15
910/13/2026,
AMNSG4330
Page1:58:15
1-ofLecture
910/13/2026,
AMNSG4330
8 - Liver,
1:58:15
Pancreas
- Lecture
AMNSG4330
8
and
- Liver,
Biliary
Pancreas
- Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Lecture 8and
- Liver,
Biliary
Pancreas
Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
and Biliary Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWRORWUOI
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWR
(&*$ **F VJyvhjbnoP
NSG4330 - Lecture 8 - Liver, Pancreas and Biliary Tract
T
T or F - The liver is the body's largest solid
organ
F - an individual cannot survive without a functioning liver
T or F - An individual can survive without
thier liver
- secretion of bile (needed for fat emulsion)
- metabolism of bilirubin
- blood storage
- metabolism of nutrients, manages glucose
- conversion of ammonia into urea for excretion
What are functions of the liver?
- detoxifies alcohol, nicotine and other toxins
- synthesis of clotting factors
an orange-yellow pigment formed in the liver from the breakdown of hemoglobin in
What is bilirubin? red blood cells after their 120-day lifespan
- Kupffer cells separate hemeoglobin into heme and global
- iron taken from the heme is stored in the liver or used by the bone marrow to form
new red blood cells (erythropoiesis)
What is the process of hemoglobin - global is broken down into amino acids theatre used to form new proteins
breakdown? - the byproduct that is left when the iron is taken from the red blood cells becomes
bilirubin
- The bilirubin binds to albumin which created unconjugated bilirubin which is lipid
soluble
- hepatocytes in the liver convert unconjugated bilirubin to conjugated bilirubin which
is water soluble and secretes it in bile
- bacteria in the intestines convert it to urobilinogen
How is bilirubin excreted from the body? - secreted in the kidney as urine
- a small amount is secreted in the faces as stercobilin, which contributes to the
brown pigmentation
What causes the brown pigment in stool? stercobilin - digested bilirubin
Elevated levels of bilirubin in the blood, which results in yellowish discolouration of
What is jaundice? sclera and body tissue
What are normal serum bilirubin levels? Serum total bilirubin levels = 3-22 mcmcl/L
- a yellow tinge to the skin and whites of eyes
- itchiness, fatigue
- weight loss
What are signs and symptoms of jaundice? - nausea and vomiting
- pale stools
- Pre-hepatic jaundice
- Hepatic jaundice
What are the types of jaundice? - Post-hepatic jaundice
Pre-hepatic jaundice is due to overproduction if unconjugated bilirubin
- This can be due to hemolysis of (breakdown of) red blood cells
What is pre-hepatic jaundice? - transfusion reaction and/or sickle cell crisis
Hepatic jaundice is a decrease in the liver's ability to take up bilirubin from the blood,
decreased ability to conjugate bilirubin or excrete bilirubin into bile
What is hepatic jaundice? - hepatocyte cells are damaged
- cirrhosis, alcohol, drug-induced hepatitis, liver carcinoma
Post hepatic jaundice is failure of the bile to reach the duodenum, usually an
instruction of bile through the liver or biliary duct system
What is post hepatic jaundice? - gallbladder stones or pancreatic cancer
15
MPage
AMNSG4330
1 Page
of 910/13/2026,
1-ofLecture
910/13/2026,
1:58:15
8 - Liver,
1:58:15
AMNSG4330
Pancreas
AMNSG4330
and
- Lecture
Biliary- Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Lecture
8 - Liver,
8 -Pancreas
Liver, Pancreas
and Biliary
andTract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Biliary Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWRORWUOI
(&*$ **F
(&*$
VJyvhjbnoP+_IREO
**F VJyvhjbnoP
,15
910/13/2026,
AMNSG4330
Page1:58:15
2-ofLecture
910/13/2026,
AMNSG4330
8 - Liver,
1:58:15
Pancreas
- Lecture
AMNSG4330
8
and
- Liver,
Biliary
Pancreas
- Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Lecture 8and
- Liver,
Biliary
Pancreas
Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
and Biliary Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWRORWUOI
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWR
(&*$ **F VJyvhjbnoP
NSG4330 - Lecture 8 - Liver, Pancreas and Biliary Tract
When the liver does not function properly, protein metabolism, blood coagulation,
and bile production are all impacted
What is liver disease? - challenges with the digestion of nutrients, bleeding disorders, and impaired
immune function
Can hepatocytes regenerate? With acute injuries, some hepatocytes can regenerate
Widespread inflammation of the liver
- common types are A,B,C,D,E
What is viral hepatitis? - these cases much be reported to public health
- they have long term implications of liver disease
- Inflammatory markers and white blood cells flood the liver
- macrophages destroy the infected and normal hepatocytes which causes liver
dysfunction
How does viral hepatitis affect the liver? - chronic infection and inflammation can cause liver fibrosis, which leads to cirrhosis
- Not all people with viral hepatitis have symptoms
- jaundice
- anorexia, nausea, vomting, weight loss
- malaise, fatigue
- headache, low-grade fever
What are the signs and symptoms of the - RUQ pain
acute phase of viral hepatitis? - Pruritis
- hepatomegaly
How is Hepatitis A transmitted? Fecal-oral route - usually through contaminated food or water
T or F - There is a vaccine for hepatitis A. T - for high risk individuals
How do you treat hepatitis A? Treat the signs and symptoms
How long is the recovery for Hepatitis A? 4-6 weeks
Bodily fluids
- contaminated needles, syringes, blood products
How is Hepatitis B transmitted? - unprotected sex
- pregnant mothers to unborn babies
T or F - There is a vaccine for Hepatitis B T
4-6 months
How long is a person infectious with
- can live outside the body for 7 days
hepatitis B?
