NCM 112: MEDICAL SURGICAL NURSING

HEPATOBILIARY SYSTEM

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

1st SEMESTER A.Y. 2022 – 2023

HEPATOBILIARY SYSTEM  It increases when there is presence of

damage in the liver only
LIVER
 Largest organ PT, PTT
 Largest gland  To determine the clotting time and clotting
factors
DIVIDED INTO FOUR LOBES
 Left Lobe AMMONIA
 Right Lobe  When increased, there will be decreased
 Caudate Lobe level of consciousness because it is
 Quadrate Lobe neurotoxic
 Intervention: Administer lactulose to
CELLS OF THE LIVER decrease levels of ammonia
 Hepatocytes
 Kupffer
HEPATIC DYSFUNCTIONS
FUNCTIONS
 Secretes bile JAUNDICE
 Storage of fat-soluble vitamins  Yellow discoloration due to increased serum
 Regulates blood glucose level by glycogen, bilirubin level (< 2mg/dl)
stored in hepatocytes
MANIFESTATIONS
 Converts ammonia to urea
 Yellow sclera
 Ammonia – a byproduct of glucogenic, which
converts amino acid to glucose  Yellow-orange skin
 Clay colored stool
GALLBLADDER  Urine: Tea colored
Stores bile  Anorexia

PANCREAS LABORATORY TESTS

Releases insulin  Prolonged PT
 Increased cholesterol
THREE PANCREATIC JUICES  Increased bilirubin
 Amylase
 Lipase HEMOLYTIC JAUNDICE
 Trypsin  Decreased bilirubin
 Damage in liver cell

LIVER
HEPATITIS
PORTAL VEIN  Inflammation of the liver
 Contains 80% of blood rich in nutrients but
lacks oxygen DRUG-INDUCED HEPATITS
 Inflammation or damage of the liver due to
HEPATIC ARTERY drug abuse
 Blood vessel that contains 20% of
oxygenated blood CLINICAL MANIFESTATIONS
PRE-ICTERIC STAGE
 Flu like symptoms
 Malaise
LIVER FUNCTION TESTS  Fatigue
 Headache
AST (SGOT)  Anorexia
 It increases when there is damage in liver,  Agnosia
cardiac muscle, and brain  Diarrhea, vomiting, nausea
ALT (SGPT)

HANNA JEULINE DR. PALAPAL

 NCM 112: MEDICAL SURGICAL NURSING
HEPATOBILIARY SYSTEM

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

1st SEMESTER A.Y. 2022 – 2023

ICTERIC STAGE (a few days-weeks after pre-  Late results of a previous bout of acute viral
icteric, with infection) hepatitis
 Jaundice  Caused by bile duct disorder
 Dark colored urine  Suppressed bile flow
 Light colored stool  Biliary atresia
 Steatorrhea
 Enlarged liver POST HEPATIC CIRRHOSIS
 Post necrotic cirrhosis
POST ICTERIC STAGE  Results from chronic biliary obstruction
 Convalescence stage  Caused by hepatitis
 With appetite
 Decreased fatigue CLINICAL MANIFESTATIONS
 Liver enlargement
MANAGEMENT  Dyspepsia – due to decreased bile
 Administer prescribed medication production
(immunoglobulin, immunization, antiviral  Constipation
medication)  Gradual weight loss
 Prevent transmission  Splenomegaly
 Encourage proper nutrition  Spider telangiectasia (Spider angioma in
vascular)
 Caput medusae – abnormal dilation of
abdominal blood vessel
 Portal hypertension – mental deterioration
VIRAL MODE OF INCUBATION OUTCOME due to increased ammonia
TRANSMISSION PERIOD
A Fecal-Oral route 15-50 days Mild with CLOTTING FACTORS
recovery I – Fibrinogen
B Parenterally, 28-160 days Severe II – Prothrombin
perinatal, sex III – Tissue Thromboplastin
C Blood 15-160 days Hepatic IV – Calcium ions
transfusion, sex cancer V – Labile factor
D Same with Hep 21-140 days Carrier state VII – Stable factor
B VIII – Antihemophilic factor
E Fecal-Oral route Affects IX – Christmas factor
pregnant X – Stuart-Power factor
women
NORMAL LEVELS FOR TRANSFUSION
 In case of severe edema and liver problems
HEPATIC CIRRHOSIS/LIVER CIRRHOSIS
 Chronic disease characterized by  PACKED RBC – 250 ml
replacement of normal liver tissue with  WHOLE RBC – 300 ml
diffused fibrosis  FRESH FROZEN PLASMA – 200 ml
 Destruction and fibrotic regeneration of liver  ALBUMIN – 100-180 ml
cells
 Fibrotic regeneration – thickening or scarring DIAGNOSTIC TESTS
due to excessive alcohol intake  SGPT/SGOT – due to increased risk for GI
bleeding
LAENNEC’S CIRRHOSIS “ALCOHOL CIRHHOSIS”  Serum protein level
 Most common  PT, PTT
 Caused by excessive alcohol intake  Liver biopsy

