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ENDOCRINE LIVER CIRRHOSIS ↳ replacement of normal liver tissue i diffuse Fibrosis that disrupts the structure and function of t...

ENDOCRINE LIVER CIRRHOSIS ↳ replacement of normal liver tissue i diffuse Fibrosis that disrupts the structure and function of the liver CAUSES 1 2. BiliaryObstruction alnutrition. 3 Alcohol Abuse 4. Infection 5. Drugs SIS : a. Fever b. Anorexia c. Esophageal varices. d Jaundice e. Weight loss. Ascites f. g Palmar erythema DIAGNOSTIC : · decreased total serum cholesterol protein , " phospholipids · prolonged PT , PTT · elevated serum ammonia , total serum bilirubin unconjugated/indirect bilirubin · elevated SGOT , SGPT , LDH (Lactate Dehydrogenase) · LIVER BIOPSY left lateral position , exhale deeply and hold breath for 5-10 seconds during needle insertion to prevent trauma to the diaphragm · PARACENTESIS check V/s , empty the bladder , upright or sitting position to localize the Fluids = monitor for signs of hypovolemic shock , Fever , pain , rigidity of the abdomen DIAGNOSTIC · elevated GGT (Gamma Glutamyl Transpeptidase) UTZ of the liver COLLABORATIVE MANAGEMENT * HEPATIC ENCEPHALOPATHY give osmotic laxative : sign of effectivity : improve LOC give NEOKAN (Neomycin & Kanamycin) ESOPHAGEAL VARICES insertion of Sengstaken - Blakemore Tube Portal Hypertension limit H20 intake , treat the cause Ascites Food high in albumin Paracentesis-invasive , Dr. secures informed consent , nurse checks ; Upright position Administer Diuretic as prescribed Spironolactone - To avoid rupture of the varices , advice pX to avoid : 1. Screaming, shouting. 2 Straining at stool. 3 Bending stooping , 4. Coughing sneezing , * Supportive measures for variceal bleeding : Vit K Antibiotics Avoid ASA Frozen plasma - Fresh , , , PANCREATITIS inflammation of the pancreas ACUTE can be medical emergency I high risk of life-threatening complication s mortality CHRONIC often undetected bes classic clinical diagnostic Findings are not always present in the early stages of the disease FUNCTIONS OF the Pancreas 1. Produces pancreatic enzymes a Lipase for fat absorption b Amylase for carbohydrate absorption c. Trypsin For protein absorption. 2 Insulin production CAUSES severe alcoholism increase fat intake S/S : alcohol a. Severe abdominal pain occurs in midepigastrium , 24-48 hrs after heavy meal or ingestion and it maybe diffuse or difficult to localize b. Rigid or boardlike abdomen. c Ecchymosis in theFlank or around the umbilicus. Nausea d & vomiting DIAGNOSTIC · CT scan · elevated NBC · MRI · elevated Hgb ! Hot levels · UTz · elevated serum amylase & lipase levels within 48-72 hours · ERCP MEDICAL MANAGEMENT Antiemetics H2 antagonists Proton pump inhibitors Nasogastric suction to relieve N/ Pain management : morphine " Fentanyl All oral intake is withheld to inhibit stimulation of the pancreas and its secretion of enzymes NURSING MANAGEMENT 1. Give pain med as ordered. 2 Frequently assess pain level. 3 Semi-Fowler's position to decrease the pressure on the diaphragm 4. IVF as prescribed CHOLELITHIAS IS presence of gallstone Acute cholecystitis is an inflammation of the gallbladder CAUSE : unknown PREDISPOSING FACTORS : Female , Fat , Fair , Forty COLLABORATIVE MANAGEMENT Pain management : Morphine antidote is Naloxam Not Demerol Antispasmodic NSAIDs like Toradol Diet : NPO : IV Fluids administered during NN Antiemetics for NN CHENIX decreases cholesterol production , lowering content of bile & Facilitates dissolution of gallstones ACTIGALL bile salt , suppresses hepatic synthesis and secretion of cholesterols inhibits intestinal absorption of cholesterol ! Facilitates dissolution of gallstones MAJOR SIDE EFFECTS Of MEDICATIONS : Abdominal pain Diarrhea Nausea & Vomiting SURGICAL INTERVENTION a. Cholecystectomy removal of gallbladder bile duct. b Choledochotomy removal of stone from the common c. Laparoscopic cholecystectomy "lap chole" involves 3-4 incisions d Incisional or open cholecystectomy involves right subcostal incision PRE-OPERATIVE CARE emphasizes teaching px on deep breathing coughing and turning , exercise (PBCT) POST-OPERATIVE PERIOD 1. Position the px in Semi-Fowler's to promote lung expansion. 