Gastrointestinal & Hepatic-Gastrointestinal & Hepatic-Biliary SystemsBiliary SystemsChapter 5 Part IIChapter 5 Part II

Objectives

Discuss the common illnesses/ Discuss the common illnesses/ conditions involving the hepatic/biliary conditions involving the hepatic/biliary organsorgans signs & symptomssigns & symptoms etiologyetiology management management

Hepatic-Biliary Diseases

HepatitisHepatitis Gallstones & Gallbladder diseaseGallstones & Gallbladder disease Acute & chronic pancreatitis Acute & chronic pancreatitis

Hepatic-Biliary Diseases

HepatitisHepatitis AA

contracted orally (usually through food)contracted orally (usually through food)persons infected with A usually recover fullypersons infected with A usually recover fully

B, C, & DB, C, & Dcontracted through contact with body fluidscontracted through contact with body fluidsB & C cause the most damage to the liverB & C cause the most damage to the liver

Hepatic-Biliary Diseases

HepatitisHepatitis Signs & SymptomsSigns & Symptoms

JaundiceJaundiceFatigueFatigueLoss of appetiteLoss of appetiteDark urineDark urineLight stoolsLight stools

Diarrhea Diarrhea FeverFeverJoint painJoint painPain in RUQPain in RUQEnlarged liverEnlarged liver

Hepatic-Biliary Diseases

HepatitisHepatitis Management Management

No specific medical treatmentNo specific medical treatmentSometimes antiviral meds are usedSometimes antiviral meds are usedPrevention of spread of diseasePrevention of spread of disease

• Hand-washingHand-washing

• Proper protection (gloves, etc.)Proper protection (gloves, etc.)

• VaccinationVaccination

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease CholelithiasisCholelithiasis – formation of gallstones – formation of gallstones

within the gallbladder or bile ductswithin the gallbladder or bile ductsmore common among women than menmore common among women than mengallstones may be present without producing gallstones may be present without producing

symptomssymptomssymptoms begin when stones obstruct symptoms begin when stones obstruct

abiliary ductabiliary duct

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Cholelithiasis – Cholelithiasis – etiologyetiology

obesityobesityhigh calorie dietshigh calorie dietsoral contraceptivesoral contraceptivesmultiple pregnanciesmultiple pregnancies increasing ageincreasing age

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Cholelithiasis – Cholelithiasis – signs & symptomssigns & symptoms

acute onset of pain in URQacute onset of pain in URQradiating pain to shoulder and back (shoulder radiating pain to shoulder and back (shoulder

blade)blade)nausea, vomitingnausea, vomitingflatulence, belching, & heartburnflatulence, belching, & heartburn tend to follow large meals or fatty foodstend to follow large meals or fatty foods

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Cholelithiasis – Cholelithiasis – diagnostic proceduresdiagnostic procedures

diagnostic ultrasounddiagnostic ultrasound

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Cholelithiasis – Cholelithiasis – managementmanagement

laparoscopic cholecystectomy to remove laparoscopic cholecystectomy to remove gallbladder IF symptoms don’t subside on gallbladder IF symptoms don’t subside on their owntheir own

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Acute cholecystitis Acute cholecystitis

Severe inflammation of the interior wall of Severe inflammation of the interior wall of the gallbladderthe gallbladder

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Acute cholecystitis – Acute cholecystitis – etiologyetiology

obstruction of bile ducts by gallstonesobstruction of bile ducts by gallstonespressure from accumulated bile in the pressure from accumulated bile in the

gallbladdergallbladderchemical changes in the bilechemical changes in the bilesecondary infection from multiplying secondary infection from multiplying

bacteriabacteria

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Acute cholecystitis – Acute cholecystitis – signs & symptomssigns & symptoms

gradual onset of pain in URQ localized over gradual onset of pain in URQ localized over gallbladdergallbladder

nausea, vomitingnausea, vomiting low grade feverlow grade fever

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Acute cholecystitis – Acute cholecystitis – diagnostic diagnostic

proceduresproceduresBlood testsBlood testsDiagnostic ultrasoundDiagnostic ultrasoundAbdominal x-rayAbdominal x-ray

