C h a p t e r 3 0
Disorders of Hepatobiliary and Exocrine Pancreas Function
751
R E V I EW E X E R C I S E S
1.
A 24-year-old woman reports to her health care
professional with complaints of a yellow discoloration
of her skin, loss of appetite, and a feeling of upper
gastric discomfort. She denies use of intravenous
drugs and has not received blood products. She
cannot recall eating uncooked shellfish or drinking
water that might have been contaminated. She has a
daughter who attends day care.
A.
What tests could be done to confirm a diagnosis
of hepatitis A?
B.
What is the most common mode of transmission
for hepatitis A? It is suggested that the source
might be through the day care center that her
daughter attends. Explain.
C.
What methods could be used to protect other
family members from getting the disease?
2.
A 56-year-old man with a history of heavy alcohol
consumption and a previous diagnosis of alcoholic
cirrhosis and portal hypertension is admitted to the
emergency department with acute gastrointestinal
bleeding due to a tentative diagnosis of bleeding
esophageal varices and signs of circulatory shock.
A.
Relate the development of esophageal varices to
portal hypertension in persons with cirrhosis of
the liver.
B.
Many persons with esophageal varices have
blood coagulation problems. Explain.
C.
What are the possible treatment measures
for this man, both in terms of controlling the
current bleeding episode and preventing further
bleeding episodes?
■■
The pancreas is an endocrine and exocrine
organ.The exocrine function of the pancreas
produces digestive enzymes that are secreted
in an inactive form and transported to the small
intestine through the main pancreatic duct, which
empties into the hepatopancreatic ampulla and
then into the duodenum through the sphincter of
Oddi.
■■
Acute pancreatitis is an inflammatory condition
of the pancreas due to inappropriate activation of
pancreatic enzymes, with manifestations that can
range from mild to severe and life-threatening.
■■
Chronic pancreatitis causes progressive destruction
of the endocrine and exocrine pancreas. It is
characterized by episodes of pain and epigastric
distress that are similar to but less severe than
those that occur with acute pancreatitis.
■■
Pancreatic cancer, the cause of which is
unknown, is considered to be one of the most
deadly malignancies.
3.
A 40-year-old woman presents in the emergency
department with a sudden episode of vomiting and
severe right epigastric pain that developed after
eating a fatty evening meal. Although there is no
evidence of jaundice in her skin, the sclera of her
eyes is noted to have a yellowish discoloration.
Palpation reveals tenderness of the upper right
quadrant with muscle splinting and rebound pain.
Right upper quadrant abdominal ultrasonography
confirms the presence of gallstones. The woman
is treated conservatively with pain and antiemetic
medications. She is subsequently scheduled for a
laparoscopic cholecystectomy.
A.
Relate this woman’s signs and symptoms
to gallstones and their effect on gallbladder
function.
B.
Explain the initial appearance of jaundice in the
eyes as opposed to the skin. Which of the two
laboratory tests for bilirubin would you expect
to be elevated—direct (conjugated) or indirect
(unconjugated or free)?
C.
What effect will removal of the gallbladder have
on the woman’s digestive system?
R E F E R E N C E S
1. Guyton A, Hall JE.
Textbook of Medical Physiology
. 12th ed.
Philadelphia, PA: Elsevier Saunders; 2011:837–842.
2. Ross MH, Pawlina W.
Histology: A Test and Atlas
. 6th
ed. Philadelphia, PA: Lippincott Williams & Wilkins;
2010:576–609.
3. Crawford JM, Liu C. Liver and biliary tract. In: Kumar V,
Abbas AK, Fausto N, et al., eds.
Robbins and Cotran Pathologic
Basis of Disease
. 8th ed. Philadelphia, PA: Saunders Elsevier;
2010:833–890.
4. Herrine S, Navarro V, Rubin R. The liver and biliary system.
In: Rubin R, Strayer DS, eds.
Rubin’s Pathophysiology:
Clinicopathologic Foundations of Medicine
. 6th ed. Philadelphia,
PA: Wolters Kluwer Health/Lippincott Williams & Wilkins;
2012:677–736.
5. Aragon G, Younoussi Z. When and how to evaluate mildy
elevated serum enzymes in apparently healthy patients.
Cleve
Clin J Med.
2010;77(3):195–204.
6. Krier M, Ahmed A. The asymptomatic outpatient with abnormal
liver function tests.
Clin Liver Dis.
2009;13:167–177.
7. Rockey DC, Caldwell SH, Goodman ZD, et al. Liver biopsy.
Hepatology.
2009;49:1017–1044.
8. Matheny SC, Kingery JE. Hepatitis A.
Am Fam Physician.
2012;86:1027–1034.
9. Lavanchy D. Viral hepatitis: Global goals for vaccination.
J Clin
Virol.
2012;55(4):296–302.
10. Carey W, Anand B, Lauer G, et al. Viral hepatitis B and D.
First Consult
. 2012. Available at:
Accessed September 1, 2013.
11. World Health Organization. Hepatitis B. 2013. Available at:
. Accessed August 28,
2013.
12. Centers for Disease Control and Prevention. Hepatitis B for
health professionals. 2012. Available at:
/
hepatitis/HBV. Accessed August 28, 2013.
13. Hajarizadeh B, Grebely J, Dore GJ. Epidemiology and natural
history of HCV infection.
Nat Rev Gastroenterol Hepatol.
2013;10:553–562.
