abdominal pain  centered over epigastric region  may radiate pain toward back  abdominal tenderness  abdominal distension (not always present)  persistent vomiting  alterations in vitals  fever  tachycardia  rapid, shallow respirations  decrease in blood pressure

20. Hepatic-Biliary Diseases Acute Pancreatitis – diagnostic procedures Acute Pancreatitis – diagnostic procedures  blood tests  elevated level of amylase enzyme  diagnostic ultrasound  abdominal CT scan

21. Hepatic-Biliary Diseases Acute Pancreatitis – management Acute Pancreatitis – management  Aimed at reducing symptoms  maintain circulation & fluid volume through IV  decrease pain  decrease pancreatic secretions

22. Hepatic-Biliary Diseases Chronic Pancreatitis Chronic Pancreatitis  Slow, progressive destruction of pancreatic tissue accompanied by:  inflammation  fibrosis  dilation of pancreatic ducts

23. Hepatic-Biliary Diseases Chronic Pancreatitis – etiology Chronic Pancreatitis – etiology  Most commonly associated with alcoholism

24. Hepatic-Biliary Diseases Chronic Pancreatitis – signs & symptoms Chronic Pancreatitis – signs & symptoms  severe, persistent, dull abdominal pain  pain that worsens after a meal  weight loss

25. Hepatic-Biliary Diseases Pancreatic cancer – signs & symptoms Pancreatic cancer – signs & symptoms  severe, persistent, dull abdominal pain  pain in midback  pain that worsens after a meal  weight loss  jaundice  weakness  fatigue  diarrhea  nausea  vomiting

26. Hepatic-Biliary Diseases Pancreatic cancer – management Pancreatic cancer – management  Palliative – aimed at making person comfortable by managing pain  most pancreatic cancers are diagnosed after they have metastasized to the lungs, liver, and bones  80-85% of cases are advanced at first diagnosis

27. Questions?