- Pegylated Interferon Alfa: antiviral
- entecavir: antiviral
What is the treatment for hepatitis B? - lamivudine: antiviral
- do not reuse needles or syringes
- safe sex practices
What is patient education for hepatitis B? - infants born with HBV need immunoglobulins at birth and vaccination
T - 80% of patients with Hepatitis C will develop a chronic infection
T or F - Hepatitis C is the most likely of the
viruses to cause long-term liver damage
- Unprotected sex
- Needles and syringes
How is Hepatitis C transmitted? - blood and blood products
1-2 weeks
When is the symptom onset for hepatitis
C?
direct acting antivirals
- Glecaprevir/pibrentasvir
What is the treatment for hepatitis C? - sofosbuvir/velpatasvir
15
MPage
AMNSG4330
2 Page
of 910/13/2026,
2-ofLecture
910/13/2026,
1:58:15
8 - Liver,
1:58:15
AMNSG4330
Pancreas
AMNSG4330
and
- Lecture
Biliary- Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Lecture
8 - Liver,
8 -Pancreas
Liver, Pancreas
and Biliary
andTract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Biliary Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWRORWUOI
(&*$ **F
(&*$
VJyvhjbnoP+_IREO
**F VJyvhjbnoP
910/13/2026,
AMNSG4330
Page1:58:15
1-ofLecture
910/13/2026,
AMNSG4330
8 - Liver,
1:58:15
Pancreas
- Lecture
AMNSG4330
8
and
- Liver,
Biliary
Pancreas
- Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Lecture 8and
- Liver,
Biliary
Pancreas
Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
and Biliary Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWRORWUOI
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWR
(&*$ **F VJyvhjbnoP
NSG4330 - Lecture 8 - Liver, Pancreas and Biliary Tract
T
T or F - The liver is the body's largest solid
organ
F - an individual cannot survive without a functioning liver
T or F - An individual can survive without
thier liver
- secretion of bile (needed for fat emulsion)
- metabolism of bilirubin
- blood storage
- metabolism of nutrients, manages glucose
- conversion of ammonia into urea for excretion
What are functions of the liver?
- detoxifies alcohol, nicotine and other toxins
- synthesis of clotting factors
an orange-yellow pigment formed in the liver from the breakdown of hemoglobin in
What is bilirubin? red blood cells after their 120-day lifespan
- Kupffer cells separate hemeoglobin into heme and global
- iron taken from the heme is stored in the liver or used by the bone marrow to form
new red blood cells (erythropoiesis)
What is the process of hemoglobin - global is broken down into amino acids theatre used to form new proteins
breakdown? - the byproduct that is left when the iron is taken from the red blood cells becomes
bilirubin
- The bilirubin binds to albumin which created unconjugated bilirubin which is lipid
soluble
- hepatocytes in the liver convert unconjugated bilirubin to conjugated bilirubin which
is water soluble and secretes it in bile
- bacteria in the intestines convert it to urobilinogen
How is bilirubin excreted from the body? - secreted in the kidney as urine
- a small amount is secreted in the faces as stercobilin, which contributes to the
brown pigmentation
What causes the brown pigment in stool? stercobilin - digested bilirubin
Elevated levels of bilirubin in the blood, which results in yellowish discolouration of
What is jaundice? sclera and body tissue
What are normal serum bilirubin levels? Serum total bilirubin levels = 3-22 mcmcl/L
- a yellow tinge to the skin and whites of eyes
- itchiness, fatigue
- weight loss
What are signs and symptoms of jaundice? - nausea and vomiting
- pale stools
- Pre-hepatic jaundice
- Hepatic jaundice
What are the types of jaundice? - Post-hepatic jaundice
Pre-hepatic jaundice is due to overproduction if unconjugated bilirubin
- This can be due to hemolysis of (breakdown of) red blood cells
What is pre-hepatic jaundice? - transfusion reaction and/or sickle cell crisis
Hepatic jaundice is a decrease in the liver's ability to take up bilirubin from the blood,
decreased ability to conjugate bilirubin or excrete bilirubin into bile
