DISORDERS OF LIVER, PANCREAS AND BILIARY TRACT
Download as PPTX, PDF35 likes8,287 views
This document provides information on various disorders of the liver, pancreas, and biliary tract. It begins with an introduction to cirrhosis of the liver, including its definition, incidence, causes such as alcoholism and hepatitis, types, pathophysiology, clinical manifestations, diagnostic studies, medical and surgical management, complications, and nursing management. It then covers topics such as jaundice, hepatitis, liver abscess, Wilson's disease, Gilbert's syndrome, haemochromatosis, portal hypertension, and ascites. For each topic, it provides definitions, incidence, causes, pathophysiology, clinical manifestations, diagnostic studies, management, and other relevant details.
DISORDERS OF LIVER, PANCREAS AND BILIARY TRACT
- 1. WELCOME SEMINAR ON DISORDERS OF LIVER ,PANCREAS AND BILIARY TRACT
- 2. LIVER
- 4. INTRODUCTION Liver is normally able to regenerate damaged cells. Cirrhosis develops when the factor damage the liver such as alcohol and chronic infections are present over a long period of time. When this happens, the liver become injured and scarred. A scarred liver cannot function properly and cirrhosis results.
- 5. DEFINITION: Cirrhosis is a chronic disorder characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver.
- 6. INCIDENCE: Cirrhosis and chronic liver diseases were the tenth leading cause of death for men and twelth leading cause of death in women. In India 2,08,185 total deaths due to cirrhosis. The age adjusted death rate is 23.59 per 1,00,000 of population ranks India 27 in world.
- 7. CAUSES: Alcholism Hepatitis B and C Fatty liver disease Idiopathic
- 8. TYPES: Alcholic cirrhosis Post necrotic cirrhosis Biliary cirrhosis Cardiac cirrhosis
- 10. CLINICAL MANIFESTATIONS: Early manifestations Late manifestations GI disturbances Liver dysfunction Fever Portal hypertension Weight loss Endocrine problems Abdominal pain Peripheral neuropathy Enlargement of liver and spleen Mental deterioration
- 11. DIAGNOSTIC STUDIES: History collection Physical examination Serum levels AST, ALT, GGT Bilirubin tests Ultrasound CT, MRI Liver biopsy ABG analysis
- 12. MEDICAL MANAGEMENT: Anti-inflammatory drugs Anti-oxidants Pottassium-sparing diuretics Histamine 2 antagonist Vitamins and nutritional supplements
- 13. SURGICAL MANAGEMENT: LIVER TRANSPLATATION
- 14. COMPLICATIONS: Ascites Esophageal variceal bleeding Hepatic encephalopathy Infection Hepatocellular carcinoma Spontaneous bacterial peritonitis
- 15. NURSING MANAGEMENT: Promote rest Improving nutrition Providing skin care Reduce the risk of injury Managing and monitoring complications
- 16. JAUNDICE
- 17. INTRODUCTION: Jaundice causes your skin and the whites of your eyes to turn yellow. Too much bilirubin causes jaundice. Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in your red blood cells. The term jaundice comes from the French word jaune, meaning yellow.
- 18. DEFINITION: Jaundice (also known as icterus ) is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae (whites of the eyes), and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood).
- 19. INCIDENCE: Many healthy babies have some jaundice during the first week of life. It usually goes away. However, jaundice can happen at any age and may be a sign of a problem.
- 20. ETIOLOGY: Jaundice can happen for many reasons, such as Blood diseases Genetic syndromes Liver diseases, such as hepatitis or cirrhosis Blockage of bile ducts Infections Medicines
- 21. TYPES: Pre-hepatic jaundice Hepatic jaundice Post-hepatic jaundice
- 22. PATHOPHYSIOLOGY:
- 23. CLINICAL MANIFESTATIONS: The main symptom of jaundice is a yellow discoloration of the white part of the eyes (sclera) and of the skin. The conjunctiva of the eye are one of the first tissues to change color as bilirubin levels rise in jaundice. This is sometimes referred to as scleral icterus. However, the sclera themselves are not "icteric" (stained with bile pigment) but rather the conjunctival membranes that overlie them. The yellowing of the "white of the eye" is thus more properly termed conjunctival icterus.
