Hepatobiliary and Pancreatic Nursing Care and Diagnostic Evaluation

Vocabulary practice flashcards covering pathophysiology, diagnostic tests, lab reference values, clinical signs, and nursing management of hepatobiliary and pancreatic conditions.

Hepatitis A Virus (HAV)

A viral liver infection transmitted via the fecal-oral route through contaminated food or water; characterized by mild flu-like illness, an incubation period of $2\text{--}4\,\text{weeks}$, and no chronic phase. Prevention includes hand hygiene, the HepA vaccine, and post-exposure gamma-globulin injection.

Hepatitis B Virus (HBV)

A bloodborne viral disease transmitted through infected blood, high-risk behaviors, or perinatally; it represents the leading cause of liver cancer, has an incubation period of $1\text{--}4\,\text{months}$, causes chronic infection in approximately $10\%$ of cases, and is preventable via vaccine or Hepatitis B immune globulin administered within $7\,\text{days}$ of exposure.

Hepatitis C Virus (HCV)

A bloodborne virus and the leading indication for liver transplantation; characterized by an incubation period of $7\text{--}8\,\text{weeks}$, high rate of chronic progression (approximately $80\%$), a resolution rate of only about $20\%$, and no current preventative vaccine.

Jaundice (Icterus)

A clinical sign caused by elevated serum bilirubin (typically total bilirubin $> 2.5\,\text{mg/dL}$), characterized by yellow pigmentation of the sclera, skin, and hard palate along with dark brown urine.

Hemolytic Jaundice

A category of jaundice caused by an increased breakdown of red blood cells, resulting in excessive unconjugated bilirubin production.

Hepatocellular Jaundice

Jaundice resulting from the liver's inability to extract unconjugated bilirubin from the bloodstream or a decreased ability of hepatocytes to conjugate it.

Obstructive Jaundice

Jaundice caused by blocked or decreased bile flow through the hepatic or biliary ducts, typically resulting in conjugated bilirubin excreted in urine and clay-colored stools.

Conjugated (Direct) Bilirubin

Water-soluble bilirubin that has been metabolized and conjugated by hepatocytes (normal: $0.1\text{--}0.3\,\text{mg/dL}$); elevated direct bilirubin levels can filter into urine and are indicative of biliary obstruction.

Unconjugated (Indirect) Bilirubin

Lipid-soluble bilirubin formed from the catabolism of red blood cell heme prior to processing by the liver (normal: $0.2\text{--}0.8\,\text{mg/dL}$); it is not water soluble, cannot be excreted into urine, and is elevated in hemolytic and hepatocellular disorders.

Portal Hypertension

Sustained high blood pressure within the portal venous system due to structural resistance to hepatic blood flow in cirrhosis, leading to ascites, splenomegaly, and portosystemic collateral veins (varices).

Ascites

The accumulation of serous fluid within the peritoneal cavity resulting from portal hypertension, decreased serum albumin synthesis, and sodium retention; monitored clinically by measuring abdominal girth at the level of the umbilicus.

Caput Medusae

A network of dilated, engorged collateral veins radiating outward across the abdomen from the umbilicus, resulting from portal hypertension in advanced cirrhosis.

Spider Angioma

A telangiectatic cutaneous vascular lesion characterized by a central red arteriole with radiating spider-like vessels, commonly seen on the nose, cheeks, and upper body in chronic liver disease.

Asterixis

A neuromuscular manifestation of hepatic encephalopathy described as a coarse 'liver flap' or metabolic tremor, assessed by having the patient extend their arms with wrists dorsiflexed.

Hepatic Encephalopathy

A reversible neuropsychiatric complication of advanced liver disease caused by excessive serum ammonia ($\text{NH}_3$) crossing the blood-brain barrier; managed by restricting dietary protein ($20\text{--}40\,\text{g/day}$) and administering lactulose titrated to $2\text{--}4$ stools per day.

Paracentesis

The insertion of a needle into the peritoneal cavity to remove excess ascitic fluid with the goal of relieving respiratory distress; nursing protocols require informed consent, baseline vital signs, voiding beforehand, and placing the patient in supine or high-Fowler's position.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

A non-surgical interventional procedure that creates an intrahepatic tract between the portal vein and hepatic vein using a metal stent to decompress portal hypertension, control refractory ascites, and decrease variceal bleeding.

Endoscopic Variceal Ligation

An endoscopic therapeutic procedure (banding) in which small rubber 'O' rings are placed around the base of esophageal varices to interrupt circulation and prevent or control active bleeding.

Endoscopic Sclerotherapy

The injection of a chemical sclerosing agent directly into esophageal or rectal varices via an endoscopic needle to promote thrombosis and obliterate the lumen of fragile bleeding vessels.

Balloon Tamponade

An emergency therapeutic maneuver using a specialized multi-lumen nasogastric tube (e.g., Sengstaken-Blakemore or Minnesota tube) with inflatable gastric and esophageal balloons that physically compress actively bleeding varices.

Acute Pancreatitis

An inflammatory disorder involving the premature activation of pancreatic digestive enzymes leading to autodigestion, edema, and tissue necrosis; commonly caused by gallstones and alcohol abuse, with CT scan serving as the definitive imaging modality.

