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Mercy CLS 5: Chemistry > 15) Pancreatic function > Flashcards

15) Pancreatic function Flashcards

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1
Q

Comprised of small clusters of glandular epithelial cells

Make up 98% of the pancreatic mass

A

Acini

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2
Q

Produce pancreatic juice

A

acini

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3
Q

Inactive form of enzymes

A

zymogens

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4
Q

how do zymogen granules change during meal?

A

Number increases in the
fasting state, and
decreases following a meal.

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5
Q

Pancreas synthesizes — digestive enzymes.

A

22

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6
Q

The endocrine portion of the pancreas consists of the …

A

islets of Langerhans

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7
Q

Comprise approximately 1% of the pancreas

A

islets of Langerhans

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8
Q

products of islet cells

A

alpha —glucagon
beta —insulin
delta —somatostatin
F cells —pancreatic polypeptide

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9
Q

Identical to the growth-hormone-inhibiting factor secreted by the pituitary

A

somatostatin

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10
Q

autoregulates both endocrine and exocrine functions of pancreas

A

pancreatic polypeptide

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11
Q

Results in the inability to digest food, or maldigestion.

A

exocrine pancreatic insufficiency

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12
Q

Two major categories of pancreatic function tests

A

invasive and noninvasive

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13
Q

most common invasive pancreatic test

requires intubation

A

Secretin-cholecystokinin (CCK)

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14
Q

Following an overnight fast, the patient is intubated with a gastroduodenal tube into the duodenum.

Pancreatic juice is collected in 15-minute intervals and volume, pH, bicarbonate, and enzymes are measured.

A

Secretin-Cholecystokinin (CCK)

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15
Q

Decreased volume of pancreatic juice and increased enzyme concentration provide evidence of…

during CKK test

A

pancreatic obstruction

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16
Q

very sensitive test for steatorrhea, but its sensitivity decreases with increased damage to the pancreas.

A

fecal chymotrypsin

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17
Q

A ————- <3 IU/g of stool suggests advanced chronic pancreatitis

A

fecal chymotrypsin

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18
Q

Significant increase in serum concentrations occur in about 75% of patients with acute pancreatitis

↑ 10-20 times upper limit of normal = acute pancreatitis

A

amylase

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19
Q

nonpancreatic sources of amylase

A

mumps, cholecystitis, hepatitis, cirrhosis, ruptured ectopic pregnancy, and macroamylasemia

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19
Q

(urine/serum) amylase remains elevated longer

A

urine

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20
Q

amylase creatinine clearance ratio

A

(100)(urine AMY/serum AMY)(serum Cr/urine Cr)

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21
Q

ACCR RR

A

<3.1%

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22
Q

ACCR 8-9%

A

acute pancreatitis

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23
Q

Most —— derives from the pancreas, but some is secreted by gastric and intestinal mucosa.

A

lipase

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24
Q

Doctors consider ——- a more sensitive indicator of acute pancreatitis or other causes of pancreatic necrosis.

A

lipase

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25
Q

breath test

A

The C-mixed-chain triglyceride test

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26
Q

Evaluates intraluminal pancreatic lipase activity

A

C-mixed-chain triglyceride test

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27
Q

1,3 distearyl, 2(carboxyl-C13) octanoyl glycerol given orally to fasting patients with a “standard meal” of toast and butter

A

C-mixed-chain triglyceride test

28
Q

performed to determine if the steatorrhea is due to a pancreatic or intestinal dysfunction

A

fecal fat

29
Q

4 fats found in feces

A

Neutral fats (triglycerides)
Fatty acid salts (soaps)
Fatty acids
Cholesterol

30
Q

fecal fat stains

A

Sudan III
Sudan IV
Oil Red O

31
Q

2 fecal fat slides

A

One: only neutral fats are stained; is a suspension of the stool examined microscopically for the presence of fat droplets stained orange or red depending on the dye.

Two: stool is mixed with acetic acid and heated to release the fatty acids by hydrolysis of the soaps and neutral fats. Fatty acids and soaps are now observed with neutral fats.

32
Q

Cholesterol crystals are observed by ——after heating and cooling

A

sudan III

33
Q

Exact mechanism is not known, ——— is released into the serum during an acute pancreatic attack.

A

phospholipase A2

34
Q

Uses HPLC (not readily available)

A

NBT-PABA Test (Bentiromide)

35
Q

results of NBT-PABA test indicating pancreatic insufficiency

A

decreased chymotrypsin levels; less peptide being hydrolyzed

36
Q

based on the hydrolysis of a synthetic tripeptide N-benzoyl-1-tyrosyl-ρ-aminobenzoic acid (NBT-PABA) or bentiromide by chymotrypsin.