2 Diet : Low-fat For diet 2-3 months. 3 Early ambulation The endocrine system involves the release of chemical transmitter substances known as HORMONES PITUITARY GLAND main organ of the endocrine system Hypophysis commonly referred to as the MASTER GLAND Function : secrete and regulate hormones Location : midbrain 2 parts : Anterior : FSH, LH , PRL , ACTH , TSH , GH , MSH Posterior : Oxytocin ADH , ADH (Anti-diuretic Hormone) Function reabsorbs water only : DIABETES INSIPIDUS (PI) ADH an injury to the hypothalamus or pituitary gland with a deficiency in that results in the excretion of large volumes of dilute urines extreme thirst ETIOLOGY : surgery , infection inflammation , , brain tumors or idiopathic CLINICAL MANIFESTATION a very dilute urine , urine specific gravity : 1 001-1 005.. b. px drinks 2-20L of Fluid MEDICAL MANAGEMENT Isotonic Fluids Drug of Choice : Desmopressin orally or intranasally NURSING MANAGEMENT 1. Monitor for dehydration 2. 14 0 monitoring SIADH SYNDROME of INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION hypersecretion of ADH characterized by excessive retention of water, without proportionate retention of sodium CAUSES : head injury , brain surgery and tumor MEDICAL MANAGEMENT Diuretics Focused Treatment on eliminating underlying cause Restricting fluid intake NURSING MANAGEMENT 1 Blood chemistries. 2 Intake & Output. 3 Daily weight monitoring 4. Supportive measures CUSHING SYNDROME long-term exposure to increase glucocorticoid in blood CAUSES : autoimmune tumor iatrogenic DIAGNOSTIC · CT scan · Urinary cortisol test · MRI · Midnight saliva cortisol test CLINICAL MANIFESTATION Moon Face Weight gain Thin skin and Buffalo hump Increased bodya Facial hair subcutaneous tissue Red cheeks Pendulous Abdomen Slow wound healing Ache Purple stride Thinning of hair Ecchymosis resulting from easy bruising Supraclavicular fat pad Thin extremities I muscle atrophy MEDICAL MANAGEMENT Chemotherapy Adrenalectomy Somatostatin analogs : octreotide and pasireotide Steroidogenesis inhibitors : ketoconazole , metyrapone , aminoglutethimide Isturia (Osilodrostat) 1st FDA approved medicine for Cushing's disease Transsphenoidal surger NURSING MANAGEMENT 1 Prepare pX For Hypophysectomy to remove pituitary gland. 2 Prepare pX For Adrenalectomy : educate px about cortisol replacement therapy 3. Risk for infectionI skin breakdown 4. Monitor electrolytes blood sugar , K , Na and La PATHOPH+SIOLOGY  ACROMEGALY Somatotroph adenoma ; Growth hormone excess rare disorder of excessive bone and soft tissue growth due to elevated GH levels can develop at any age after puberty ; third decade of age usually CLINICAL MANIFESTATION Coarse Facial Features Osteoarthritis Soft tissue overgrowth Headache Weight gain Impotence Overgrowth of bone ; Skulledible Lethargy Glucose intolerance Visual Impairment Irregular or absent menses Depression Enlargement of hands & Feet over 1-10 years DIAGNOSTIC Radioimmunoassay enzyme linked immunosorbent assay for GH level · or · HIGH Serum GH level · HIOH insulin-like growth factor · CT scan or MRI For pituitary edema localization · Oral GTT leaky value echocardiogram may show leaky mitral value or aortic · a · Xray This disease may also alter the results of these tests : Fasting plasma glucose (high Glucose tolerance test (too high at 2 hours) creatinine - vrine SURGICAL MANAGEMENT TRANSSPHENOIDAL SURGERY used to treat tumors that arise from the pituitary gland NURSING MANAGEMENT 1 Reduce production of GH to normal levels.stop 2 & reverse the symptoms caused by over-secretion of GH 3. correct other endocrine abnormalities 4. Reduce the tumor size : Reduce production of GH to normal levels GIGANTISM excess of growth hormone (GH) during childhood CAUSES noncancerous (benign) tumor of the pituitary gland is the most common cause of ↑GH release other causes : Genetic disorder CLINICAL MANIFESTATION Very prominent foreheadI jaw Large hands & feet i thick fingers ? toes Gaps between their teeth Thickening of facial features very tall/large for their age S/S :. 