Chronic Pancreatitis

A progressive, destructive inflammatory disorder that causes permanent fibrosis of pancreatic parenchyma, manifested by severe abdominal pain, ascites, weight loss requiring high caloric support ($4000\text{--}6000\,\text{cal/day}$), and steatorrhea.

Turner's Sign

Bluish ecchymotic discoloration of the bilateral flanks caused by retroperitoneal hemorrhage and subcutaneous enzyme tracking in severe acute hemorrhagic pancreatitis.

Cullen's Sign

A bluish-purple discoloration encircling the periumbilical region caused by tracking of retroperitoneal blood and pancreatic enzyme exudate into cutaneous tissues in necrotizing pancreatitis.

Pancreatic Pseudocyst

A localized collection of necrotic debris, pancreatic enzymes, and fluid encapsulated by fibrous tissue located adjacent to or surrounding the outside of the pancreas.

Pancreatic Abscess

A large, infective, purulent fluid collection forming within the pancreatic parenchyma as a result of extensive tissue necrosis, requiring prompt surgical debridement and drainage.

Pancreatic Enzyme Replacement Therapy (PERT)

Therapeutic oral administration of exogenous digestive enzymes (e.g., pancrelipase) taken before or with meals to alleviate malabsorption; capsules must not be crushed or chewed, lip contact must be wiped away, and powder should not be mixed with protein foods.

Steatorrhea

Pale, bulky, oily, floating stools resulting from undigested fat excretion due to deficient pancreatic lipase secretion or impaired biliary excretion.

Cholelithiasis

The formation or presence of calculi (gallstones) within the gallbladder or bile ducts; classic risk factors include middle age, female sex, fair skin, obesity, high-fat diets, and oral contraceptives.

Cholecystitis

Inflammation of the gallbladder wall, commonly triggered by gallstones obstructing the cystic duct, characterized by right upper quadrant epigastric pain that radiates to the right shoulder following high-fat meals.

T-Tube

A pliable surgical drain placed directly into the common bile duct during open cholecystectomy connected to a bile collection bag to preserve lumen patency and drain excess bile while surrounding postoperative edema resolves.

Abdominal Ultrasound (Hepatobiliary)

A non-invasive diagnostic scan possessing a $95\%$ accuracy rate in detecting gallstones; requires the patient to remain NPO for $8\,\text{hours}$ prior to examination to prevent meal-stimulated gallbladder contraction.

Hepatobiliary Scintigraphy (HIDA Scan)

A nuclear medicine diagnostic study where technetium-99 ($\text{Tc-99}$) is administered intravenously, cleared by hepatocytes, and excreted into bile to evaluate patency of the common bile duct and ampulla when ultrasound findings for cholecystitis are inconclusive.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

An endoscopic and fluoroscopic diagnostic procedure used to visualize and cannulate the pancreatic, hepatic, and common bile ducts; necessitates $8\,\text{hours}$ of NPO status, sedation, and post-procedure surveillance for pancreatitis and return of the gag reflex.

Percutaneous Liver Biopsy

A procedure obtaining liver tissue via an aspirating needle introduced through the 6th/7th or 8th/9th intercostal space on the right side; requires breath-holding after expiration during needle insertion, followed by right-side-lying positioning for $2\,\text{hours}$ and head of bed flat for $12\text{--}24\,\text{hours}$.

Serum Amylase

A carbohydrate-digesting pancreatic enzyme with a normal range of $60\text{--}120\,\text{u/L}$; in acute pancreatitis, serum concentrations elevate within $12\,\text{hours}$, peak at $24\,\text{hours}$, and normalize within $48\text{--}72\,\text{hours}$.

Serum Lipase

A fat-digesting pancreatic enzyme with a normal reference range of $0\text{--}160\,\text{u/L}$; in acute pancreatitis, serum levels increase within $24\text{--}48\,\text{hours}$ and remain elevated for $5\text{--}7\,\text{days}$.

Serum Ammonia ($\text{NH}_3$)

A toxic nitrogenous compound resulting from protein metabolism normally converted into urea by the liver (normal: $< 80\,\mu\text{g/dL}$); elevated levels cross the blood-brain barrier and cause progressive hepatic encephalopathy.

Serum Albumin

A major plasma protein synthesized by the liver responsible for intravascular oncotic pressure (normal: $3.5\text{--}5.0\,\text{g/dL}$); levels drop in advanced cirrhosis, promoting peripheral edema and ascites.

Prothrombin Time (PT)

A coagulation test evaluating the extrinsic pathway of clotting factor synthesis by the liver (normal: $11\text{--}16\,\text{sec}$); prolonged values reflect impaired hepatic production of clotting factors.

Alanine Aminotransferase (ALT)

A liver transaminase enzyme primarily found within hepatocytes (normal: $4\text{--}36\,\text{units/mL}$); elevated blood concentrations reflect acute or active hepatocellular necrosis and damage.

Alkaline Phosphatase (Alk Phos)

An enzyme concentrated in biliary tract cell membranes (normal: $30\text{--}120\,\text{units/L}$); marked serum elevations occur in cholestasis and biliary obstruction.