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792 UNIT EIGHT Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems

rejection usually develop between the 4th and 10th postoper-

CRITICAL THINKING
Mrs. Conner
■ Mrs. Conner, a 76-year-old retired businesswoman,
has lived alone for the past 20 years since the death of her
husband. She has a long history of poor nutritional habits
but does not consume alcohol. She is admitted with
cirrhosis.
ative days. The patient who has received an organ transplant
needs extended medical follo w-up. Teach the patient to
promptly report to the physician an y symptoms of infection,
bleeding episodes, or RUQ pain.
As a short-term bridge to li ver transplant, bioartif icial
livers with filtering membranes have been used. Under study,
for longer term support is hepatoc yte transplantation via a
splenic artery catheter.

1. What risk factors does Mrs. Conner have for
cirrhosis?
2. What symptoms would you expect Mrs. Conner to
exhibit with early cirrhosis?
3. What values do you expect to see for serum albumin?
Prothrombin time?
4. What are the two greatest concerns with portal
hypertension?
5. What is the usual treatment for ascites?
Suggested answers are at the end of the chapter.
Liver Transplantation
The patient with end-stage liver failure from cirrhosis, hepatitis,
biliary disease, metabolic disorders, or hepatic vein obstruction
might be evaluated for a liver transplant. The patient will be
evaluated for emotional and physical stability and must accept
that he or she will be on daily medications for life (“Cultural
Considerations”).
After the surgical implantation of a donor liver, the patient
must be closely observed for evidence of donor organ rejection.
The patient will be on drugs to suppress immune system
responses and prevent tissue rejection. Observe the patient for
the following signs of impending rejection:
• Pulse greater than 100 beats per minute
• Temperature greater than 101°F (38°C)
• Reports of RUQ pain
• Increased jaundice
• Decrease in bile from the T-tube or change in bile color.
In addition, laboratory studies may show increased serum
transaminases (ALT and AST), serum bilirubin, alkaline
phosphatase, and prothrombin time. Symptoms of acute tissue
Cancer of the Liver
Cancer of the liver usually results from metastasis from a
primary cancer at a distant location. The liver is a likely area
of involvement if cancer originated in the esophagus, lungs,
breast, stomach, colon, pancreas, kidne y, bladder, or skin.
For some patients, li ver cancer is the primary tumor site.
Patients with a history of chronic hepatitis B or C infection,
nutritional deficiencies, heavy alcohol use or smoking, and
exposure to hepatotoxins have an increased risk for cancer
of the liver.
Symptoms of cancer of the liver include encephalopathy,
abnormal bleeding, jaundice, and ascites. Laboratory tests
show elevated serum alkaline phosphatase. Radiologic exam-
inations may include abdominal radiographs or radioisotope
scans, which show tumor growth. Liver cancer is definitively
diagnosed with a positive needle biopsy combined with an
ultrasound exam of the liver.
Liver cancer is staged upon diagnosis. If found early ,
surgery can be curati ve. Rarely, though, is it found
early. Care of the postsur gical patient is similar to other
abdominal surgery patients. If surgery is not an option, the
patient may receive chemotherapeutic drugs by injection
directly into the affected lobe of the liver or into the hepatic
artery; sorafenib, which, slo ws the spread of cancer
cells; or radiation therapy. The overall survival rate for liver
cancer is low. (See Chapter 11 for care of patients with
cancer.)
DISORDERS OF THE PANCREAS
Pancreatitis
Pancreatitis, inflammation of the pancreas, may be either
acute or chronic. The two forms of pancreatitis have different
courses and are considered two different disorders.

Cultural Considerations
Jewish law addresses organ transplantation from the perspectives of the recipient, the living donor, the cadaver donor,
and the dying donor. If a recipient’s life can be prolonged without considerable risk, transplant is ordained. For a living
donor to be approved, the risk to the life of the donor must be considered. One is not obligated to donate a part of
himself or herself unless the risk is small. The use of a cadaver for transplant is usually approved if it is saving a life.
The nurse may need to help a patient who is Jewish contact a rabbi when making a decision regarding organ donation
or transplantation.