Liver Lengkap
Liver Lengkap
Liver Lengkap
OF
THE DIGESTIVE
SYSTEM
REVIEW OF ANATOMY AND
PHYSIOLOGY
ACCESSORY ORGANS OF THE
DIGESTIVE SYSTEM:
Liver
Panrea"
This is an in-situ photograph
of the chest and abdominal
contents. As can be seen,
the liver is the largest
parenchymal organ, lying
just below the diaphragm.
The right lobe (at the left in
the photograph) is larger
than the left lobe. The
falciform ligament is the
rough dividing line between
the two lobes.
REVIEW OF ANATOMY AND
PHYSIOLOGY
LIVER
Liver l%bule"
Carb%*#dra!e
$e!ab%li"$
Gl#%.ene"i"
Gl#%.en%l#"i"
Glu%ne%.ene"i"
Fa! $e!ab%li"$ 2
3e!%.ene"i"
Pr%!ein $e!ab%li"$
anab%li"$
dea$ina!i%n
urea ,%r$a!i%n
Sere!i%n %, bile
De!%4i,ia!i%n
Me!ab%li"$ %,
vi!a$in" A/D/+/5 0
Head/
5%d#
Tail
Panrea!i du!
F1NCTIONS OF THE PANCREAS:
Daundie
A"i!e"
GeneraliEed Ede$a
In!%lerane %, Seda!i%n
MANIFESTATIONS OF LIVER
DISORDERS
DA1NDICE
CA1SES:
Pre*e&a!i - *e$%l#"i"
Mana.e$en! :
Mana.e$en!:
S*%r! ,in.ernail"
MANIFESTATIONS OF LIVER
DISORDERS
ASCITES
Cau"e" :
&%r!al *#&er!en"i%n
*#&erald%"!er%ni"$
MANIFESTATIONS OF LIVER
DISORDERS
ASCITES
Mana.e$en! :
*i.* ,%)ler>"
!urnin. 0 &%"i!i%nin.
IV albu$in/
Paraen!e"i"
Peri!%ne%ven%u" S*un!
MANIFESTATIONS OF LIVER
DISORDERS
GENERALIGED EDEMA
In"u,,iien! albu$in
INTOLERANCE OF SEDATION
HEPATITIS
CIRRHOSIS
Viral He&a!i!i"
In,e!i%u"
Feal2%ral r%u!e
He&a!i!i" 5
Seru$ *e&a!i!i"
SGOT
Al3aline P*%"&*a!a"e
SGPT
I$a.in.: 1l!ra"%und
Grossly, there are areas of necrosis and
collapse of liver lobules seen here as ill-
defined areas that are pale yellow. uch
necrosis occurs with hepatitis.
HEPATITIS
PLANNING 0 IMPLEMENTATION
67 Preven! "&read %, !*e di"ea"e7
He&a!i!i" A
En!eri &reau!i%n"
Hand)a"*in.
HEPATITIS
PLANNING 0 IMPLEMENTATION
67 Preven! "&read %, !*e di"ea"e7
He&a!i!i" 5
H%$%"e4ual $ale"
IV dru. u"er"
He$%dial#"i" &a!ien!"
87 Ob!ain re"! !% &r%$%!e liver
re.enera!i%n
HEPATITIS
PLANNING 0 IMPLEMENTATION
97 Nu!ri!i%n : Well2 balaned/ *i.* P/
*i.* C
=7 Pr%vidin. %$,%r! $ea"ure"
<7 Ad$ini"!er $edia!i%n" :
An!iviral"
Liver "u&&le$en!"
CIRRHOSIS
END RESULT OF E!"TO#$ELLUL"R %N&UR'
Re.enera!i%n 0 "arrin.
Fa!!# de.enera!i%n
An%re4ia
Nau"ea 0 v%$i!in.
Wei.*! l%""
Fla!ulene
Fa!i.ue
A5DOMINAL PAIN
HEPATOMEGALY
ASCITES
Ongoing liver damage with liver cell necrosis followed by
fibrosis and hepatocyte regeneration results in cirrhosis.
This produces a nodular, firm liver. The nodules seen
here are larger than 3 mm and, hence, this is an example
of "macronodular" cirrhosis.
Mall%r#I" *#aline i" "een *ere/ bu! !*ere are al"% neu!r%&*il"/ ner%"i"
%, *e&a!%#!e"/ %lla.en de&%"i!i%n/ and ,a!!# *an.e7 T*e"e ,indin."
are !#&ial ,%r au!e al%*%li *e&a!i!i"7 Su* in,la$$a!i%n an %ur in
a &er"%n )i!* a *i"!%r# %, al%*%li"$ )*% .%e" %n a drin3in. Jbin.eJ
and %n"u$e" lar.e Fuan!i!ie" %, al%*%l %ver a "*%r! !i$e7
CIRRHOSIS
ASSESSMENT:
End%rine S#"!e$
TE L%(ER %S UN")LE TO *ET")OL%+E OR*ONES
OF TE "DREN"L $ORTE,- O("R%ES- ESTRO.EN "ND
TESTES
AMENORRHEA
GYNECOMASTIA
IMPOTENCE
He&a!%2Renal S#ndr%$e
REN"L F"%LURE /%TOUT D%SE"SE
CIRRHOSIS
ASSESSMENT:
O!*er:
DA1NDICE
ICTERIC SCLERAE
PR1RIT1S
SPIDER ANGIOMA
PALMAR ERYTHEMA
M1SCLE ATROPHY
PROLONGED
EASY 5R1ISING
LA5S:
S7 5ILIR15IN
PROLONGED
Pr%!*r%$bin !i$e
DECREASED Seru$
Albu$in
DECREASED H.b 0
H!
