•Prevents bile flow/drainage

•Leads to jaundice & can then lead to cirrhosis and liver failure

•Potential triggers: genetic mutations, viral infection, or autoimmune response

•Jaundice lasting beyond 2 weeks of life

•Pale/clay-colored stools, dark urine

•Weight loss/irritability

•Enlarged liver/spleen

Tests

•Labs: elevated direct bilirubin & liver enzymes

•Imaging: ultrasound, x-rays

•Poor weight gain, failure to thrive

•Abdominal swelling (ascites)

•Pales stools, dark urine

•Connects liver to intestines to bypass blocked ducts

•Supportive care/Education

•Collaboration

•Meet caloric needs (NG tube feedings?)

•Fat-soluble vitamins (vitamin A, D, E, & K)

•Excessive alcohol use

•Hepatotoxic medications

•Hap A: fecal-oral; contaminated food/water, dirty diapers in daycare setting

•Hep B: blood, body fluids, sexual contact

•Hep C: blood & body fluids; primarily blood-to-blood contact (IV drug use)

•Hep D: co-infection w/ Hep B; blood and body fluids

•Hep E: fecal-oral; contaminated food/uncooked meat & water (common in 3^rd world counties)

•GI symptoms: N/V, abdominal pain, anorexia, clay-colored stool

•Dark-colored urine

•Fatigue

•Fever

•Jaundice

•Elevated labs: ↑ AST/ALT, bilirubin, & ammonia

•Liver ultrasound: visualize inflammation

•Liver biopsy: identify liver damage

•Specific blood tests for each type of Hepatitis

•Hep B & C

•Acute cases supportive care

•Chronic cases antiviral therapy & monitor for complications

•Hep D

•Supportive care & proper Hep B treatment

•Vaccines only exist for Hep A & B

•Universal precautions for healthcare workers (needle safety, PPE)

•Sharp precautions

•Safe food handling & clean water sources

•Adequate nutrition & hydration

•↑ carb & calorie, ↓ protein & fat diet

•Monitor for complications

•jaundice, bleeding, hepatic encephalopathy, cirrhosis, liver failure

•Meds

Antivirals, antiemetics, supplements (vit Kà coagulopathy)

•Strict hand hygiene

•NOT to share personal hygiene products/razors

•Safe sex & avoid sex until hepatitis antibodies are negative

•Needle/syringe precautions

•Eat small, frequent meals

•Adequate rest

•Avoid hepatotoxic substances

Alcohol, acetaminophen, aspirin, sedatives

•Normal functions of liver are compromised

•Chronic Hepatitis (B, C, &D)

•Non-alcoholic fatty liver disease

•Obesity

•Diabetes

•Hyperlipidemia

•Cystic fibrosis

•Damage to biliary ducts

•Toxins & hepatotoxic drugs

•Liver biopsy: assess amount of liver damage

•CT scan/MRI: assess for fatty tissue & damage

•Abd Ultrasound: access for ascites

•Vague & nonspecific

•Fatigue

•decreased appetite/ weight changes

•N/V

•Abd pain

•liver tenderness/hepatomegaly

Late S/S

•Jaundice

•Ascites

•Edema

•Puritis/itchy skinà from build of toxins

•clay-colored stools

•anemia

•bleeding & bruising easily

•Portal HTN

•Splenomegaly

•Enlarged veins on Abd

•Hepatic Encephalopathy (altered LOC, neuro symptoms, impaired thinking, neuromuscular disturbances)

Esophageal varices (high risk for hemorrhage)

•Lactulose: ↓ ammonia

•Albumin: ↓ ascites & edema

•Diuretics: ↓ edema

Procedures

•Paracentesis: drain fluid in peritoneum (ascites)

•Transjugular intrahepatic portosystemic shunt (TIPS)

•Liver transplant

•No alcohol, ↓ protein, ↓ Na+, limit fluid intake

•Bleeding precautions

•Soft toothbrush, electric razor, monitor for bloody stools

•Avoid hepatotoxic meds (no acetaminophen, aspirin, sedatives/narcotics)