NURSING MANAGEMENT
BILIARY CIRRHOSIS  Promote adequate nutrition

HANNA JEULINE DR. PALAPAL

NCM 112: MEDICAL SURGICAL NURSING
HEPATOBILIARY SYSTEM

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

1st SEMESTER A.Y. 2022 – 2023

 Early phase – high protein diet to promote  Monitor level of consciousness

healing of the liver  Administer vasopressin
 Late phase (irreversible liver damage) – low  Balloon tamponade – to control the bleeding
protein diet using NGT
 Variceal band ligation
CLOTTING PROBLEMS MANAGEMENT
 Give antacid
 Avoid alcohol intake HEPATIC ENCEPHALOPATHY
 Avoid visitors due to risk for infection  Neurologic syndrome that develops as
 Prevent tissue or skin damage complication of liver disease
 Increased serum ammonia level due to GI
bleeding, due to ruptured varices caused by
PORTAL HYPERTENSION portal hypertension
 Elevated pressure in portal veins
 Increased resistance to blood flow through CLINICAL MANIFESTATIONS
the portal venous vein  Changes in mental status
 Motor disturbances
CLINICAL MANIFESTATIONS  Mood alterations
 Ascites  Asterixis – involuntary flapping of the hands
 Rapid weight loss “flapping tremors”
 Shortness of breath due to impaired blood  Fetor hepaticus – sweet, slightly fecal order
flow, decreased oxygenation to the breath
 Caput medusae – seen and radiates to  Increased bilirubin level
umbilicus area, palpable spleen
(hypersplenism) MANAGEMENT
 Fluid and electrolyte imbalance – Na & K  Administer prescribed medications
 Lactulose – to evaluate bowel movement
MANAGEMENT waste products stocked in colon
 Avoid too much activity  Antibiotics (neomycin) – to halt bacteria that
 Promote bed rest increases ammonia
 Avoid spicy foods  Decrease protein in diet
 Diet – soft diet only  Monitor vital signs
 Administer diuretics
 Measure abdominal girth – early morning
before breakfast

FOR DETERIORATION (MENTAL)

 Monitor serum ammonia
 Administer lactulose
 Perform gastric lavage: silicone
 Paracentesis – do not aspirate fluid <1500
ml

ESOPHAGEAL VARICES
 Upper bleeding
 Hemorrhagic process
 Dilation of tortuous vein

GALLBLADDER DISORDERS

MANAGEMENT RISK FACTORS

 Asses for epistaxis and gum bleeding  Obesity
 Use soft-bristle toothbrush

HANNA JEULINE DR. PALAPAL

NCM 112: MEDICAL SURGICAL NURSING
HEPATOBILIARY SYSTEM

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

1st SEMESTER A.Y. 2022 – 2023

 Gender (women because of increased dose

of estrogen) ACUTE PANCREATITIS
Inflammation of the pancreas
CHOLELITHIASIS
 Formation of calculi (stones) in the CAUSES
gallbladder  Self-digestion of enzymes – trypsin
 Changes in the bile components due to  Cholecystitis
cirrhosis and infection  Hemorrhage

CLINICAL MANIFESTATIONS CLINICAL MANIFESTATIONS

 Pain at RUQ  Turner’s sign – bluish discoloration of skin,
 Nausea and vomiting specifically in the trunk
 Fat intolerance  Cullen’s sign – purple discoloration around
 Leukocytosis the umbilicus
 Jaundice  Abdominal tenderness and distention
 Epigastric pain  Decreased blood pressure
 Increased lipase and amylase  Hypovolemia which can lead to hypovolemic
shock due to internal bleeding (as
manifested by turner’s and cullen’s sign)
CHOLECYSTITS
 Inflammation of the gallbladder DIAGNOSTIC TESTS
 Can be acute or chronic  CBC with APC (increased WBC)
 Obstruction of cystic duct – there is no bile  Lipid profile (increased amylase and lipase)
flow  Electrolytes (decreased calcium)
 Due to septicemia (blood infection); and  IV Fluid: D5NM, D5NR
overuse of analgesics, opioids: tramadol
MANAGEMENT
CLINICAL MANIFESTATIONS  Opioids
 With tenderness at RUQ  Histamine – to decrease pancreatic acid
 Murphy’s sign with pain  Drug of choice for pain – Morphine
 Heartburn  NPO
 Maintain fluid and electrolyte valance
DIAGNOSTIC TESTS through IV fluids
 Whole abdominal ultrasound (NPO at Post
Midnight)
 Abdominal Xray
 Abdominal CT scan
 ERCP – Endoscopic Retrograde
Cholangiopancreatography

PHARMACOLOGICAL MANAGEMENT
 Ursodeoxycholic (urso) – dissolves
gallstones, administer morphine
 Low fat diet
 High protein diet

SURGICAL APPROACH
 Lap Chole
 Cholecystectomy
 Choledochotomy – surgical incision of the
common bile duct

HANNA JEULINE DR. PALAPAL

NCM 112: MEDICAL SURGICAL NURSING
HEPATOBILIARY SYSTEM

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

1st SEMESTER A.Y. 2022 – 2023

HANNA JEULINE DR. PALAPAL