Hepatic-Biliary Diseases

Gallstones & gallbladder diseaseGallstones & gallbladder disease Acute cholecystitis – Acute cholecystitis – managementmanagement

dietary changesdietary changesmedication to reduce inflammation and/or medication to reduce inflammation and/or

spasm of gallbladderspasm of gallbladder

Hepatic-Biliary Diseases

Acute PancreatitisAcute Pancreatitis severe, life-threatening inflammation of severe, life-threatening inflammation of

the pancreasthe pancreas pancreatic enzymes begin digesting pancreatic enzymes begin digesting

pancreatic tissue producing:pancreatic tissue producing:swellingswelling tissue necrosistissue necrosishemorrhagehemorrhage

Hepatic-Biliary Diseases

Acute Pancreatitis – Acute Pancreatitis – etiologyetiology alcoholismalcoholism gallstonesgallstones trauma to abdomentrauma to abdomen viral infectionsviral infections drug reationsdrug reations pancreatic cancerpancreatic cancer complications from a duodenal ulcercomplications from a duodenal ulcer

Hepatic-Biliary Diseases Acute Pancreatitis – Acute Pancreatitis – signs & symptomssigns & symptoms

sudden onset of severe, persistent abdominal painsudden onset of severe, persistent abdominal pain centered over epigastric regioncentered over epigastric region may radiate pain toward backmay radiate pain toward back

abdominal tendernessabdominal tenderness abdominal distension (not always present)abdominal distension (not always present) persistent vomitingpersistent vomiting alterations in vitalsalterations in vitals

feverfever tachycardiatachycardia rapid, shallow respirationsrapid, shallow respirations decrease in blood pressuredecrease in blood pressure

Hepatic-Biliary Diseases

Acute PancreatitisAcute Pancreatitis – – diagnostic proceduresdiagnostic procedures blood testsblood tests

elevated level of amylase enzymeelevated level of amylase enzyme diagnostic ultrasounddiagnostic ultrasound abdominal CT scanabdominal CT scan

Hepatic-Biliary Diseases

Acute PancreatitisAcute Pancreatitis – – managementmanagement Aimed at reducing symptomsAimed at reducing symptoms

maintain circulation & fluid volume through maintain circulation & fluid volume through IVIV

decrease paindecrease paindecrease pancreatic secretionsdecrease pancreatic secretions

Hepatic-Biliary Diseases

Chronic PancreatitisChronic Pancreatitis Slow, progressive destruction of Slow, progressive destruction of

pancreatic tissue accompanied by:pancreatic tissue accompanied by: inflammationinflammationfibrosisfibrosisdilation of pancreatic ductsdilation of pancreatic ducts

Hepatic-Biliary Diseases

Chronic PancreatitisChronic Pancreatitis – – etiologyetiology Most commonly associated with Most commonly associated with

alcoholismalcoholism

Hepatic-Biliary Diseases

Chronic PancreatitisChronic Pancreatitis – – signs & symptomssigns & symptoms severe, persistent, dull abdominal painsevere, persistent, dull abdominal pain pain that worsens after a mealpain that worsens after a meal weight lossweight loss

Hepatic-Biliary Diseases Pancreatic cancerPancreatic cancer – – signs & symptomssigns & symptoms

severe, persistent, dull abdominal painsevere, persistent, dull abdominal pain pain in midbackpain in midback pain that worsens after a mealpain that worsens after a meal weight lossweight loss jaundicejaundice weaknessweakness fatiguefatigue diarrheadiarrhea nauseanausea vomitingvomiting

Hepatic-Biliary Diseases

Pancreatic cancerPancreatic cancer – – managementmanagement Palliative – aimed at making person Palliative – aimed at making person

comfortable by managing paincomfortable by managing painmost pancreatic cancers are diagnosed after most pancreatic cancers are diagnosed after

they have metastasized to the lungs, liver, they have metastasized to the lungs, liver, and bonesand bones

80-85% of cases are advanced at first 80-85% of cases are advanced at first diagnosisdiagnosis

Questions?