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Nutrition > Biliary and pancreatic function > Flashcards

Biliary and pancreatic function Flashcards

1
Q

list the effects of pancreatic insufficiency

A

maldigestion (causing wt loss and malnutrition especially in vitamins ADEK and steatorrhoea)

Diabetes

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2
Q

list some causes of pancreatic insufficiency

A

1) chronic pancreatitis - usually alcohol
2) cystic fibrosis- children
3) Duct obstruction -Ca
4) pancreatic atrophy - elderly

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3
Q

what might be used to test pancreatic function?

A

1) faecal elastase
2) serum amylase (^x3 suggestive of acute pancreatitis)
3) tubeless function tests - poor sensitivity and specificity (urinary metabolites, pancreolauryl)

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4
Q

what is the imaging of choice for the pancreas

A

CT -> good for parenchyma
US -> quick and cheap good for masses and biliary obstruction (bad if gas)
ERCP -> best for ducts but invasive, MR also used but not first line

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5
Q

what is the average daily bile flow

A

600ml/day

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6
Q

name 4 bile acids which are ionized forms of bile salts (conjugated with taurine or glycine 3:1)

A

1) glycocholic acid
2) glycochenodeoxycholic acid
3) taurocholic acid
4) taurocendodeoxycholic acid

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7
Q

where is taurine and glycine removed from the bile

A

by bacteria in the intestine

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8
Q

what are the two essential fatty acids

A

linoleum acid

linolenic acid

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9
Q

what do the products of degraded lipids aggregate into and then what are the transferred into

A

multilamellar vesicles

to mixed micelles

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10
Q

where are bile salts ionised into acids

A

the duodenum

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11
Q

where and how are bile acids degraded

A

by the flora in the duodenum

they are converted from primary to secondary acids

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12
Q

what are the functions of bile acids

A

excretion route for cholesterol
emulsify lipids
form mixed micelles

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13
Q

where are bile acids reabsorbed and how are they transported back to the liver

A

95% in the terminal ileum

transported back to liver by albumin

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14
Q

what are the functions of the pancreas

A

endocrine –> metabolic control

Exocrine –> digestive enzyme secretion and neutralisation of the duodenum

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15
Q

what controls the exocrine function of the pancreas

A

1) cephalic phase –> vagus
2) in response to lipids, proteins and secretin –> CCK
3) low pH –> HCO3
4) inhibitory hormones –> amylin, pancreatic polypeptide, somatostatin/ghrelin

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16
Q

what is the cephalic phase of pancreas stimulation

A

sight/taste/smell of food
stimulates hypothalamus
vagus nerve
stimulates 40% of max secretion

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17
Q

what is the duodenal phase of pancreatic function

A

endocrine cells secrete secretin in response to low pH; and CCK in response to lipids and proteins

