Biliary & Pancreatic disease

Question 1

Function of pancreas

Answer 1

• produce endocrine: insulin & glucagon

* Produce exocrines (digestive enzymes): e.g. lipase, amylase, trypsin

Question 2

Difference b/w acute, mild & severe pancreatitis*

Answer 2

• Acute: 5≤ times fold of amylase
• Mild: inflammation & edema in pancreas
• Severe: necrosis & 2º injury to extrahepatic organs (bones, joints)

Question 3

What are mumps?

Answer 3

• salivary gland lesions & inflammation of parathyroid gland = inc amylase in blood => may inc pancreatitis

Question 4

Diagnose pancreatitis w/ 2 common markers & the difference

Answer 4

• Amylase (early marker = stays for 2-3 days) in serum, plasma, urine
• lipase (late marker = 3-5 days) in serum, plasma

Question 5

when is amylase relevant result?*

Answer 5

5x higher than normal = acute pancreatits

Question 6

How does pancreatitis occur? compare w/ normal activation of trypsin

Answer 6

• cathepsin activates trypsinogen -> trypsin => auto-digestion of pancreas => necrosis & apoptosis
• BUT enteropeptidase activates trypsinogen -> trypsin in SI

Question 7

What are the two commonest disposing (causing) factors for pancreatitis? (& 2 more)

Answer 7

• alcoholism: causes inflammation to pancreas
• hepatobiliary disease: gall stones block biliary tract
• hyperparathyroidism => hypercalcemia = Ca2+ cofactor for enzymes
• hyperlipidaemia: 20% alcoholics have hypertriglyceridemia

Question 8

Other than pancreatitis what other disorders increase amylase in blood

Answer 8

• Mumps = Salivary gland lesions
• Renal failure = glomerulus blocked
• macroamylasemia = auto-Ab bind to amylase ≠> filtered out of glomerulus
• Intestinal obstruction

Question 9

Differentiate b/w S- & P- form amylase

Answer 9

S-: (salivary) found in serum; inhibited by lectin

P-: (pancreatic) found in urine;

Question 10

in pancreatits, (a) which enzyme is more specific & remains elevated for 3-5 days?
(b) which isoenzyme is more specific

Answer 10

a) lipase

b) L2

Question 11

to exclude other acute abdominal pain such as (a), we can use these 2 test to aid in diagnosing pancreatitis (b)

Answer 11

a) ectopic preg., perforated peptic ulcer, intestinal obstruction
b) Imaging techniques; ultrasound; measure lipase & amylase enzymes in blood

Question 12

what is cystic fibrosis? & how it can be linked to pancreatitis

Answer 12

• aka mucovisidosis
• poor ion chloride channel secretion
• inc Na reabsorption
  = inc body fluid viscosity
  => stimulates pancreatitis

Question 13

bile acid helps to

Answer 13

helps to absorbs:

• some FA
• Vit A, D, K, E

Question 14

how do gall stones form?

Answer 14

• lack of melatonin => dec conversion of cholesterol into bile