- 25. ASSESSMENT AND DIAGNOSTIC STUDIES: This hyperbilirubinemia subsequently causes increased levels of bilirubin in theextracellular fluid. Concentration of bilirubin in blood plasma is normally below 1.2 mg/dL (<25μmol/L). A concentration higher than approx. 3 mg/dL (>50μmol/L) leads to jaundice. Laboratory findings include: Urine: no bilirubin present, urobilinogen > 2 units (i.e., hemolytic anemia causes increased heme metabolism; exception: infants where gut flora has not developed). Serum: increased unconjugated bilirubin.
- 26. MANAGEMENT: Correction of coagulopathy Fluid and electrollyte balance Low fatty spicy foods Blood transfusion if needed Antibiotics Encourage fluid and fiber diet Biliary drianage with ERCP(Endoscopic retrograde cholangiopancreatography)
- 28. INTRODUCTION: Hepatitis is an inflammation of the liver. Hepatitis is of various types that is: Viral hepatitis Non-viral hepatitis
- 29. VIRAL HEPATITIS: DEFINITION: It is a systemic viral infection in which necrosis and inflammation of liver cells produce a characteristic cluster of clinical, biochemical and cellular changes.
- 30. CLASSIFICATION: Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
- 31. INCIDENCE: Approximately 61000 cases occur in U.S and 10 million cases world wide The prevalance of HAV antibodies increases with age and most people older than 50 yrs of age have prior exposure.
- 32. ETIOLOGY: Viral hepatitis is caused by one of the major viruses that is A,B,C,D,E and G Other viruses include Cytomegalovirus Herpes virus Coxsackie virus Rubella virus
- 33. MODE OF TRANSMISSION: Over crowding Poor sanitation Faeceal-oral route Infected food handler Multiple sex partners Blood transfusions
- 34. CLINICAL MANIFESTATIONS: Flu like upper respiratory tract infections Low grade fever Anorexia Jaundice Indigestion Epigastric distress Nausea and vomitting Heart burn, flatulence
- 40. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Antigen test Blood tests Stool culture Polymerase chain reaction Biopsy
- 41. MEDICAL MANAGEMENT: Anti-viral agents Adequate bed rest Administer IV fluids Restrict the physical activity Frequent small feedings
- 42. VACCINATION:
- 43. PREVENTION: Vaccination Hand washing Safe drinking water Proper control of sewage disposal Caution about contaminated foods Health education
- 44. LIVER ABSCESS
- 45. DEFINITION: Liver abscess is accumulation or stagnantion of pus in the liver due to infection INCIDENCE: It is most commonly occurs in developing countries of the trophics and sub trophics due to poor sanitation and hygiene
- 46. TYPES: AMOEBIC LIVER ABSCESS PYOGENIC LIVER ABSCESS
- 47. ETIOLOGY: Cholangitis Benign loss malignant obstruction of biliary tree Abdominal trauma Infections
- 48. PATHOPHYSIOLOGY: Due to infection Infective organisms reach the liver through the biliary, portal arterial loss lymphatic system Bacterial toxins destroy the neighbouring liver cells Necrotic tissue serves a protective wall for the organisms
- 49. Leukocyte migrate serves a protective wall for the organism Abscess cavity full liquid containig living and dead leukocytes, liquefied liver cells, and bacteria LIVER ABSCESS
- 50. CLINICAL MANIFESTATIONS: Fever with chills Diaphoresis Malaise Anorexia Dull abdominal pain Tenderness in right upper quadrant Anemia
- 51. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Blood culture Aspiration of liver abscess guided by ultrasound CT MRI Percutaneous drainage of pyogenic abscess
- 52. MEDICAL MANAGEMANT: IV antibiotics thearpy depend on the organism Continuous supportive care is provided Open surgical drainage may be required if antibiotic thearpy and percutaneous drainage is ineffective A catheter is left in place for continuous drainage.
- 53. NURSING MANAGEMENT: Continuous monitoring of the drinage and skin care is provided Vital signs monitoring Administer antibiotics as prescribed Management of drainage
- 54. WILSONS DISEASE:
- 55. INTRODUCTION: Wilsons disease is a progressive, familial, terminal neurologic disease accompained by chronic liver disease leading to cirrhosis.It is associated with increased storage of copper.
- 56. DEFINITION: Wilsons disease is an inherited condition that causes the body to retain excess copper.
