Disorder Of The Pancreas

Question 1

Most common GI diagnosis requiring hospitalization in the US

Answer 1

Acute Pancreatitis

Question 2

Most sensitive and specific tests to detect early chronic pancreatic disease

Answer 2

Secretin tests ( direct tests of pancreatic secretory function)

Question 3

Onset and duration of increase in amylase,lipase

Answer 3

Within 24 hours of onset, remain so for 3-7 days

Return to normal within 7 days

Question 4

Normal levels of secretin test

Answer 4

Volume output > 2ml/kg/hr
Bicarbonate conc> 80 mmol/L
HCo3 output>10 mmol/L

Question 5

Level of severe Pancreatic Exocrine Insufficiency

Answer 5

Elastase -1 activity

<100 ug/g

Question 6

Stimulus needed for release of secretin (S cells)

Answer 6

Gastric acid

Question 7

Release of CCK (Cholecystokinin) from Ito cells is triggered by

Answer 7

Long chain fatty acids
Essential amino acids (tryptophan, phenylalanine, valine, methionine)
Gastric acid

Question 8

Cystic Fibrosis Transmembrane conductance Regulator

Answer 8

Bicarbonate enters the duct lumen through the sodiun bicarbonate cotransporter with the depolarization caused by chloride efflux

Question 9

Lipolytic enzymes

Answer 9

Lipase
Phospholipase A2
Cholesterol esterase

Question 10

Autodigestion of pancreas prevented by

Answer 10

1. packaging of pancreatic proteases in precursor
2. Intracellular calcium homeostasis
3. Acid-base balance
4. Synthetis of protective protease inhibitors

Question 11

Prophylaxis after ERCP shown to reduce pancreatitis after ERCP

Answer 11

1. Pancreatic Duct stent

2. Rectal NSAID (indomethacin)

Question 12

Risk Factors for post ERCP pancreatitis

Answer 12

1. Minor papilla sphincterotomy
2. Sphincter of Oddi dysfunction
3. Prior history of post-ERCP pancreatitis
4. Age <60
5. > 2 contrast injections into the pancreatic duct
6. Endoscopic trainee involvement