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DEMS Pt 1 > Exocrine Pancreas and Salivary Gland Physiology > Flashcards

Exocrine Pancreas and Salivary Gland Physiology Flashcards

1
Q

Salivary Glands

A

3 pairs of glands: parotid, submandibular and sublingual

Produce a serous (proteinaceous) or mucus product, or both

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2
Q

Constituents of Saliva and their Functions

A

Water: Facilitates taste and dissolution of nutrients; aids in swallowing and speech

Bicarb: Neutralizes refluxed gastric acid

Mucins: Lubrication

Amylase: Strach digestion

Lysozyme, lactoferrin, IgA: innate and acquired immune protection

Epidermal and nerve growth factors: Assumed to contribute to mucosal growth and protection

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3
Q

What is the secretory unit of the Salivary Gland

A

Acinus

Acinar cells make the saliva and striated duct cells modify its ionic content

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4
Q

Salivary Secretion Regulation by ANS

A

Parasympathetic – increased acinar cell secretion and vasodilation of blood vessels surrounding the acini (results in protein rich & fluid/ion rich solution)

Sympathetic – increased acinar cell secretion (results in high protein/low fluid solution); less water (think gross, crusty running mucus)

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5
Q

Myoepithelial cells

A

help squeeze acinar cells and force them to secrete into the acinus

Pancreatic gland DONT have them

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6
Q

What downregulates salivary secretions

A

Sleep
Fatigue
Fear

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7
Q

What upregulates salivary secretion

A

Smell, taste, sound, and sight of food

Pressure in mouth

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8
Q

Which system primarily facilitates salivary secretion?

A

Parasympathetic through octic gangion (parotid gland) and submandibular ganglion (submandibular gland)

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9
Q

Saliva formation

A

Formation by passive filtration

Content and secretion rate is dependent on blood flow

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10
Q

Mechanism of Salivary Secretion: Fast vs. Slow Flow Rate

A

Low flow rate: duct cells absorb Na+ and Cl- and secrete K+ and HCO3-

High flow rt: Don’t have time to modify it so much more NaCl present in the secretions and less K Bicarb

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11
Q

Are acinar secretions hypertonic, hypotonic, or isotonic?

A

Close to isotonic

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12
Q

What allow movement of ions and water from the blood into saliva?

A

Tight junctions

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13
Q

Movement of water in salivary ducts

A

is restricted by TJs, leaving the saliva hypotonic

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14
Q

What establishes a concentration gradient in salivary duct cells?

A

Na+/K+ ATPase

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15
Q

Pancreas and Pancreatic Secretions

A

Acinar cells produce a variety of enzymes (proteases, lipases and amylases)

Ductal cells produce a bicarbonate solution to help liquefy and neutralize acidic chyme in the duodenum

Endocrine organ

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16
Q

Secretory Products of the Pancreas

A

Proteases: Trypsinogen, Chymotrypsinogen, Proleastase, Procarboxypeptidase A, Procarboxypeptidase B*

Amylases: Amylase

Lipases: Lipase, Nonspecific esterase, Prophospholipase A2*

Nucleases: Deoxyribonuclease, Ribonuclease

Others: Procolipase*, Trypsin inhibitors, Monitor peptide,
*= stored and secreted in inactive forms

17
Q

Regulation of Pancreatic Secretion

A

Acetylcholine (ACh) – released from the vagus and ENS nerves; stimulates the release of digestive enzymes from acinar cells (mostly cephalic stage)

Secretin – released from endocrine cells in the proximal small intestines in response to acid; stimulates the release of a bicarbonate rich solution from pancreatic duct cells

Cholecystokinin (CCK) – released from endocrine cells in the proximal small intestines in response to fats & proteins; stimulates the release of digestive enzymes from acinar cells but has other effects in the duodenum

18
Q

Structure of the Exocrine Pancreas

A

Acinar cells make the enzymes and duct cells secrete a water/bicarbonate rich solution

19
Q

Effects of Cholecystokinin Cluster Unit in the Duodenum

A

Gallbladder contraction, pancreatic acinar secretion, reduced emptying of stomach, relaxation of sphincter of Oddi

Protein, carbohydrate, lipid absorption and digestion
Matching of nutrient delivery to digestive and absorptive capacity

20
Q

cAMP and Ca2+ have what eddect on pancreatic acinar cell secretion?

A

Phosphorylation of structural and regulatory proteins causing fusion of granules with with apical membrane and discharge of contents

21
Q

Trypsin

A

The bulk of the enzymes released by the pancreas are proteases

Trypsin is secreted from the pancreas in an inactive, pro-enzyme form called trypsinogen. Also released is a trypsin inhibitor.

