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Digestion > 2 C: Anatomy/Phy/Path of Pancreas > Flashcards

2 C: Anatomy/Phy/Path of Pancreas Flashcards

1
Q

Describe the endocrine pancreas

A

Production of insulin & glucagon; plasma glucose regulation

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2
Q

Describe the exocrine pancreas

A

Production of pancreatic juice

  • **Source of HCO3- to neutralize gastric acid
  • **Source of many digestive enzymes
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3
Q

What does pancreatic juice consist of ? pH?

A
  • HCO3- and the digestive enzymes are secreted by the pancreas as pancreatic juice.
  • pH= 7.6-8.2
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4
Q

Pancreatic juice travels from the pancreas to the duodenum via the ________________________

A

Main pancreatic duct

***1500 ml of pancreatic juice secreted per day

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5
Q

What neutralizes the gastric acid, raising the duodenal content to 6.0-7.0?

A

Pancreatic juice, Bile, and Intestinal juices are neutral or alkaline

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6
Q

What are the enzymes that are included in the pancreatic juice?

A

1) Pancreatic amylase
2) Pancreatic lipase
3) Colipase
4) * Trypsinogen
5) * chymotrypsinogen
6) * procarboxypeptidase (A/B)
7) * proelastase
8) ribonuclease
9) deoxyribonuclease

**these 4 are proteases (inactive until they hit the duodenum)

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7
Q

Proteases of the pancreatic juice are secreted as __________

A

inactive “proenzymes”

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8
Q

What is Trypsinogen converted into?

What converts it?

A

Trypsin

***Converted by the brush border enzyme ENTEROKINASE (also known as enteropeptidase) when the pancreatic juice enters the duodenum

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9
Q

What does Trypsin convert chymotrypsinogen into active ____________

A

chymotrypsin

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10
Q

What does Trypsin convert procarboxypeptidase into active ____________

A

carboxypeptidase

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11
Q

What does Trypsin convert proelastase into active ____________

A

elastase

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12
Q

How can Enterokinase deficiency occur?

A

As a congenital abnormality, which leads to protein malnutrition

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13
Q

Where do these proenzymes get converted to active forms?

A

In the duodenum (brush border) on epithelial cells

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14
Q

What can releasing trypsin in its active form lead to ?

A

A chain reaction of producing several active enzymes capable of digesting THE PANCREAS!

Note: **Pancreatic tissue has TRYPSIN INHIBITORS to prevent this!

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15
Q

Secretion of pancreatic juice is under what control?

A

Hormonal control

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16
Q

What does Secretin act on?

A

The pancreas to cause copies secretion of a very alkaline pancreatic juice that is rich in HCO3- and LOW in enzymes

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17
Q

What does CCK do?

A

Stimulates production of pancreatic juice rich in enzymes and LOW in HCO3-

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18
Q

What does the stimulation of the parasympathetic fibers with the vagus nerves do?

A

Causes secretion of a small amount of pancreatic juice rich in enzymes, but this influence is much less potent that CCK

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19
Q

What has some evidence shown about vagally-mediated conditioned reflex secretion of pancreatic juice?

A

Secreted In response to sight or smell of food

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20
Q

What is Acute Pancreatitis ?

A

A severe life-threatening disorder associates with the escapee of activated pancreatic enzymes into the pancreas and surrounding tissues.

21
Q

If small amount of pancreatic digestive enzymes already naturally leak into circulation, how is different with acute pancreatitis?

A

The circulating levels of the digestive enzymes rise markedly.

22
Q

What is a useful in diagnosing problems associated with inflammation and necrosis of pancreatic acinar cells?

A

Measurement of the plasma pancreatic amylase or pancreatic lipase

23
Q

In pancreatitis what do these enzymes cause?

A

Fat necrosis or auto -digestion of the pancreas and produce fatty deposits in the abdominal cavity with the hemorrhage from the necrotic vessels.