What is hepatic jaundice? - hepatocyte cells are damaged
- cirrhosis, alcohol, drug-induced hepatitis, liver carcinoma
Post hepatic jaundice is failure of the bile to reach the duodenum, usually an
instruction of bile through the liver or biliary duct system
What is post hepatic jaundice? - gallbladder stones or pancreatic cancer
15
MPage
AMNSG4330
1 Page
of 910/13/2026,
1-ofLecture
910/13/2026,
1:58:15
8 - Liver,
1:58:15
AMNSG4330
Pancreas
AMNSG4330
and
- Lecture
Biliary- Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Lecture
8 - Liver,
8 -Pancreas
Liver, Pancreas
and Biliary
andTract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Biliary Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWRORWUOI
(&*$ **F
(&*$
VJyvhjbnoP+_IREO
**F VJyvhjbnoP
,15
910/13/2026,
AMNSG4330
Page1:58:15
2-ofLecture
910/13/2026,
AMNSG4330
8 - Liver,
1:58:15
Pancreas
- Lecture
AMNSG4330
8
and
- Liver,
Biliary
Pancreas
- Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Lecture 8and
- Liver,
Biliary
Pancreas
Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
and Biliary Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWRORWUOI
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWR
(&*$ **F VJyvhjbnoP
NSG4330 - Lecture 8 - Liver, Pancreas and Biliary Tract
When the liver does not function properly, protein metabolism, blood coagulation,
and bile production are all impacted
What is liver disease? - challenges with the digestion of nutrients, bleeding disorders, and impaired
immune function
Can hepatocytes regenerate? With acute injuries, some hepatocytes can regenerate
Widespread inflammation of the liver
- common types are A,B,C,D,E
What is viral hepatitis? - these cases much be reported to public health
- they have long term implications of liver disease
- Inflammatory markers and white blood cells flood the liver
- macrophages destroy the infected and normal hepatocytes which causes liver
dysfunction
How does viral hepatitis affect the liver? - chronic infection and inflammation can cause liver fibrosis, which leads to cirrhosis
- Not all people with viral hepatitis have symptoms
- jaundice
- anorexia, nausea, vomting, weight loss
- malaise, fatigue
- headache, low-grade fever
What are the signs and symptoms of the - RUQ pain
acute phase of viral hepatitis? - Pruritis
- hepatomegaly
How is Hepatitis A transmitted? Fecal-oral route - usually through contaminated food or water
T or F - There is a vaccine for hepatitis A. T - for high risk individuals
How do you treat hepatitis A? Treat the signs and symptoms
How long is the recovery for Hepatitis A? 4-6 weeks
Bodily fluids
- contaminated needles, syringes, blood products
How is Hepatitis B transmitted? - unprotected sex
- pregnant mothers to unborn babies
T or F - There is a vaccine for Hepatitis B T
4-6 months
How long is a person infectious with
- can live outside the body for 7 days
hepatitis B?
- Pegylated Interferon Alfa: antiviral
- entecavir: antiviral
What is the treatment for hepatitis B? - lamivudine: antiviral
- do not reuse needles or syringes
- safe sex practices
What is patient education for hepatitis B? - infants born with HBV need immunoglobulins at birth and vaccination
T - 80% of patients with Hepatitis C will develop a chronic infection
T or F - Hepatitis C is the most likely of the
viruses to cause long-term liver damage
- Unprotected sex
- Needles and syringes
How is Hepatitis C transmitted? - blood and blood products
1-2 weeks
When is the symptom onset for hepatitis
C?
direct acting antivirals
- Glecaprevir/pibrentasvir
What is the treatment for hepatitis C? - sofosbuvir/velpatasvir
15
MPage
AMNSG4330
2 Page
of 910/13/2026,
2-ofLecture
910/13/2026,
1:58:15
8 - Liver,
1:58:15
AMNSG4330
Pancreas
AMNSG4330
and
- Lecture
Biliary- Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Lecture
8 - Liver,
8 -Pancreas
Liver, Pancreas
and Biliary
andTract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
Biliary Tract(*((&#*!(*#*($$(*($(*$Y(&*&$(*)&*)((&$*^$&*&$
(&*$ **F VJyvhjbnoP+_IREOLKDJ(UWRORWUOI
(&*$ **F
(&*$
VJyvhjbnoP+_IREO
**F VJyvhjbnoP
