Diagnostic imaging modalities for pancreatitis

Question 1

Explain what is meant by the exocrine pancreas

Answer 1

It is the portion of thepancreas that produces pancreatic juice which contain bcarbonate ….

Question 2

Explain what is the function of the endocrine pancreas

Answer 2

• Insulin secretion by the β-cell is also influenced by plasma levels of amino acids such as arginine, lysine, leucine, and free fatty acids.
• GIP, GLP-1, and CCK stimulate insulin release, while somatostatin inhibits insulin release.
• Glucagon is a 29-amino-acid, single-chain peptide
• Glucagon secretion increases rapidly in response to a fall in plasma
  glucose
• Glucose is the primary regulator of glucagon secretion, as it is with insulin

Question 3

List the functions of insulin

Answer 3

Inhibits endogenous (hepatic) glucose production

Facilitates glucose transport into cells, thus lowering plasma glucose levels.

Inhibits glycogenolysis, fatty acid breakdown, and ketone formation, and stimulates protein synthesis.

Question 4

What is the function of glucagon

Answer 4

Promotes hepatic glycogenolysis and gluconeogenesis

Counteracts the effects of insulin through its hyperglycaemic action

However, it has an inhibitory rather than stimulatory effect??

Question 5

What is the presentation and causes of acute pancreatitis

Answer 5

• Typically presents as an acute abdomen and variable degree of shock
• Common causes: alcohol, gall stones, as a complication of ERCP
• Less common: infection (viral), hypertriglyceridaemia, hypercalcaemia, autoimmune disease, drugs

Question 6

Explain the pathology of acute pancreatitis

Answer 6

• The pancreas becomes acutely inflamed and in severe cases haemorrhagic
• Initial lesion involves intracellular activation of enzyme precursors and inflammatory response.

Lipase – high sensitivity and specificity.

Question 7

What is the diagnostic criteria for acute pancreatitis

Answer 7

Presence of three or more of these criteria constitute sever pancreatitis

On admission:
* Age >55 years
* WBC >16 X109 /L
* Blood glucose >11.1 mmol/L
* LDH > 350U/L
* AST >250U/L

During the first 48 hrs
* Packed cell volume decrease >10%
* Urea increase >1.8 mmol/L
* Calcium <2 mmol/L
* PO2 <60 mmHg
* Base deficit > 4mmol/L

Question 8

Explain the direct chronic pancreatitis test

Question 9

Explain the indirect chronic pancreatitis test

Question 10

What are other causes of pancreatic dysfunction

Answer 10

Carcinoma of the pancreas
Cystic fibrosis
Diabetes Mellitus