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Disorders of the Exocrine Pancreas UNIT 13 Alterations in Function of the Hepatobiliary System and Exocrine Pancreas Originally developed by: Anne Mueller RN, MN Revised (1993) by: Dot Hughes RN, Msc, PhD Updated (2000) by: Marlene Reimer RN, PhD, CNN (C) Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary Unit 15 The Hepatobiliary System and Exocrine Pancreas 1 Unit 15 Table of Contents Overview..................................................................................................... 3 Aim .........................................................................................................3 Objectives ..................................................................................................3 Resources ..................................................................................................3 Web Links..................................................................................................4 Section 1: Disorders of the Liver ........................................................................ 5 Learning Activity #1 .....................................................................................5 Section 2: Disorders of the Liver—Hepatitis........................................................ 12 Introduction .............................................................................................12 Learning Activity #2 ...................................................................................12 Section 3: Disorders of the Exocrine Pancreas ...................................................... 14 Introduction .............................................................................................14 Pathophysiology ........................................................................................15 Clinical Manifestations.................................................................................17 Learning Activity #3 ...................................................................................18 Evaluation and Treatment.............................................................................19 Section 4: Disorders of the Gallbladder.............................................................. 22 Introduction .............................................................................................22 Pathophysiology ........................................................................................23 Clinical Manifestations.................................................................................25 Evaluation and Treatment.............................................................................26 Final Thoughts............................................................................................ 30 References ................................................................................................. 31 Glossary.................................................................................................... 32 Acronym List .............................................................................................. 32 Checklist of Requirements ............................................................................. 32 Required Readings .....................................................................................32 Learning Activities .....................................................................................32 Answers to Learning Activities........................................................................ 33 Answers to Learning Activity #2.....................................................................33 Structure and Function of the Pancreas .............................................................33 Answers to Learning Activity #3.....................................................................34 Answers—Surgical interventions in pancreatitis ..................................................35 Disorders of the Gallbladder..........................................................................36 Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary 2 Unit 15 The Hepatobiliary System and Exocrine Pancreas UNIT 15 Alterations in Function of the Hepatobiliary System and Exocrine Pancreas The hepatobiliary system may not seem like a very exciting topic, certainly not as stimulating as cardiology or immunology. You may be approaching this section with some dread; however, by the end of this unit you may think differently. The hepatobiliary system has a profound impact on our very existence. Without an adequately functioning system we would be unable to process and utilize nutrients provided through digestion, and would be unable to rid ourselves of toxic materials. Dysfunction of the hepatobiliary system can lead to a life of discomfort and restrictions, and may ultimately lead to death. The hepatobiliary system is comprised of the “accessory organs of digestion.” You will come to see shortly that these accessory organs are closely linked, such that disease in one organ can have serious consequences on other organs. Similarly, disease within one portion of the system can have serious and sometimes fatal effects on the whole. The knowledge you will acquire in this section about disorders of the liver, the pancreas and the gallbladder will strengthen your assessment skills and aid in providing complete, competent nursing care. Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary Unit 15 The Hepatobiliary System and Exocrine Pancreas 3 Overview This unit contains three parts: 1. Disorders of the liver (cirrhosis, hepatitis). 2. Disorders of the exocrine pancreas. 3. Disorders of the gallbladder. Aim The general aim of this unit is to assist you in gaining an understanding of how disorders of the hepatobiliary system and exocrine pancreas affect the individual. By the end of this section you will appreciate the complexity of the hepatobiliary system and its impact on total body functioning. You will accomplish this by integrating knowledge of pathophysiology, clinical manifestations and treatment regimes. Objectives Following the completion of this unit you will be able to: 1. Differentiate between different types of hepatitis. 2. Explain the mechanism behind the clinical manifestations of liver disease. 3. Describe the clinical manifestations of acute pancreatitis. 4. Describe the pathogenesis of cholelithiasis and cholecystitis. Resources Required Print Companion: Alterations in Function of the Hepatobiliary System and Exocrine Pancreas Haicken, B. (1991). Laser laparoscopic cholecystectomy in the ambulatory setting. Journal of Post Anesthesia Nursing, 6(1), 33-39. McCance, K. L., & Huether, S. E. (2001). Pathophysiology: The biologic basis for disease in adults (4th ed.). St. Louis: Mosby, pp. 1285-1299. Peicher, A., & Schiff, E. R. (1988). Acute viral hepatitis. Hospital Medicine, 24(6), 23-41. Learning Activities Activities for this unit include Learning Activities 1, 2, and 3. Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary 4 Unit 15 The Hepatobiliary System and Exocrine Pancreas Supplemental Materials Supplemental materials include: Ambrose, M.S. & Dreher, H.M. (1996). Pancreatitis: Managing a flare- up. Nursing 96, 24 (4), 33-40. Brown, A. (1991). Acute pancreatitis: Pathophysiology, nursing diagnoses, and collaborative problems. Focus on Critical Care, 18 (2), 121-130. Covington, H. (1993). Nursing care of patients with alcoholic liver disease. Critical Care Nurse, 13 (3), 47-59. Doherty, M.M. & Carver, D. (1993). Transjugular intrahepatic portosystemic shunt: New relief for esophageal varices. American Journal of Nursing, 93 (4), 58-63. It is recommended strongly that you skim through an anatomy and physiology text. This will refamiliarize you with the normal anatomy and physiology of the accessory organs of digestion, and help you to visualize what you are about to study. Web Links All web links in this unit can be accessed through the Web CT system. Rankin, Reimer & Then. © 2000 revised edition. NURS 461 Pathophysiology, University of Calgary Unit 15 The Hepatobiliary System and Exocrine Pancreas 5 Section 1: Disorders of the Liver In the unit dealing with disorders of the gastrointestinal system the pathophysiology of specific units was examined by studying representative diseases or disorders. The format used led you through an examination of the disorder’s pathophysiology, clinical manifestations, and treatment. We will depart from this format while examining liver disorders. While there are numerous liver disorders, many of them share common clinical manifestations. These include portal hypertension, ascites, esophageal varices, hepatic encephalopathy, and jaundice. It is important therefore to understand the underlying mechanisms of these manifestations so that you will appreciate their impact on the patient regardless of their underlying etiology. Learning Activity #1 In preparing this section, it became evident that your text book, McCance, K. L., & Huether, S. E., (2001), Pathophysiology: The biologic basis for disease in adults and children, addresses diseases of the liver very well. Therefore, a different approach will be used to study this section. Prior to beginning this portion, you are expected to read Disorders of the Accessory Organs of Digestion, pp. 1285-1299 in your text. When you complete your reading, work through the following case study and apply your knowledge in answering the case study questions.
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