Trypsin becomes activated in the duodenal lumen when trypsinogen is cleaved by enzymes (enterokinases) located on the surface of enterocytes

Activated trypsin then autoactivates more trypsinogen along with most of the other pancreatic enzymes

22
Q

Effect of Secretin

A

Secretin acts by increasing cAMP levels in the duct cells. The release of secretin is enhanced by CCK

23
Q

Pancreatic secretion regulation

A

ANS and hormones

Salivary is just ANS

24
Q

Pancreatic acini compared to salivary acini

A

Pancreatic acini are not as vascular and respond to ACh and CCK. Ductal cells actively secrete a water and a bicarbonate rich solution in response to secretin.

The salivary acinus is very vascular and increased blood flow results in a dilute saliva that is modified by duct cells. Salivary ducts, on the other hand, are fairly impermeable to water.

25
Q

Saliva vs pancreatic juice

A

Saliva is rich in KHCO3 whereas pancreatic juice is rich in NaHCO3.

26
Q

Salivary Gland Diseases

A 
Mumps 
Cytomegaloviral Sialadenitis
Bacterial Sialadenitis
Sarcoidosis
Sjögren’s Syndrome
Salivary Lymphoepithelial Lesion
Xerostomia or dry mouth
Halitosis
27
Q

Benign Neoplasms

A

Mixed Tumor (pleomorphic adenoma)
Monomorphic Adenomas
Ductal papilloma

28
Q

Endocrine Pancreatic Cancer

A

Gastrinoma (Zollinger-Ellison Syndrome)

Glucagonoma – usually large, often mets, 70% malignant

Insulinoma – the most common pancreatic neuroendocrine tumors

Nonfunctional islet cell tumors (NICT) – Usually malignant and hard to detect

Somatostatinoma – occur anywhere in the pancreas or doudenum

VIP-Releasing Tumor – usually in the body and tail of the pancreas

29
Q

Pleomorphic Adenoma

A

The diverse microscopic pattern of this lesion is one of its most characteristic features.

Islands of cuboidal cells arranged in ductlike structures is a common finding.

30
Q

Warthin’s Tumor

A

Warthin’s tumor (benign papillary cystadenoma lymphomatosum)

the second most common benign tumor of the parotid gland

It accounts for 2-10% of all parotid gland tumors

Bilateral in 10% of the cases

may contain mucoid brown fluid in FNA

Oncotic epithelial Component (fronds) and Lymphoid Component
BOTH must be present to diagnose

31
Q

Monomorphic Adenoma

A

Similar to Pleomorphic Adenoma except no mesenchymal stromal component

32
Q

Basal Cell Adenoma

A

A monomorphic adenoma is composed of uniform basaloid epithelial cells with a monomorphous pattern.

Histologically, these tumors are distinguished from pleomorphic adenomas by their absence of stroma and the presence of a uniform epithelial pattern.

33
Q

Malignant Neoplasms

A 
Mucoepidermoid Carcinoma (mucin+)
Polymorphous Low-grade Adenocarcinoma
Adenoid Cyctic Carcinoma
Clear Cell Carcinoma
Acinic Cell Carcinoma (no glycogen, fat & mucin, 3% maligant and bilateral)
34
Q

Features Suggestive of Malignancy

A 
Induration (hardness)
Fixed to Overlying Skin or mucosa
Ulceration of skin or mucosa
Rapid Growth; Growth Spurt
Short Duration
Pain, often severe
Facial N. Palsy
35
Q

Mucoepidermoid Carcinoma

A

MECs contain two major elements: mucin-producing cells and epithelial cells (Epidermoid and Mucinous components)

36
Q

Adenoid Cystic Carcinoma

A

Adenoid cystic carcinoma with Swiss cheese pattern.

It is the second-most common malignant tumor of the salivary glands.

ACC is the most common malignant tumor found in the submandibular, sublingual, and minor salivary glands.

37
Q

Exocrine Pancreatic Cancer

A

Acinar Cell Carcinoma – Rare, leads to overproduction of lipase

Adenocarcinoma – 90% of all pancreatic cancer starts in duct

Adenosquamous carcinoma - forms glands that flatten as it grows

Intraductal Papillary-Mucinous Neoplasm – fingerlike projections into the duct, prelude to malignancy

Mucinous Cystadenocarcinoma – rare malignant spongy cystic tumor

Pancreatoblastoma – Rare, occurs in kids

DEMS Pt 1 (35 decks)

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