Chapter 48 Liver, Biliary Tract and Pancreas Problems

The liver, pancreas, and gallbladder are closely positioned together anatomically and highly associated in their digestive functions. Nursing care focuses on helping the patient and caregiver manage symptoms and develop ways to cope with the diagnosis and sometimes, prognosis. Disorders of the Liver Hepatitis-the inflammation of the liver. • Most often caused by viruses. o Viral hepatitis is a public health problem • Other causes o Alcohol o Medications o Chemicals o Autoimmune diseases o Metabolic problems Viral hepatitis-there are several types. • Hepatitis A o A self-limiting infection that can cause a mild flu-like illness and jaundice. o Can cause acute liver failure o Transmitted primarily through the fecal-oral route. o Foodborne outbreaks are usually due to food that is contaminated by infected food handlers o The greatest risk of transmission occurs before clinical symptoms appear o Virus is found in feces 1 to 2 weeks before the onset of symptoms and at least 1 week after the onset o HAV vaccination and thorough hand washing are the best measures to prevent outbreaks. o Isolation is not needed for HAV, but if the patient is incontinent of stool or has poor hygiene, they should be placed in a private room. • Hepatitis B o A blood-borne pathogen that can cause either acute or chronic hepatitis o Several ways of transmission are ▪ perinatally from mothers infected with HBV to their infants ▪ percutaneously ▪ small cuts on mucosal surfaces and exposure to infectious blood, blood products, or other body fluids ▪ Sexual transmission o At-risk persons ▪ Those who live with chronically HBV-infected ▪ patients on hemodialysis ▪ health care personnel ▪ public safety workers ▪ IV drug users ▪ recipients of blood products ▪ Native Alaskans, Pacific Islanders, and Native Americans o If gastrointestinal (GI) bleeding occurs, feces can be contaminated with the virus from the blood. o There is no evidence of fecal-oral transmission o Organ and tissue transplantation is another potential source of infection o HBV is a complex structure with 3 distinct antigens: surface antigen (HBsAg), core antigen (HBcAg), and e antigen (HBeAg). o In most people who acquire HBV infection as an adult, the infection completely resolves without any long-term complications. o In chronic HBV infections, he liver may range from a normal-appearing liver to severe liver inflammation and scarring (fibrosis). o . HBsAg in the serum for 6 months or longer after infection indicates chronic HBV infection. o To prevent HBV, identify those at risk, screen them and vaccinate if not infected. o The first dose of Hep B vaccine should be given at age 6-18 months. • Hepatitis C o type of hepatitis that can result in both acute illness and chronic infection. o Acute Hep C can be hard to detect unless a diagnosis is made with laboratory testing. o Most common causes ▪ injection drug users ▪ MSM with HIV infection. ▪ High-risk sexual behavior o HCV is an RNA virus that is blood-borne and primarily transmitted percutaneously. o Most patients usually develop chronic infection. o Most people are unaware of their infection because symptoms are generally mild o HBV and HCV account for most cases of liver cancer o HCV is the most common reason for liver transplantation in the US. o A positive antibody test is usually enough for a diagnosis. o There is currently no vaccine for Hep C o Teach patient to modify high-risk behaviors, use infection control precautions, be screened. o Hep C patients are not recommended to have IG or antiviral agents. • Hepatitis D o also called delta virus o only those who are infected with HBV can be infected with HDV o it can be acquired at the same time as HBV o There is no vaccine for HDV • Hepatitis E o transmitted by the fecal-oral route. o The usual mode of transmission is drinking contaminated water. o occurs primarily in developing countries o Usually acute and self-resolving o Pregnant women may be affected severely Pathophysiology • During acute viral hepatitis, large numbers of infected hepatocytes are destroyed. This can lead to a wide range of liver-related dysfunction o Bile production, coagulation, blood glucose, and protein metabolism can be affected o Detoxification and processing of drugs, hormones, and metabolites (e.g., ammonia from protein catabolism) may be disrupted • Liver cells can regenerate after an acute infection • Chronic viral hepatitis and be silent causing destruction of infected hepatocytes • Scar tissue can develop and compromise liver function • Fibrosis can lead to cirrhosis and liver failure Systemic effects • The manifestations of this activation are rash, angioedema, arthritis, fever, and malaise. • Cryoglobulinemia (abnormal proteins found in the blood), glomerulonephritis, vasculitis, and involvement of other organs can occur from immune complex activation. Acute Hepatitis • In acute hepatitis, most patients have no symptoms and may not know they have been infected • Symptoms they may see o Amprexoa o Lethargy o Nausea o Vomiting o Skin rashes o Diarrhea