BLEEDING ESOPHAGEAL VARICES

BLEEDING ESOPHAGEAL VARICES - dilated tortuous veins usually found in the submucosa of the lower esophagous , it may extend up to the esophagus and down into the stomach


CAUSES:

• due to portal hypertension, which may result from obstruction of the portal venous circulation and cirrhosis of the liver
  
• due to abnormalities of the circulation of splenic vein or superior vena cava

SIGNS AND SYMPTOMS:

• melena-passage of black tarry stools
• hematemesis- vomiting of blood
• rectal bleeding
  

MANAGEMENT:
1.to control hemorrhage -

• pressure is exerted in the cariac portion of the stomach and against the bleeding varices by double balloon tamponade
• bleeding treated by sedation or complete rest of the esophagus ( parenteral feeding)
• vomiting must be prevented

2.surgical procedures-

• injection of sclerosing drug by way of the esophagoscope
  
• direct surgical ligation of varices
• portacaval and sphlenorenal venous shunt operation

my nursing notes
reference: medical-surgical nursing

LIVER ABSCESSES

LIVER ABSCESSES - due to several kinds of bacteria and or fungus and the common agents is like protozoa .

SIGNS AND SYMPTOMS:

• high fever
• chills alternating with sweats
• jaundice
• painful enlargement of the liver
• anemia
• toxemia

my nursing notes

TOXIC HEPATITIS

TOXIC HEPATITIS-

• liver poison due to ingestion or injected parenterally of chemicals like chloroform, carbon tetrachloride, phosphorous and gold compounds

SIGNS AND SYMPTOMS:

• jaundice become extremely intense
• fever
• persistent vomiting
• vomitus containing blood
• hemorrhage under the skin
• delirium
• coma
• convulsion
• patient may die

my nursing notes:

HOMOLOGOUS SERUM JAUNDICE ORSERUM HEPATITIS

HOMOLOGOUS SERUM JAUNDICE or SERUM HEPATITIS

• this disease occasionally follows after the therapeutic or prophylactic injection of human serum, such as convalescent serum, vaccines or whole blood or plasma
• it may acquired from medical or dental instrument or other skin-puncturing such as tatooing or ear piercing needles
• drug addicts acquire the disease from needles that have used by infected individual and not been properly sterilized

SIGNS AND SYMPTOMS:

• lose of appetite then turn yellow
• jaundice
• dyspepsia
• abdominal pain
• body malaise
• generalized aching
• weakness
• enlarged liver
• splenomegaly

MEDICAL AND NURSING MANAGEMENT:

• bed rest
• adequate nutrition
• supplemental nutrient like vitamin B complex

my nursing notes

INFECTIOUS HEPATITIS

INFECTIOUS HEPATITIS -

• disease is acquired through ingestion of food or liquid infected with virus. It is transmitted by direct or indirect contact
• an infected person working in a restaurant can spread the disease
• those people who drink sewage- contaminated water or eat shellfish from sewage polluted shoreland
  
• incubation period 2 - 7 weeks

SIGNS AND SYMPTOMS:

• symptoms of mild upper respiratory infention
• fever
• jaundice
• anorexia
  
• nausea
• heartburn
• flatulence
• liver and spleen are moderately enlarged

Nursing Care and Medical Management

• Bed rest
• diet should be nutritious -optimal foods and fluid levels to counter act weight loss
  
• anorexia- small but frequent feeding and be supplemented as ordered by the physician

my nursing notes

VIRAL HEPATITIS

In Public Health Nursing is concerned about increasing incidence of viral hepatitis. Mortality rate is now increasing and must prevent the spread of the disease. The nurse must not only concerned to care those afflicted but have to focus for the prevention of the spread of the disease for the whole community by:

• proper public and home sanitation
• personal hygiene at all times
• hygienic practices of preparing food and dispensing to consumers
• effective health supervision in schools, dormitories, barracks and camps
• repeated health educational programs
• Immunizations
  

HEPATIC COMA

HEPATIC COMA -

• one of the most serious complication of liver disease
• manifestation of liver failure due to failure of liver cells to detoxify ammonia

Early Signs and Symptoms:

• slightly confused
• far away look in his eyes
• drowsy during the day
• wander at night
• disoriented with time and date
• if progresses - lapses with frank coma

Complication:

• gastrointestinal bleeding
• enteric infection
• fluid and electrolyte imbalance
• hyponatremia - sodium deficit
• hypokalemia- potassium deficit

NURSING CARE:

• close observation of neurologic status and record
  
• accurate record of fluid intake and output
• monitor and record vital signs and blood pressure
• symptoms of pulmonary infection to be reported

Treatment as per doctor's order:

• protein intake reduced or eliminated
• antibiotic
  
• sedatives
• analgesics

Reference: medal nursing book and my nursing notes