24
Q

What is the common cause of Pancreatitis?

A

Most cases result from gallstone (stones in the common bile duct) or alcohol abuse

25
Q

What is believed to activate the enzymes in the pancreatic duct system?

A

Biliary tract obstruction due to gall stones, pancreatic duct obstruction or bilary reflux

26
Q

When does Gallstone pancreatitis occur?

A

When a gallstone blocks the opening to the pancreas. Stone can lodge into an opening to the intestine. A pancreas duct shares this opening; when it is blocked, the pancreas becomes inflamed.

27
Q

What is known to be a potent stimulator of pancreatic secretions ?

A

Alcohol

*** Also known to cause contraction of the sphincter of Oddi of the pancreatic duct

28
Q

What is Acute Pancreatitis also associated with?

A

Hyperlipidemia, hyperparathyrodism, infections (viral), abdominal & surgical trauma, and drugs such as steroids and thiazide diuretics.

29
Q

What is the most common initial symptom of Pancreatitis?

A

Severe epigastric and abdominal pain that radiates the back

30
Q

When is the pain aggravated ?

A

When the person is lying supine; It is less severe when the person is sitting and leaning forward.

***Abdominal distention accompanied by hypoactive bowel sounds in common.

31
Q

What is an important disturbance related to acute pancreatitis ?

A

The loss of a large volume of fluid into the abdominal cavity

***Tachycardia, hypotension, cool and clammy skin, and fever often are evident.

32
Q

Why do signs of hypocalcemia develop?

A

Develop as a result of the precipitation of serum calcium in areas of the fat necrosis.

33
Q

What appears after the first 24 hours because of biliary obstruction ?

A

Mild jaundice

34
Q

What does pancreatic cancer refer to?

A

A ductal adenocarcinoma of the pancreas (including its subtypes)

35
Q

More than 95% of malignant neoplasms of the pancreas ares from what?>

A

The exocrine elements and are refereed to as exocrine pancreatic cancers

36
Q

What is the most common presenting symptoms in patients with exocrine pancreatic cancer?

A

Pain, jaundice, and weight loss.

37
Q

Approx. 60-70% exocrine pancreatic cancers are localized where?

A

To the head of the pancreas

38
Q

Approx. (the rest), 20-25% exocrine pancreatic cancers are localized where?

A

In the body/tail and the remainder involve the whole organ.

39
Q

Which tumors present more often with jaundice, steatorrhea, and weight loss?

A

Pancreatic head tumors (compared to tumors of the body and tail of the gland)

40
Q

What is the only potentially curative treatment for exocrine pancreatic cancers?

A

Surgical resection (pancreatectomy )

***Because of late presentation only 15-20% of patients are candidates for pancreatectomy

41
Q

What is the five-year survival following pancreaticoduodenectomy ?

A

25-30% for node-negative and 10% for node-positive tumors

42
Q

Whgat is the major risk factors for pancreatic cancer?

A

1) Cigarette smoking
2) High body mass and lack of physical activity
3) History of chronic pancreatitis

43
Q

Why is a role for familial aggregation and/or genetic factors suggested ?

A

Because 5-10 % of patients w/ pancreatic cancer have a 1st degree relative with the disease

44
Q

What is the most common lethal genetic disease among white?

A

Cystic Fibrosis (CF)

45
Q

What does CF result from?

A

From a defect in the Cl- channels that is caused by a mutation in the cystic fibrosis transmembrane conductance regulator gene (CFTR) gene

46
Q

What are the characteristics of CF?

A

Malfunction of exocrine glands, resulting in INCREASED viscosity of mucus and INCREASED chloride concentration in sweat and tears

47
Q

What are clinical manifestations of CF?

A

1) Chronic pulmonary disease
2) Pancreatic insufficiency
3) Meconium ileus

48
Q

What is an important diagnostic procedure?

A

Sweat test.

Digestion (15 decks)

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