hepatitis

inflammation of the liver resulting from viral or bacterial infection; medications, alcohol, or chemicals toxic to the liver; and metabolic or vascular disorders.

hepatitis A (HAV)

fecal- oral route: fecal-contaminated floodwater or raw shell fish from poor hand hygiene by infected person or inadequate sanitation

hepatitis B (HBV)

blood or body fluids such as saliva, semen, menstrual or vaginal fluid; equipment contaminated by infected blood

hepatitis C (HCV)

Blood or body fluids that contain blood: Iv drug use is the most common. birth from HCV- infected mother

rarer: unprotected sex

alanine aminotransferase (ALT)

male: 19-36

female: 24-36

most specific enzyme for liver damage. can elevate 50 times normal with death of liver cells

aspartate aminotransferase (AST)

male: 20-40

female: 15-30

ammonia

10-80

cirrohosis

the progressive replacement of healthy liver tissue with scar tissue

signs and symptoms of cirrhosis

the liver may be enlarged, firm and tender upon palpation. lab results reflect progressive loss of liver function. as it progresses, increasing loss of liver function and complications are present

portal hypertension

persistent elevated blood pressure in the portal vein

hepatic encephalopathy

caused by elevated ammonia, a by-product of protein metabolism, which disrupts mental status.

hepatorenal syndrome

a secondary failure of the kidneys from cirrhosis. the impaired liver circulation reduces renal blood flow

wernicke-korsakoff syndrome

a brain disorder caused by thiamine (B) deficiency. wernicke encephalopathy and Korsakoff physchosis often occur together

ascites

treated with diuretics such as spironolactone (aldactone) or furosemide , sodium and fluid restrictions , abstinence from alcohol and albumin infusions for serve ascites

esophageal varices

for bleeding prevention, medications can be used such as the beta blockers propranolol and nadolol. if the patient cannot tolerate the beta blockers or if they have large varies, preventative treatment can include endoscopic variceal ligation using rubber bands

acute liver failure

sudden massive loss of liver tissue

early symptoms of acute liver failure

vague, jaundice, hepatic encephalopathy , confusion, coma and bleeding

actue pancreatitis

inflammation of the pancreas appears to be caused by a process called auto digestion.

autodigestion (where the pancreas begins to digest the pancreas)

liver transplantation patient is observed for signs of impending rejection

• pulse greater than 100 beats per minute
• temperature greater than 101 F
• reports of RUQ pain
• increased jaundice

cancer of the liver

the liver is a likely area of involvement for cancers that originated in the esophagus, lungs, breast, stomach , colon, pancreas, kidney, bladder, or skin

Chvostek sign

twitching of facial muscles with tapping in front of ear over facial nerve indicates neuromuscular irritability and decreased calcium levels

turner signs

a purplish discoloration of the flanks or a purplish discoloration around the umbilicus (Cullen sign) may occur with extensive hemorrhagic destruction of the pancreas

serum amylase

normal: 100-300 units/L

serum lipase

normal: 0-60 units/L

chronic pancreatitis

a progressive fibre-inflammatory disease in which functioning pancreatic tissue is replaced with fibrotic tissue because of inflammation

signs and symptoms of chronic pancreatitis

the patient will report epigastric or LUQ pain that worsens after eating, nausea, and vomiting, weight loss, steatorrhea, and intolerance of fatty foods

steatorrhea

foul smelling greasy loose stools

cancer of pancreas

most primarily tumors of the pancreas are ductal adenocarcinomas. they occur In the endocrine (digestive secretion) parts of the pancreas.

signs and symptom- cancer of the pancreas

epigastric or back pain, anorexia, nausea, fatigue, and malaise are early symptoms. weight loss is the classic sign of pancreatic cancer. reports of abdominal pain worse at night.

the Whipple procedure

a very complex surgery, is the most common for exocrine pancreatic cancer. this surgery removes the head of the pancreas, lymph nodes. nearby, the common bile duct, the gallbladder, most of the duodenum and parts of the stomach