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Digestive > 2C A&P and Pathology of the Pancreas > Flashcards

2C A&P and Pathology of the Pancreas Flashcards

1
Q

What does the endocrine part of the pancreas produce?

A

Insulin, glucagon, plasma glucose regulation

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2
Q

What does the exocrine part of the pancreas produce?

A

Pancreatic juice

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3
Q

What are the two function of pancreatic juice?

A

Source of bicarbonate to neutralize gastric acid. Source of many digestive enzymes

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4
Q

What is the pancreas shaped like?

A

Like the letter L

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5
Q

Where is the head of the pancreas? Tail?

A

Short arm of L close to the duodenum. The tail is the long arm of the L furthest from the small instenstine

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6
Q

What are the lighter staining areas of pancreatic tissue?

A

Islets of Langerhans (endocrine)

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7
Q

What kinds of cells are in the pancreatic islets?

A

Alpha, Beta, and Delta cells

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8
Q

What does the exocrine part of the pancreas look like histologically?

A

Stains dark

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9
Q

What percent of the pancreas consists of exocrine cells? Endocrine cells?

A

90% exocrine, 10% endocrine

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10
Q

What are exocrine cells surrounded in?

A

Pancreatic acini

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11
Q

What does the pancreatic juice have a lot of?

A

Bicarb and enzymes

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12
Q

What is the typical pH of pancreatic juice?

A

7.6-8.2

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13
Q

How much pancreatic juice is secreted per day?

A

About 1500 mL

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14
Q

How does the pancreatic juice get to the duodenum?

A

Via the man pancreatic duct

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15
Q

Is pancreatic juice alkaline or acidic?

A

Alkaline

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16
Q

What else, besides pancreatic juice helps to neutralize the gastric acid in the duodenum?

A

Bile and intestinal juices are also neutral or alkaline

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17
Q

What pH are the duodenal contents raised to?

A

6.0 to 7.0

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18
Q

Which duct merges with the main pancreatic duct?

A

Common bile duct

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19
Q

Before reaching the sphincter of Oddi, does the bile duct and pacreatic duct each have their own spincters?

A

Yes, sir!

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20
Q

What does the sphincter of Oddi do?

A

Regulates the flow thru the papilla of vater

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21
Q

What is the opening into the duodenum from the common bile duct called?

A

Papilla of Vater

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22
Q

What enzymes are included in the pancreatic juice?

A

Pancreatic amylase, pancreatic lipase, colipase, trypsinogen, chymotrypsinogen, procarboxypeptidase (A/B), proelastase, ribonuclease, deoxyribonuclease

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23
Q

Which four enzymes of pancreatic juice are proteases (breakdown proteins)?

A

Trypsinogen, chymotrypsinogen, procarboxypeptidase (A/B), proelastase

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24
Q

What are proteases initially secreted as?

A

Proenzymes

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25
Q

What is the brush border enzyme that activates trypsinogen into trypsin?

A

Enterokinase

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26
Q

What does trypsin do?

A

Converts his proenzyme protease friends into enzymes - Chymotrypsinogen into chymotrypsin; proelastase into elastase; procarboxypeptidase into carboxypeptidase

27
Q

T/F Enterokinase deficiency can occur as a congenital abnormality

A

T

28
Q

Why are trypsin inhibitors normally produced in pancreatic tissue?

A

Since trypsin can cause a chain reaction activating several active enzymes too soon, this is a way to prevent these enzymes from digesting the pancreas

29
Q

How do we control the flow of pancreatic juice?

A

Hormonally and neurally?

30
Q

Pancreatic juice is primarily under what control?

A

Hormonal

31
Q

What does secretin do?

A

Acts on the pancreas to cause copious secretion of a very alkaline pancreatic juice that is rich in bicarb and low in enzymes

32
Q

What does CCK do?

A

Stimulates production of pancreatic juice rich in enzymes and low in bicarb

33
Q

Which nervous system also causes secretion of a small amount of pancreatic juice rich in enzymes?

A

ParaSNS

34
Q

Which is a more potent stimulator of pancreatic juice rich in enzymes, CCK or ParaSNS?

A

CCK

35
Q

What is acute pancreatitis?