•Can be acute or chronic

•Most common cause: acetaminophen overdose

•May also be caused by viral hepatitis, toxins, malignancy, HELLP syndrome, or shock

•Secondary to chronic liver diseases like cirrhosis

•Hepatitis panel: assess for hepatitis

•Blood culture: assess for infection

•Liver biopsy: evaluate liver damage

•CT scan/MRI: assess for fatty tissue & evaluate damage

•RUQ pain (liver pain)

•N/V

•Fatigue

Coagulopathy

•Cerebral edema: d/t ↑ ammonia levels

•Sepsis: ↑ risk of infection d/t liver injury

•Bleeding/clotting: liver regulates coagulation

•Hypoglycemia: liver stores glycogen

•multi-organ failure

•Meds:

•Acetylcyseine: antidote for acetaminophen (for acute liver d/t overdose)

•Osmotic diuretics: ↓ cerebral edema

•FFP or Vit K: for bleeding

•Lactulose: ↓ ammonia

•Liver transplant

•↑ HOB to ↓ICP from cerebral edema

•Close monitoring (neuro checks, VS, blood glucose, ICP, I &O)

•Infection prevention

•Education no alcohol or hepatotoxic substances

•autodigestion of pancreas

•Pancreatic duct becomes blockedà digestive enzymes can’t move out of pancreasà activate early in pancreasà causes inflammation & damage

Acute or chronic

•↑lipase & amylase, ↑bilirubin , ↑WBC, ↑glucose, ↓Ca+, ↓platelets

•CT scan: show enlarged pancreas

ERCP

•Cholecystitis (gallbladder inflammation)

•Cystic fibrosis

•ERCP (can cause trauma to pancreatic duct)

•Smoking

Hyperlipidemia

•Symptoms

•Sudden/severe LUQ pain radiating to back

•Fever

•Tetany (involuntary muscle contractions d/t ↓Ca+)

•N/V

•Turner sign (bruising on flank)

•Cullen sign ( bruising around navel)

•Symptoms

•Chronic persistent abd pain (worse after consuming fatty meals)

•Steatorrhea (fatty stools)

•Unintended weight loss (no enzymes to digest food)

•Dark urine (from excessive bile)

•Peritonitis à can lead to Sepsis!

•Antiemetics for nausea

•Antacids/PPI to ↓ acid production

•Pain medication  (opioids)

•IV fluids for hydration

ERCP: diagnostic & remove gallstones

•NG tube insertion (for gastric decompression)

•Monitor glucose, VS & electrolytes

•Give pancreatic enzymes before meals

Diet: ↓fat, ↓sugar, no alcohol

•Very common type of colon cancer

3^rd most common form of cancer & 2^nd leading cause of death in US

•Hx of polyps

•Inflammatory bowel disease (IBD)

•Ulcerative colitis

•Sedentary lifestyle/ obesity

•Diet ↑ in fats, red meat consumption, processed meats

•Smoking/alcohol

↑ age (often >50 y/o)

•Blook in stool (bright red or melena)

•Abd pain or cramping

•Unintended weight loss

•Fatigue/ weakness (d/t anemia from occult bleeding)

•Feeling of incomplete evacuation

•Blood test: CEA (carcinoembryonic antigen)

•Imaging: CT, MRI, x-ray

•Surgical management

•Colectomy- removing part or all of colon

•Hemicolectomy- removing half or less of colon

•Abdominoperineal resection- affected colon & affected rectum removed à anus closed à ileostomy is permanent

•Postoperative:

•Monitor for infection, anastomotic leakage, & stoma complications

•Pain management

•Early ambulation

•Diet: ↑ protein, ↓ residue diet

•Monitor for potential complications: ileus & bowel obstruction

•Signs of complications (bleeding, infection, obstruction)

•Importance of follow-up and regular screening for recurrence