Overview
This lecture covers the nursing management of hepatic (liver) and biliary (gallbladder) disorders, focusing on pathophysiology, clinical manifestations, and management strategies for conditions like jaundice, portal hypertension, hepatitis, cirrhosis, and gallbladder disease.
Manifestations of Hepatic Dysfunction
- Jaundice results from impaired bilirubin metabolism and presents as yellowing of skin/eyes and other symptoms.
- Four types of jaundice: hepatocellular, obstructive, hemolytic, and hereditary hyperbilirubinemia.
- Portal hypertension is increased pressure in the portal vein, mainly due to cirrhosis, leading to complications like ascites and esophageal varices.
- Ascites is fluid accumulation in the peritoneal cavity, managed by sodium restriction, diuretics, paracentesis, or TIPS procedure.
- Esophageal varices are dilated veins at high risk for bleeding; managed by medications, endoscopic therapies, or TIPS.
Hepatic Encephalopathy and Nutritional Deficiencies
- Hepatic encephalopathy is due to ammonia build-up; symptoms range from mild confusion to coma.
- Treatment includes lactulose to promote ammonia excretion (goal: 2-3 soft bowel movements/day).
- Vitamin deficiencies from liver dysfunction can cause night blindness (A), skin/mucous lesions (B2, B6), scurvy (C), and bleeding (K).
Hepatitis Types and Management
- Hepatitis A: transmitted fecal-oral; prevent with hand hygiene and vaccination; supportive care is key.
- Hepatitis B: transmitted via blood, saliva, semen; prevent with vaccine, safe practices; treat with antivirals and monitoring.
- Hepatitis C: mainly bloodborne; often leads to chronic disease; managed with antivirals and risk-reduction education.
- Non-viral hepatitis: often due to alcohol or drugs; managed with abstinence, nutrition, and stopping offending agents.
Cirrhosis (Cirrhosis)
- Characterized by fibrotic replacement of normal liver tissue.
- Compensated cirrhosis may be asymptomatic or show nonspecific symptoms.
- Decompensated cirrhosis presents with ascites, jaundice, edema, bleeding, and hepatic encephalopathy.
- Nursing management includes rest, skin care, injury prevention, and monitoring for complications.
Biliary Disorders: Gallstones and Cholecystitis
- Gallstones (cholelithiasis) can cause pain, GI distress, and complications like cholecystitis or peritonitis.
- Cholecystitis is acute inflammation of the gallbladder, often due to stones; diagnosed by Murphy's sign and imaging.
- Management includes bowel rest, fluids, antibiotics, pain management, and possibly surgery.
Key Terms & Definitions
- Jaundice — yellowing of skin/eyes from bilirubin accumulation.
- Portal Hypertension — increased pressure in portal vein system.
- Ascites — fluid buildup in peritoneal cavity.
- Esophageal Varices — dilated veins in lower esophagus prone to bleeding.
- Hepatic Encephalopathy — brain dysfunction from liver failure and ammonia buildup.
- Cirrhosis — replacement of normal liver tissue with fibrosis, impairing function.
- Cholelithiasis — gallstone formation in gallbladder.
- Cholecystitis — inflammation of the gallbladder.
Action Items / Next Steps
- Review YouTube videos on paracentesis, TIPS, and cholecystectomy as assigned.
- Read Table 24-2 (stages of hepatic encephalopathy) in textbook.
- Follow up on dietary restrictions (low sodium for ascites, avoid high-fat foods post-cholecystectomy).
- Complete assigned readings on hepatitis types and management.