- 57. INCIDENCE: Wilsons disease occurs world wide with an average prevalance of 30 individuals per million population. Wilsons disease is an inherited disorder that affects about one to 4 in 30,000-1,00,000 individuals of any race or ethnicity. CAUSES: The condition is due to “mutations” in the wilson disease protein (ATP7B) gene.
- 58. PATHOPHYSIOLOGY: Due to etiological factors Copper accumulates in the liver Ceruminoplasmin is still secreted Terminated apoceruloplasmin
- 59. Rapidly degraded into the blood stream Clinical manifestations
- 60. CLINICAL MANIFESTATIONS: Corneal-kayser fleischer rings Neurological dysfunction Drooling Rigid dystonia Seizures Migrane Headache Insomnia
- 62. ASSESSMENT AND DIAGNOSTIC STUDIES History collection Physical examination Serum ALT and AST levels Serum uric acid level decreases Liver biopsy Genetic testing
- 63. MEDICAL MANAGEMENT: Generally pencillamine I the firt treatment used. Zinc actate Physical thearpy
- 64. SURGICAL MANAGEMENT: Liver transplantation
- 66. INTRODUCTION: Gilbert’s syndrome is often shortened to GS also called Gilbert-Meulengracht syndrome. DEFINITION: Gilberts syndrome is a genetic liver disorder and the most common hereditary cause of increased bilirubin and is found upto 5% of the population.
- 67. INCIDENCE: It is mostly seen in 5% of population Gilbert syndrome is closer to 10% of caucasian people. CAUSES: Idiopathic Genetic disorder Reduction activity of the enzyme.
- 68. PATHOPHYSIOLOGY: Due to etiological factors Reduced activity of enzyme gluuronyltransferase It conjugates bilirubin and a few other lipophilic molecules Conjugation renders bilirubin water-soluble Excreted in bile into the duodenum
- 69. CLINICAL MANIFESTATIONS: Mild jaundice Fatigue Difficulty in maintaining concebtration Loss of appetite Abdominal pain Weight loss Itching
- 70. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Increased bilirubin levels TREATMENT Gilbert syndrome usually doesnot need any treatment.
- 71. HAEMOCHROMATOSIS
- 72. INTRODUCTION: Haemochromatosis is a systemic disease that affecs the liver, heart, pancreas and the endocrine system. It is caused by increased and inappropriate absorption of dietary iron.
- 73. DEFINITION: Haemochromatosis is iron over load indicates accumulation of iron in the body from any cause. INCIDENCE: It is most common in white people and occurs in 0.6% of the population. It is uncommon in indian population due to low prevalance of gene associated with haemochromatosis.
- 74. CAUSES: Genetic disorder Transfusional iron over load (repeated blood transfusion) Increased and inappropriate absorption of dietary iron.
- 75. CLINICAL MANIFESTATIONS: Abdominal pain Weight loss Arthritis Joint pain and bone pain Lethargy Cirrhosis of liver
- 76. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Serum ferritin Liver biopsy MRI CT scan
- 77. MANAGEMENT: Phlebotomies Deferoxamine drug Dietary modifications such as avoidance of vitamin c and iron supplements, uncooked foods, and iron-rich foods. Complications include cirrrhosis, liver failure, hepatic carcinaoma, and cardiac failure
- 79. DEFINITION: The normal venous pressure is 5-10 mm of Hg. A wedged hepatic venous pressure or direct portal pressure that is more than 5 mm of Hg greater than the inferior vena caval pressure, a splenic pressure of more than 15 mm of Hg measured at suregry of greater than 30 cm water is abnormal and indicates the presence of portal hypertension.