2 Joint pain b. Excessive Sweating (hyperhidrosis). c Muscle weakness d Sleep apnea.. e Headaches f Irregular menstruation. g. Delayed puberty 1. Double vision or difficulty with side (peripheral) vision i. Enlargement of internal organs esp. child's heart PRESENT or REAL-LIFE GIANTS Andre Rene Roussimoff "Andre the Giant" (224cm) Richard Kiel "Jaws in two James Bond movie" (218cm) Robert Wadlow "Alton Giant" (212cm) tallest man ever ; died in 1940 foot became infected DIAGNOSTIC · An echocardiogram to check for heart issues Growth hormone and IGF-1 (insulin-like growth factor 1) blood tests Imaging tests · Glucose tolerance test Sleep study tests to check for sleep apnea · Xray or a DEXA (DXA) scan to check bone health SURGICAL MANAGEMENT Transsphenoidal surgery Radiation therapy helps lower growth hormone levels when surgery isn't effective COMPLICATIONS 60 % with gigantism develop hypopituitarism after treatment Mobility issues due to muscle weakness Osteoarthritis Peripheral neuropathy sleep appea Enlarged heart Type 2 Diabetes Hyperpituitary System increase in the function of the pituitary gland CAUSES : unknown S/S : ADH-SIADH ACTH-cushing Syndrome GH-Gigantism &Acromegaly TSH - Grave's Disease = I ↑ ↑ excess of GH in children Major action and overgrowth of long osa sizeofskull prominent Forhead skill , size of Viscera andovergrowthflowerjaw ofthelimilowerinanice Muscle mass increase in muscle mass increase in bone mass ↑ 11I table promotion promotiontesorption potogenes a CA ++ Proteogenesis Lipolysis , and ADDISON'S DISEASE primary adrenal insufficiency ; rare ; 70-90 % autoimmune ASSESSMENT and DIAGNOSTIC · Hyperkalemia · Hyponatremia · Combined measurements of early morning serum cortisol & Plasma ACTH COLLABORATIVE MANAGEMENT Hydrocortisone , Betametasone , Cortisone , Fludrocortisone Administering fluids and corticosteroids Restoring blood circulation Recumbent position with legs elevated Monitoring vital signs NURSING MANAGEMENT ↓ Assess for signs of shock. 2 Assess for signs of dehydration Assess for weight changes muscle weakness a fatigue. 3 , Monitor for signs of Addisonian crisis : · Shock Rapid , weak pulse · Hypotension · Rapid RR and extreme weakness Monitor for side effects of steroids · Hyperglycemia Hypertension · Hypokalemia Sodium and water retention PATHOPHYSIOLOGY DWARFISM insufficient secretion of GH during childhood CAUSES : Genetics and brain doesn't make enough GH CLINICAL MANIFESTATION Delayed in motor skill development ; sitting up crawling , , and walking Progressive severe hunching (Kyphosis ( Weight gain Hyperlipidemia (high cholesterol) crowded teeth Increase cholesterol build up Pressure on spinal cord and base of the skull Difficulty breathing during sleep (obstructive sleep appeal MEDICAL MANAGEMENT SOMATOTROPIN to increase the GH and must be given before puberty ROUTE : SQ MYXEDEMA deficiency in the thyroid hormone in adults , cretinism in children decrease in TSH and T3 (Triiodothyronine) and T4 (Thyroxine CAUSES Autoimmune Thyroidectomy Radioactive Iodine Therapy Antithyroid drugs CLINICAL MANIFESTATION 2. Slowed physical& mental reactions b. Apathy , lethargy , Fatigue c. Weight gain d. Cold intolerance ; subnormal , body temperature. 2 Coarse , dry sparse hair , loss of body hair Dull , expressionless mask-like Face f. , Anorexia. g h. Bradycardia i. Constipation. Dry skin brittle nails j , MEDICAL MANAGEMENT Levothyroxine (Syntroid) taken before breakfast (same time each day pregnancy category : A Low caloric diet High Fiber intake Antihyperlipidemic Statis : Atorvastatin rosuvastatin ; , , simvastatin MYXEDEMIC COMA severe form of Hypothyroidism that can be precipitatedbt acute illness, rapid withdrawal of thyroid hormones -Is : Bradycardia Respiratory failure Extreme low metabolism Coma 3"g"Seizure , Shock , Sugar is low 3 "H"Hypotension , Hypothermia, Hyponatremia MANAGEMENT Report to MD