A

NBT-PABA test

37
Q

differentiate pancreatic insufficiency from those without pancreatic insufficiency in cystic fibrosis patients

A

Fecal Elastase-1

38
Q

——- has been found to be superior to fecal chymotrypsin to evaluate pancreatic exocrine function in CF patients.

A

Fecal elastase

39
Q

Serum ——– less than 20 ng/mL is specific for chronic pancreatitis, but sensitive only for advanced disease.

A

trypsin

40
Q

———– levels over 150 ng/mL are indicative of pancreatic inflammation.

A

trypsin

41
Q

What is measured in the pancreatic juice collected in the secretin-CCK test?

A

Volume, pH, bicarbonate, and enzymes

42
Q

C-peptide function

A

appears to protect the correct protein structure of insulin

43
Q

3 parts of sweat chloride test

A
  • Sweat stimulation by pilocarpine iontophoresis
  • Collection of sweat onto the appropriate medium
  • Qualitative or quantitative measurement of sodium, chloride, or osmolality.
44
Q

Marker for colorectal and pancreatic carcinoma

Monitor patients with pancreatic cancer (not a screening marker).

A

CA19-9

45
Q

glycolipid synthesized by pancreatic and biliary ductal cells and also gastric, colon, endometrial, and salivary epithelia

A

CA19-9

46
Q

cause of acute pancreatitis

A

autodigestion by prematurely activated enzymes

47
Q

critical early step of acute pancreatitis

A

conversion of trypsinogen to trypsin

trypsin can activate most other enzymes

48
Q

2 major etiologies of acute pancreatitis

A

Alcohol
Biliary tract disease/obstructive liver disease

49
Q

Helpful in determining the severity of an acute pancreatitis attack

A

Ranson’s Indicators of Severity in Acute Pancreatitis

50
Q

4 main goals in acute pancreatitis

A
  • Provide supportive care
  • Decrease and prevent further local pancreatic necrosis and the inflammatory process
  • Recognize and treat complications
  • Prevent future attacks
51
Q

Ranson’s indicators of severity in acute pancreatitis

A

Five signs that can be documented at admission:
Age >55 yr
Plasma glucose >200 mg/dL
LD >350 IU/L
AST >250 U/L
WBC count >16,000/μL

Within 48 hours of admission:
Hematocrit decreases greater than 10% within 24h
BUN increases by >5 mg/dL within 24h
Calcium <8.0 mg/dL
Arterial PO2 <60 mmHg

52
Q

3 ranson’s signs positive

A

<5% mortality

53
Q

≥3 Ranson’s signs positive

A

15-20% mortality

54
Q

chronic pancreatitis occurs after…

A

repeated bouts of acute pancreatitis and results in the pancreatic cells being replaced with scar tissue

55
Q

most common cause of chronic pancreatitis

A

years of alcohol abuse

56
Q

—% chronic pancreatitis causes are idiopathic

A

25

57
Q

complications of acute pancreatitis

A
  • Acute respiratory distress syndrome (ARDS)
  • Cardiac complications
  • Metabolic complications
  • Gastrointestinal bleeding
  • Pancreatic infection and abscess
  • Pseudocysts
  • Bile duct and duodenal obstruction
58
Q

collection of pancreatic juice that is enclosed by a wall of fibrous or granulation tissue that usually occurs 2 weeks after initial symptoms

A

pseudocysts

59
Q

In rare cases, chronic pancreatitis or drugs toxic to the pancreas can lead to….

A

DM

60
Q

2 explanations for hyperlipidemia in acute pancreatitis

A

Hypertriglyceridemia or hyperlipidemia can be an etiological factor, or can occur as a consequence of acute pancreatitis.

61
Q

why is Ca decreased in acute pancreatitis?

A

Calcium binds with the free fatty acids to form soaps.

62
Q

Pancreatic cancer is the —– leading cause of death from cancer in both males and females in the United States.

A

4th

63
Q

95% of pancreatic neoplasms are ——— pancreatic cancers

A

exocrine

64
Q

main risk factor for pancreatic cancer

A

Tobacco smoking (20-30% of pancreatic cancers)

65
Q

Low plasma glucose

Inappropriately elevated levels of insulin and C-peptide

A

insulinoma

66
Q

Necrolytic migratory erythema (NME)

glucagon levels above 1000 pg/mL

A

glucagonoma

67
Q

Glucose intolerance (diabetes mellitus)
Gallbladder disease
Weight loss
Diarrhea, often associated with steatorrhea

A

somatostatinoma

68
Q

Has a marked effect on gastrointestinal transit time, intestinal motility, and absorption of nutrients from the duodenum.

A

somatostatinoma

Mercy CLS 5: Chemistry (24 decks)

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