Chapter 33 - Pancreas Flashcards
What is the only pancreatic enzyme secreted in active form?
Amylase - hydrolyzes alpha 1-4 glucose chains
Alpha cells secrete what?
Glucagon
Beta cells secrete what?
Insulin
Delta cells secrete what?
Somatostatin
PP cell secrete what?
Pancreatic polypeptide
Islet cells secrete what?
VIP, serotonin, neuropeptide Y, gastrin-releasing peptide
Which cells receive the majority of blood supply relative to size?
Islet cells
Secretin causes excretion of what?
HCO3-
CCK causes excretion of what?
Enzymes
ACh causes excretion of what?
Enzymes and HCO3-
Somatostatin leads to what?
Decreased exocrine function of pancreas
Migration of ventral pancreatic bud?
Migrates posteriorly, to the right, and clockwise to fuse with dorsal bud
Ventral bud forms what?
Uncinate and inferior portion of the head, Duct of Wirsung
Dorsal pancreatic bud forms what?
Body, tail, superior aspect of pancreatic head; Duct of Santorini
What is an annular pancreas?
2nd portion of duodenum trapped in pancreatic band; due to failure of rotation of ventral bud
Radiographic findings of annular pancreas?
Double bubble on x ray
Syndrome associated with annular pancreas?
Down Syndrome
Treatment for annular pancreas?
Duodenojejunostomy or duodenoduodenostomy and sphincteroplasty; pancreas NOT resected
Most common site of heterotopic pancreas?
Duodenum; surgical resection only if symptomatic
Ranson’s criteria: on admission
Age >55, WBC >16, glucose >200, AST >250, LDH >300
Ranson’s criteria: after 48h
Hct decrease by 10%, BUN increase by 5, Ca 4, pa02 6L
% of time pancreatic necrosis occurs following pancreatitis?
15%
% of time surgery required for necrosis?
10% (due to infection)
Risk factor for pancreatic necrosis?
Obesity
Complications following pancreatic necrosis?
ARDS, coagulopathy (protease-related)
Expectant management of pancreatic pseudocyst for how long?
3mo
Treatment of pancreatic fistulas?
Allow to close spontaneously if <200ml/d; drainage via ERCP or distal pancreatectomy, TPN, octreotide