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Gastrointestinal & Hepatic-Gastrointestinal & Hepatic-Biliary SystemsBiliary Systems
Chapter 8Chapter 8
PathologyPathology
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