- 80. CAUSES: Idiopathic Increased portal venous blood flow Splenomegaly Thrombosis Liver diseases Congenital hepatic fibrosis Prolonged ingestion of arsenic
- 81. PATHOPHYSIOLOGY: Due to etiological factors Increased blood flow in the portal vein Increased hepatic arterial flow Increased resistance PORTAL HYPERTENSION
- 82. CLINICAL MANIFESTATIONS: Splenomegaly Ascites Varices Weight gain Lethargic Fatigue Nausea Vomiting
- 83. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Ultrasonography Splenoportography Angiography Measurements of portal venous pressure Doppler ultrasound Liver biopsy
- 84. MANAGEMENT: Hepatic vein catheterization Direct transhepatic portal venous pressure Measurement of hepatic artey and portal venous blood flow
- 85. ASCITES
- 86. DEFINITION: Ascites is the accumulation of the serous fluid in the peritoneal or abdominal cavity
- 87. CAUSES: Cirrhosis of liver Variceal bleeding Hepatic encephalopathy Jaundice Portal hypertension Increased flow of hepatic lymph Impaired water excretion
- 88. PATHOPHYSIOLOGY: Due to etiological factors(cirrhosis of liver) Splenic arterial vasodilatation Decreased in circulating arterial blood volume Activation of renin angiotensin and symathetic nervous system
- 89. Kidney retains sodium and water Hypervolemia Edema formation ASCITES
- 90. CLINICAL MANIFESTATIONS: Increased abdominal girth Weight gain Bulging flanks Shortness of breathe Fluid and electrollyte imbalances Straie, distended veins Umbilical hernia
- 91. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Ultrasound Doppler examination Serum levels Ascites total protein and serum ascites albumin gradient is 1.1g/dl
- 93. MANAGEMENT: Sodium restriction Diuretics Large volume paracentesis Transjugular intrahepatic portosystemic shunt Peritovenous shunt Liver transplantation
- 95. DEFINITION: Fluminant hepatic failure or liver failure is a clinical syndrome characterized b severe impairement of liver function associated with hepatic encephalopathy.
- 96. INCIDENCE: It is uncommon with approximately 2,000 cases per year in the united states. It develops within 8 weeks after the first symptom of jaundice The survival rate is approximately 50%-80% It is common in men than in women
- 97. ETIOLOGY: Hepatotrophic viruses e.g:hepatitis A,B,C,D,E viruses Paromyxovirus Systemic viral infections Drug induced acute liver failure Metabolic causes Malignancie
- 98. PATHOPHYSIOLOGY: Due to etiological factors Disruption in the essential intracellular processes Accumulation of toxic metabolic products Liver cell failure
- 99. CLINICAL MANIFESTATIONS: Anorexia, nausea Epigastric and upper abdominal distress Abdominal pain and GI bleeding Tacchycardia Oliguria, hyponatremia, hypokalemia Altered mental status Cerebral edema Hepatic encephalopathy
- 100. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Doppler sonogram ABG analysis Elevation of serum alkaline, AST, ALT Blood culture Chest x-ray Echocardiography Coagulation studies
- 101. MANAGEMENT: Administration of life saving antibodies Fluid and electrollyte balance N-acetylcysteine for acetaminophen toxixity Plasmapharesis Prostaglandins thearpy Extra corporeal liver assist devices Bio artificial liver Liver transplantation
- 102. CANCER OF THE LIVER
- 103. DEFINITION: Hepatic tumours may be benign or malignant. It is an abnormal proliferation of cells in the liver. INCIDENCE: It is most frequently in women in their reproductive years
- 105. ETIOLOGY: Chronic infections Hepatitis B and C Exposure to certain chemical toxins Cigaratte smoking Alchol use
- 106. CLINICAL MANIFESTSTIONS: Pain in epigastric right upper quadrant or back Weight loss Loss of sterngth Anorexia Anemia Jaundice Ascites
- 107. ASSESSMENT AND DISGNOSTIC STUDIES: History collection Physical examination Increased serum bilirubin and alkaline Leukocytosis Erythrocytosis X-ray CT scan, MRI Arteriograpy, laproscopy Liver biopsy
- 108. MEDICAL MANAGEMENT: Chemothearpy Radiation thearpy Anti-neoplastic agents Percutaneous biliary drinage Transcatheter arterial embolization
- 109. SURGICAL MANAGEMENT: Lobectomy Cryosurgery Liver transplantation
- 110. NURSING MANAGEMENT: Constant infusion of 10% glucose may be required in first 48hrs to prevent fall in blood glucose levels Close monitoring Hydration Health education Psychological reassurance
- 111. CHOLECYSTITIS
- 112. DEFINITION: Cholecystitis is defined as acute inflammation of gallbladder. INCIDENCE: It is more common after 40 yrs of age, especially in women It is uncommon in chidren and young women
