122 - Pancreas and Gall Bladder Flashcards
What types of Pancreatitis are there?
Acute Chronic Autoimmune Hereditary Inflammatory \+ pancreatic cancer
How does acute pancreatitis present?
Acute upper abdo pain
Vomiting
prostration
Few days - few weeks
What can cause acture pancreatitis?
Mainly gallstones Alcohol Drugs (aspirin, paracetamol, Erthyromycin) Toxins (insecticide) Metabolic (hypercalcaemia, Hypertrigliceridemia) Traumatic Vascular Infectious Ideopathic
What investigations can help you diagnose actule pancreatitis?
- Blood enzyme levels (Low Lipase, High serum amylase)
- Asses endocrine function (direct enzyme secretion, in feces - enzyme / what is digested)
- Imaging
What imaging can be used for the pancreas?
AXR USS CT MR MRCP EUS ERCP
Why isn’t ERCP used all the time?
It is invasive - requires an endoscopy, and can cause acute pancreatitis itself!
What is the main cause of chronic pancreatitis?
Alcohol - in young/middle ages men
Developing world - nutitional
What is autoimmune pancreatitis associated with?
Increased IgG4 levels
What is mutated in a hereditary Pancreatitis?
Catonic trypsinogen gene - so mutant trypsin resists inactivation in the pancreas.
What does pancreatic cancer have such a poor prognosis?
- It is retroperitoneal - so not constrained by peritoneum
- It is It has a direct link into the duodenum
- Has a good blood supply - due to its endocrine function
What is the cancer marker for Pancreatic cancer?
CA19-9
How can pancreatic cancer present?
Relentless pain in upper abdomen/back Weight loss Diarrhoea Jaundice Diabetes
Describe endocrine
Substance secreted directly into the blood stream, where it travels to its place of action
Describe exocrine
Substance secreted into ducts where it travels to the place of action
What is the endocrine function of the pancreas?
Islet cells - produce Insulin, glucagon, somatostatin and pancreatic polypeptide.
What is the exocrine function of the pancreas?
Duct cells secrete bicarbonate - when stimulated by secretin
Acinar cells secrete digestive enxymes (lipase, amylase, proteases) - when stimulated by CCK.
What is the distribution of cell types in the pancreas?
10% islet cells
10% Duct cells
80% acinar cells
What does pancreatic insufficiency cause?
Diabetes Maldigestion - malabsorption Diarrhoea + Steatorrea Weight loss + malnutition Deficiency is lipid soluble nutrients - Vit A, D, E and K
What is bile?
A watery mixture of organic and inorganic compounds
- Mainly phosphatidylcholine / Lechthin
What are bile salts needed for?
Lipid digestion/absorption
What do bile salts form to aid FA + MG absorption?
Micelles
What do bile salts need to be transported in the enterohepatic circulation?
To be bound to albumin
How is cholesterol converted to a bile acid?
Cholesterol -> cholic acid in liver, catalysed by 7 alpha hydroylase
Cholic acid -> deocycholic acid (secondary bile acid) by gut flora.
What is the sensory duodenum?
The duodenum has endocrine cells that detect what is passing though it, and respond by secreting CCK or secretin.
- Acid -> secretin -> bicarb released by pancreas
- Protein + fat -> CCK -> Bile released and digestive enzymes
How is the haemoglobin in RBC’s degraded?
Haemoglobin - Haem + globin In macrophage : Haem - biliverdin - bilirubin blood - with albumin - to liver Biliribin - bilirubin anhydrase
