Nursing Care of Clients with

Gallbladder, Liver and

Pancreatic Disorders

Chapter 27

Liver, Gallbladder and Pancreas

Gallbladder Disorders
Cholelithiasis- Formation of stones
Cholecystitis-Inflammation of the
gallbladder
Patho&risk- age, hx, gender, OC
gallstones form due to
abnormal bile composition
biliary statis
inflammation of gallbladder

Gallbladder Disorders
Cholelithiasis

Acute cholecystitis

asymptomatic

RUQ pain - back

epigastric
fullness after
fatty meal

a/n/v

biliary colic
jaundice

fever with chills

Gallbladder Disorders
4 Treatment
laparoscopic cholecystectomy
4 Nursing Diagnoses
Pain
Imbalanced Nutrition
Risk for Infection

Liver

Hepatitis

Liver Disorders
4 Hepatitis
inflammation of the liver due to virus, ETOH,
drugs, toxins, may be acute or chronic
4 Viral Hepatitis
4 Hepatitis A - infectious hepatitis
fecal-oral route
benign, self-limiting

Liver Disorders
4 Hepatitis B
transmission - infected blood and body fluids
at risk - healthcare workers, drug users, multiple
sexual partners, hemodialysis clients

4 Hepatitis C
transmission - infected blood and body fluids
manifestations - mild, non-specific
world wide cause of chronic hepatitis

Liver Disorders
4 Disease pattern
Onset
Transmission
Carrier
Prevent
Treatment

Hepatitis
Course of acute viral hepatitis follows three
phases:
Preicteric- abruptly before jaundice
Icteric- after 5-10 days of exposure
Convalescent- well being improves, energy
increases, jaundice resolves.
See book.

Liver Disorders
4 Nursing Care
teaching
handwashing
blood and body fluid precautions
vaccines for persons at high risk

Advanced Cirrhosis

Liver Disorders
4 Cirrhosis
end state of chronic liver disease, progressive
and irreversible
alcoholic cirrhosis, biliary, or secondary to hepatitis

Manifestations
liver enlg. Tender, wt loss, weakness, anorexia
ascites, jaundice, edema, anemia,

Cirrhosis of the Liver

Functional liver tissue is gradually destroyed and replaced
with fibrous scar tissue, thus metobolic functions of the liver
are lost. The scar tissue forms constrictive bands in the liver
and disrupts blood and bile flow within the liver.
Impaired blood flow through the liver increases pressure in
the portal venous system, thus leading to many problems
including esophageal varices.
Discussion see book.

Cirrhosis of the Liver

As the liver is destroyed its ability to metabolize proteins is
impaired!!! Ammonia and toxic wastes accumulate in the
blood, these substances affect the CNS!!!
Hepatic Encephalopathy is the result of accumulated
ammonia and toxic wastes(protein). CM are altered levels of
consciousness, cognition and motor function.
Asterixis or liver flap is an early CM of hepatic
encephalopathy. This is a muscle tremor that causes
involuntary jerking movements that make it difficult to keep
the extremities still

Liver Disorders
4 Complications
portal hypertension
splenomegaly
ascites
esophageal varices
hepatic encephalopathy
hepatorenal syndrome

Hepatitis
Nursing CareSupportive care.
Prevent
transmission of
disease!!
Teaching needsIf at risk, need
vaccine!!!!!

ComplicationsCirrhosis!

