Chapter 18 - Pancreas Flashcards
The pancreas has how many segments:
a. 4
b. 3
c. 12
d. 100
b. 3 (Head, body and tail)
Can you name the two basic cell types in the pancreas?
exocrine and endocrine
The ___ cells are exocrine cells that form grape-like lobules to form an entire gland in the pancreas.
acinar cells 🍇
What does the acinar cells secrete?
Digestive enzymes (eg. amylase, lipase & proteases)
What is the name of the main pancreatic duct?
duct of Wirsung (runs the whole length of the pancreas joining the CBD)
The minor papilla connects to the accessory duct in the pancreas is called what?
duct of Santorini
The remaining 1% of the pancreatic cells are endocrine cells. They are located in the ____ __ _______, mainly in the tail.
islets of Langerhans
What are the 2 main functions of the pancreas?
1.
2.
- Produce enzymes for digestion (exocrine)
2. Produce hormones that regulate BSL (endocrine)
What 3 types of endocrine cells does the pancreas produce?
a. alpha - glucagon
b. beta - insulin
d. delta - somatostatin
When BSL falls below normal the ___ cells are stimulated to secrete glucagon to increase BSL.
alpha
What cell is stimulated to lower the BSL when it is higher than normal?
beta cells secrete insulin to reduce BSL
The hormone somatostatin is secreted by the ___ cells and inhibits insulin and glucagon secretions as needed.
delta
What are the 4 stages of pancreatic secretions?
- Rest - slow rate of secretion
- Cephalic phase - secretion occurs from smell and sight of food
- Gastric phase - moderate secretions from distention of the stomach
- Intestinal phase - food in stomach evoke 70% of the maximal rate of secretions
Pancreatitis can be categorized into ___ or ___ pancreatitis.
acute or chronic
Acute pancretitis is defined when two out of the three criteria is met. What are the three criterias?
- Abdominal pain
- Amylase or lipase level 3x greater than normal
(exocrine acinar cells overstimulates) - Radiologic imaging consistent with diagnosis (CT scan or MRI)
Common causes of acute pancreatitis includes alcohol, Gallstones, abdominal trauma, infections, drugs and which endoscopic procedure?
ERCP (accounts for 15% of all cases)
What is the most severe form of acute pancreatitis?
Necrotizing pancretitis
Treatment of acute pancreatitis is aimed at which objectives?
- Hemodynamic stabilization
- Correction of metabolic abnormalities
- Reducing the risk of organ failure
Medical treatment of acute pancretitis includes:
- Pain relief
- NBM
- NG sectioning if significant vomiting
- Electrolyte and fluid replacement
- Blood transfusion as required
- Insulin to control hyperglycemia
- Antibiotics as needed
In chronic pancretitis, 70% of cases in Western world is associated with long term ___ use.
alcohol
Can you name a few symptoms and signs of chronic pancretitis?
- Abdominal pain radiating to back
- Weight loss and debilitation
- Steatorrhea (oily stool)
- Diabetes
- Obstructive jaundice from bile duct stricture
- Epigastric mass
Treatment of chronic pancretitis includes:
- Abstinence from alcohol
- Pain relief
- Nutritional support
- Oral replacement of pancretatic enzymes when steatorrhea detected
- Endoscopic intervention (eg. pancreatic stent placement, stone extraction)
What is a pseudocyst?
An encapsulated fluid filled sac lined by granulation tissue (no epithlium thus not a true cyst)
Diagnosis of pancreatic cystic tumors (most common at the head segment) is obtained by FNA. What is the treatment recommendation?
Whipple procedure (head of pancreas, gallbladder, bile duct and first part of duodenum removed)
What is Zollinger-Ellison syndrome (ZES)?
A gastrinoma that releases gastrin to stimulate gastric acid hypersecretion. This leads to severe ulcers in the upper GI tract and often severe diarrhea.
What is the medical treatment of Zollinger-Ellison syndrome (ZES)?
Long term PPI use
ZES can also be malignant and is treated with chemotherapy and surgery after if not successful.
Can you name the tumours associated with the alpha, beta and delta endocrine islet cells?
a. alpha - glucagonomas
b. beta - insulinoma (most common)
d. delta - somatostatinomas
Treatment includes surgical excision.
Pancreatic exocrine insufficiency generally results from chronic pancretitis leading to acinar loss. What is the treatment?
Oral enzyme preparations and acid suppression to improve delivery of enzymes into small bowel.
Cystic fibrosis is an autosomal-recessive disease that affects the exocrine glands, respiratory system, sweat glands and reproductive system.
The definitive diagnostic test for CF is ___.
Treatment includes:
- managing respiratory complications
- Dietary regulation
- Vitamin supplements
- Pancreatic enzyme replacements
sweat electrolyte test
Can you name a few congenital abnormality of the pancreas?
- Pancreatic Rest (presence of pancreatic tissue usually in the gastric antrum)
- Pancreas divisum (separate dorsal and ventral pancreatic ducts)
- Annular pancreas (like pancreas divisum but ventral pancreas encircles duodenum leading to duodenum obstruction)
What are the features of Shwachman-Diamond syndrome?
- pancreatic insufficiency
- growth retardation (prevalent clinical sign)
- cyclic Neutropenia
- metaphyseal dysostosis