pH is monitored by vagal nerve afferents

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18
Q

what are the hormonal actions of secretin

A

causes duct cells to secrete HCO3

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19
Q

what are the hormonal actions of CCK

A

causes gall bladder contraction, oddi relaxation and acing cell excretion

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20
Q

what are the hormonal actions of amylin secreted by beta cells

A

slow gastric emptying and pancreatic secretions

inhibits glucagon production

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21
Q

what are the hormonal actions of pancreatic polypeptide produced in islets

A

inhibit gall bladdr and pancreatic secretion

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22
Q

what are the endocrine cells of the pancreas

A

alpha -> glucagon
beta -> insulin and amylin
delta -> somatostatin

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23
Q

what is the aetiology of acute pancreatitis

A 
Gallstones
Alcohol
post ERCP complication
Pregnancy
Autoimmune (rare)
24
Q

how does acute pancreatitis present

A 
sudden or gradual onset of severe epigastric pain
radiates to the back
relieved by sitting forwards
vomiting
bruising (if severe cullers sign or grey-turners sign)
tenderness
guarding
shock is severe
25
what are cullens and grey-turners signs
cullens -> periumbilical bruising grey-turners -> flank bruising both suggest necrotising pancreas +/- haemorrhage
26
what blood tests would you investigate in acute pancreatitis
``` serum amylase serum lipase U+Es BM ABG FBC ```
27
why might hypovolaemia show on U+Es in response to acute pancreatitis
renal failure can occur due to inflammatory response causing increased capillary permeability and third space sequestration
28
what type of imaging would you use to investigate acute pancreatitis
Erect CXR to exclude perforation AXR looking for calcifications abdo US to exclude gallstones CT/MRI show parenchyma (oedema/necrosis)
29
what is the PANCREAS scoring system? | >3 = severe pancreatits
``` P= PaO2 55 N = neutrophillia C = calcium < 2.0mmol/L R= raised urea >16mmol/L E= enzymes: LDH>600ui/L; AST >iu/L A= albumin 10 mmol/L ```
30
how would you manage mild pancreatitis
supportive care and analgesia
31
how do you treat severe pancreatitis
ITU pre-emptive abx surgical intervention ERCP
32
what is the aetiology for chronic pancreatitis?
alcohol malnutrition hereditary Cystic fibrosis
33
what is the pathophysiology of chronic pancreatitis
hyper secretion of proteins --> plug formation blockage of duct and premature activation of enzymes loss of pancreatic tissue and insufficiency fibrosis, scarring and calcification occur
34
what is the presentation of chronic pancreatitis
``` epigastric pain pancreatic insufficiency wt loss steatorrhoea flatus diabetes jaundice ```
35
investigations of chronic pancreatitis
``` low faecal elastase low PABA (urine) USS CT MRI/endoscopic USS ```
36
how is chronic pancreatitis managed
analgesia enzyme supplements diabetic control surgery if req
37
risk factors for carcinoma of the pancreas
>60s smoking/alcohol chronic pancreatitis FHx (BRAC2)
38
what are the different presentations of carcinoma of the head and the tail of the pancreas
Head: early presentation, obstructive jaundice, painless Tail: late presentation, epigastric pain, wt loss
39
what tumour markers can be used for carcinoma of the pancreas
CA19-9 | CA125
40
how is pancreatic carcinoma managed
usually palliatively stunting of CBD chemo/radiotherapy only 10% suitable for attempted curative surgery
41
what are the most common type of gall stone and how are they formed
cholesterol | formed by supersaturation, reduced bile salt, stasis and promoting factors
42
describe two types of pigment stone
black -> calcium bilirubinate (a/w/ haemolytic disease) brown -> Ca/FA salts -> from stasis or infection
43
predisposing factors of gall stones
``` FAT- obesity diabetes FEMALE FERTILE FAIR FORTY/age also Crohn's ```
44
what is biliary colic
gallstone lodged in cystic duct/CBD | causes mucocele of GB -> gall bladder distension
45
what is acute cholecystitis
obstruction of the cystic duct causes inflammation/infection complications: empyema of GB and perforation
46
what is obstructive jaundice
hepatic duct obstruction caused by stone or mass in head of pancreas causing bilirubin in the blood
47
what is ascending cholangitis
infection spreading up from the duodenum in static bile
48
what is gallstone ileus
large gallstone erodes from GB to duodenum and can occlude the ileocaecal junction
49
how does biliary colic present
``` crescendo pain in RUQ radiating to shoulder/scapula restless precipitated by fatty food N&V jaundice ```
50
investigations for biliary colic
bloods US MRCP HIDA scan
51
how does acute cholecystitis present
``` RUQ pain N&V guarding and tenderness fever positive Murphy's sign ```
52
what are the treatments for acute cholecystitis
cefuroxime | cholecystectomy
53
what is charcots triad
fever jaundice RUQ pain in obstructive jaundice/cholangitis
54
what would you find on investigation for obstructive jaundice
raised bilirubin ALP and gamma GT on images: dilation/masses in the CBD/pancreas
55
how is obstructive cholangitis/jaundice treated
cefuroxime | ERCP for drainage, stone removal or stenting

Nutrition (11 decks)

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