Pancreatitis
4 Pancreatitis
inflammation of pancreas characterized by
release of pancreatic enzymes into pancreatic
tissue itself leading to hemorrhage and necrosis
4 Risk factors
alcoholism, gallstones

Pancreatitis
4 Manifestations
abrupt onset of severe epigastric/abdominal
pain
relieved by leaning forward, sitting up
initiated by fatty meal or alcohol intake

n/v
abd. distention and rigidity, decreased b.s.
fever, 24 hours later jaundice

Pancreatitis

Pancreatitis
4 Diagnostic tests
labs - amylase and lipase
Ultra sound, ERCP, C-T
scan, needle bx
4 Treatment
NPO,hydration, pain
control and antibiotics

Pancreatitis
Can be acute or chronic
Acute- middle life from gallstones and alcoholism which are
the primary risk factors
Chronic- Alcoholism is the primary risk factor.
Pancreatic duct obstruction by a gallstone or spasm of the
sphincter of oddi can obstruct the outflow of pancreatic
enzymes then auto digestion begins.
See text

Pancreatic Cancer
4 Very lethal
4 Risk factors
smoking, chemical or environmental toxins

4 Manifestations
non-specific, a/n, wt. loss, dull epigastric pain
4 Treatment
surgery - Whipple, radiation and chemotherapy

NCLEX
A client diagnosed with cholelithiasis requests
medication for pain relief. Which of the
following medications is the provider most
likely to prescribe?
A. Acetaminophen (Tylenol) D. ibuprofen
B. Meperidine (Demerol) (Motrin)
C. Morphine Sulfate

NCLEX
A client who was diagnosed with hepatitis A state he was told by the
nursing assistant that his disease could be transmitted only through
blood contact. The appropriate action by the nurse would be to:
A. Provide the correct information to the client and nursing assistant.
B. Take no further action because the information is correct.
C. Remove all precautions because hepatitis A cannot be transmitted
D. Place a sign on the clients door stating blood precautions.

NCLEX
A client is diagnosed with hepatitis B. Which
of the following information, if obtained
during the admission assessment would
indicate a risk factor?
A. She ate in a dirty restaurant 2 weeks ago
B. She uses barrier protection during sex
C. She is an intravenous drug user
D. She has never received a blood transfusion

NCLEX
The nurse is caring for a client with acute pancreatitis. Which
nursing assessment should receive the highest priority?
A. Assess intake and output
B. Assess cardiovascular status and fluid volume status
C. Assess bowel sounds and fecal output
D. Assess mental status

NCLEX
A client with cirrhosis is scheduled for discharge. The nurse
recognized the need for further teaching if the client states
A. I will use a soft toothbrush for oral hygiene
B. I will maintain a low-protein diet
C. I will report increased difficulty breathing to my provider
D. I will limit alcohol intake to two servings per day

NCLEX
A 45 year old client with liver disease is prescribed lactulose
(Chronulac) 30 ML every 6 hours. Recognizing the action
of this medication in the treatment of liver disease, the
nurse would expect to assess which positive response to
the medication?
A. Increased urine output
B. Reduced serum ammonia levels
C. Reduced steatorrhea
D. Increased serum potassium levels

NCLEX
A patient tells the nurse that his bowel movements are weird
in that they look soapy and smell really bad. The nurse
realizes that this client might be experiencing:
A. A. an obstructed gallbladder
B. B. turners sign
C. C .cullens sign
D. D. steatorrhea

Ammonia Levels and liver failure

Ammonia levels are elevated because of inability of the liver
to metabolize protein products. The medication Lactulose
increases the absorption of ammonia from the bowel, thus
reducing blood ammonia levels.
What do we see clinically in a patient whos blood ammonia
levels are too high from liver cirrhosis?
What is Asterixix?
What type of diet should the patient with cirrhosis of the liver
and hepatic encephalopathy be prescribed?

Pancreatitis
Acute- The pancreas is damaged or its duct to the duodenum
is blocked, allowing pancreatic enzymes to accumulate
within the pancreas.
Pancreatic duct obstruction by a gallstone or spasm of the
sphincter of Oddi which is associated with alcohol use can
obstruct the outflow of pancreatic enzymes. This creates
autodigestion. Steatorrhea- Fatty stool. Alcoholism is the
primary risk factor for chronic pancreatitis in the US.
Labs of importance:
Serum amylase and lipase will be elevated during
pancreatitis.