CIRRHOSIS 2 $ana.e$en!
LETHARGY
CONF1SION
TREMORS
ST1POR
DIGGINESS
COMA
SPIDER TELANGIECTASIA
ene$a/
a!*ar!i"
Pri$ar#
SBSK :
An%re4ia
Wei.*! l%""
Wea3ne""
Abd%$inal &ain
CHOLELITHIASIS
CHOLECYSTITIS
CHOLELITHIASIS
FORMATION OF GALLSTONES
Mul!i&ar%u"
Oral %n!rae&!ive"
Cirr*%"i"
Obe"i!#
H#&erli&ide$ia
5ile "!a"i"
CHOLELITHIASIS
PRECIPITANTS:
67 Al!era!i%n in !*e %nen!ra!i%n %,
lei!*in/ *%le"!er%l/ and bile "al!"
87 Me!ab%li *an.e"
97 C*%le#"!i!i"
=7 5iliar# "!a"i"
5ile aid" and lei!*in derea"e in bile
T*e a&ai!# !% di""%lve *%le"!er%l i" redued
E4e"" *%le"!er%l &rei&i!a!e a" r#"!al"
GALLSTONES
PATHOPHYSIOLOGY
CHOLELITHIASIS
ASSESSMENT:
67 5iliar# %li:
E&i.a"!ri &ain
Nau"ea 0 v%$i!in.
67 Evidene %, *%led%*%li!*ia"i":
Daundie
Cla#2%l%red "!%%l"
H#&erbilirubine$ia
Pa&averine
Ni!r%.l#erine
NO M%r&*ineM
67 5ile aid" - C*en%de%4#*%li aid 'CHENIK(
and 1r"%de%4#*%li aid 'ACTIGALL( :,%r
lien!" )*% are &%%r ri"3 ,%r "ur.er#; T%4i !% !*e
liver
CHOLELITHIASIS
S1RGICAL INTERVENTION
67 C*%le#"!%"!%$# - drainin. %, !*e
.allbladder
87 C*%le#"!e!%$# - re$%val %, !*e
.allbladder
97 C*%led%*%li!*%!%$# - re$%val %,
"!%ne" ,r%$ !*e %$$%n bile du!
=7 In!ra%&era!ive C*%lan.i%.ra$ - d#e in
!*e bile du! !*ru !*e #"!i du!/ i, )i!*
*%led%*%li!*ia"i"
GALL5LADDER S1RGERY
PRE2OP N1RSING CARE:
Preven! %$&lia!i%n"
Preven!in. di"!en!i%n
Main!ain nu!ri!i%n
Preven! %$&lia!i%n"
Preven!in. di"!en!i%n
Main!ain nu!ri!i%n
=@@ $l in 6
"!
8= *r"/ 8@@ $lB8= *r" !*erea,!er
Preven! %$&lia!i%n"
Preven!in. di"!en!i%n
Ene$a - 9
rd
da# - &eri"!al"i" and
relea"e %, ,la!u"
GALL5LADDER S1RGERY
POST2OP N1RSING CARE:
Preven! %$&lia!i%n"
Preven!in. di"!en!i%n
Gall "!%ne"
Slud.e
5iliar# "!a"i"
SBSK:
Nau"ea 0 v%$i!in.
M1RPHY>S SIGN
CHOLECYSTITIS
LA5S:
67 Inrea"ed W5C
87 Inrea"ed "eru$ a$#la"e
DIAGNOSIS:
1!l!ra"%und
COMPLICATIONS:
67 Ab"e""
87 Per,%ra!i%n
97 *%led%*%li!*ia"i"
CHOLECYSTITIS
MANAGEMENT
IVF
An!ibi%!i
NG !ube de%$&re""i%n
C*%le#"!e!%$#
DISEASES OF THE
PANCREAS
PANCREATITIS
AC1TE
CHRONIC
Du%denal %b"!ru!i%n
In,e!i%n
Trau$a
Nu!ri!i%nal de,iien#
CHRONIC PANCREATITIS
PREDISPOSING FACTORS:
Al%*%l in.e"!i%n
Gallbladder di"ea"e
Au!%i$$une ,a!%r"
PANCREATITIS
RELIEF OF PAIN:
De$er%l
NO MORPHINEM
DIET
PANCREATIC EKTRACTS
An%re4ia
Wei.*! l%""
Wea3ne""
Nau"ea