- 113. CLASSIFICATION: Acute cholecystitis Chronic cholecystitis Calculous cholecystitis Acalculous cholecystitis
- 114. ETIOLOGY: Gall stones Emphysema of the gall bladder Intestinal organisms like E.coli Cytomegalovirus and cryptosporidium Generalized peritonitis
- 115. PATHOPHYSIOLOGY: Due to formation of gall stones It obstructs the bile out flow Bile in gall bladder intiates a chemical recation Autolysis and edema occurs, and blood vessel are compressed It results in gangrene of the gall bladder with perforation CHOLECYSTITIS
- 116. CLINICAL MANIFESTATIONS: Epigastric pain at right hypochondrial region Nausea and vomiting Flatulence Sweating patient with swallow Fever, Jaundice Murphys sign:Right hypochondrial tenderness is present and is exacerbated by inspiration Muscle grading and rebound tenderness
- 117. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Liver function test Abdominal radiography Ultrasound
- 118. MANAGEMENT: Analgesics like buphine and atropine is administered Antibiotics are given like amoxicillin Oral feedings are stopped and intravenous fluid administered The patient should be frequently observed with abdominal examination and sequential leukocyte cont
- 119. SURGICAL MANAGEMENT: Cholecystectomy Laproscopic cholecystectomy Endoscopic cholecystectomy Open cholecystectomy
- 120. CHOLEDOCHOLITHIASIS
- 121. DEFINITION: It is defined as formation of stones in the common bile duct is called choledocholithiasis. INCIDENCE: About 50% of patients with cholelithiasis have common bile duct stones It increase with age
- 122. ETIOLOGY: Common bile duct gall stones Cholangitis Carcinoma of bile duct and gall bladder Sclerosing cholangitis Metastatic carcinoma Haemophilia Biliary atrexia Choledochol cyst
- 123. CLINICAL MANIFEASATIONS: The classic traid of symptoms Right upper abdominal pain FEVER Jaundice Pain is colicky severe and persists for hours Vomiting Dark colour urine Faces are pale Itching
- 124. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Liver function test Prolonged prothrombin time Radiography Ultrasonography Cholangiography
- 125. MANAGEMENT: Administer antibiotics Maintain fluid and electrollyte balance Maintain nutritional status Administer parenteral vit k of prothrombin time is prolonged Sphinterotomy Cholecystectomy
- 126. PANCREATITIS:
- 127. DEFINITION: Pancreatitis is defined as inflammation of the pancreas INCIDENCE: Men of 40-45 yrs of age Women f 50-55 yrs of age Hereditary Autodigestion of pancreas
- 128. ETIOLOGY: Use of alchol Spasm and edema Blunt abdominal trauma Peptic ulcer disease Ischemic vascular disease Hyperlipidemia, hypercalcemia Oral contraceptives
- 129. PATHOPHYSIOLOGY: Due to etiological factors Enter the common bile duct Lodge at the ampulla of vater Obstructing the flow of pancreatic juice Reflux of bile from common bile duct into the pancreatic duct
- 130. Activation of pancreatic enzymes Vasodilatation and increased vascular permeability Necrosis and erosion and haemorrhage
- 131. CLINICAL MANIFESTATIONS: Severe abdominal pain and back pain Low grade fever Leukocytosis Hypotension, tacchycardia, jaundice Bowel sounds decreased Cyanosis of abdominal wall Ecchymosis Mental confusion Agitation
- 133. ASSESSMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Serum and lipase levels Urinary amylase levels White blood cell count increses Elevated serum bilirubin levels Ultrasound CT-scan ERCP
- 134. MANAGEMENT: Parenteral nutrition Nasogastric suction Histamine 2 antagonist such as cimentidine and rantidine Proton pump inhibitors such as pantoprozole Laporotomy
- 135. PANCRATIC CANCER
- 136. DEFINITION: Pancreatic cancer occurs when cancer cells develop from the pancreas a glandular organ located behind the stomach. INCIDENCE: In 2012 pancreatic cancer of all types cause 330000 deaths globally the seventh most common cause of deth due to cancer.
- 137. RISK FACTORS: Age Sex Gender Cigaratte smoking Obesity Family history
- 139. CLINICAL MANIFESTATIONS: Pain in upper abdomen Painless jaundice Unexplained weight loss Dyspepsia Heartburn Trousseaus syndrome
- 140. ASSESMENT AND DIAGNOSTIC STUDIES: History collection Physical examination Leukocytosis Erythrocytosis X-ray CT scans, MRI Ultrasound studies Arteriography PET and biopsy
- 141. MANAGEMENT: Chemothearpy Radiation thearpy Anti-neoplastic agents Cryosurgery Cryoablation