A

A severe, life threatening disorder associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues

36
Q

Do pancreatic digestive enzymes normally leak into the circulation? So why does acute pancreatitis occur

A

Yes. However, during acute pancreatitis the circulating levels of the digestive enzymes rise markedly

37
Q

How is pancreatitis measured in the plasma?

A

Pancreatic amylase or pancreatic lipase is of value in diagnosing problems associated with inflammation and necrosis of pancreatic acinar cells

38
Q

What is fat necrosis?

A

Autodigestion of the pancreas that produces fatty deposits in the abdominal cavity w/ hemorrhage fro the necrotic vessels

39
Q

What do most cases of acute pancreatitis result from?

A

Gallstones (stones in the common bile duct) or alcohol abuse

40
Q

Where do galls stones form?

A

Liver where bile is made or in the gall bladder where bile is stored. Most of the time they form in the gall bladder

41
Q

Where does the gall stone have to get stuck to get pancreatitis?

A

At the opening to the duodenum

42
Q

Why is it a problem is bile backs up into the pancreas?

A

There are some things in the bile that can activate the pancreatic enzymes in the pancreatic juice - biliary reflux

43
Q

What is the most common initial symptom of pancreatitis?

A

Severe epigastric and abdominal pain that radiates to the back. Pain is aggravated when person is supine

44
Q

What is an important disturbance related to acute pancreatitis?

A

Loss of large volume of fluid into the abdominal cavity

45
Q

What are some other symptoms of pancreatitis?

A

Tachycardia, hypotension, cool and clammy skin, fever. Signs of hypocalcemia may develop. Mild jaundice many appear after the first 24 hours

46
Q

What does pancreatic cancer usually refer to?

A

Ductal adenocarcinoma of the pancreas.

47
Q

Where do more than 95% of malignant neoplasms of the pancreas arise?

A

From exocrine elements and are referred to as exocrine pancreatic cancers

48
Q

What are the most common presenting symptoms in pts with exocrine pancreatic cancer?

A

Pain, jaundice, and weight loss

49
Q

Where are 60-70% of exocrine pancreatic cancers localized? Where is the rest?

A

In the head of the pancreas. 20-25% are in the body/tail and the remainder involve the whole organ

50
Q

Compared to tumors in the body and tail of the gland, pancreatic head tumors more often present with what?

A

Jaundice, steatorrhea, and weight loss

51
Q

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

A

Surgical resection

52
Q

What is the 5 year survival following pancreatico-duodenectomy?

A

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

53
Q

What are the major risk factors for pancreatic cancer?

A

Cigarette smoking, high BMI and lack of physical activity, history of chronic pancreatitis

54
Q

Is there a familial aggregation and/or genetic factor w/ pancreatic cancer?

A

5-10% of pts have a first degree relative with the disease

55
Q

What is the most common lethal genetic disease among whites?

A

Cystic fibrosis

56
Q

What does Cystic Fibrosis (CF) result from?

A

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

57
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

58
Q

What are clinical manifestations of CF?

A

Chronic pulmonary disease, pancreatic insufficiency, meconium ileus

59
Q

Where is the CFTR channel found?

A

In a lot of exocrine tissues - exocrine tissues in the lungs it makes mucus - goblet cells. Exocrine cells in the pancreas are making pancreatic juice. Also, exocrine cells in the small intestine that are making mucus - again goblet cells

60
Q

What happens to concentrations Cl- and Na+ inside cells when CFTR channels are missing?

A

Cl- cannot enter the cell and as a result neither can Na+, since it would enter to balance the electric charge

61
Q

What is a way to test if you have CF?

A

Test sweat to see if it has a high concentration of Cl-

62
Q

What is the end result of these electrolytes not being enter the cells?

A

The fluids get really thick and viscous - so the mucus you make in your airways is really thick (clogs up airways), sweat is thicker, pancreatic juice is thicker, all the mucus in your intestines is very thick

63
Q

What is meconium ileus?

A

The mucus in your intestines gets really thick that it creates blockage and food and fecal matter cannot get thru

64
Q

What happens to Cl- in the lungs of someone that has CF?

A

Cl- cannot get out of the cells, so Na+ is brought into the airway cells bringing water with it and the mucus gets really thick making it harder to breathe

Digestive (15 decks)

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