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Clinical Chemistry (CC 1) > (F) L5: GITP: Pancreas > Flashcards

(F) L5: GITP: Pancreas Flashcards

1
Q

The pancreas is the only digestive accessory gland located where in respect to the GIT?

A

Outside the GIT

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2
Q

Composition

Composed of the islets of Langerhans that produces insulin, glucagon, and other hormones

A

Endocrine Glandular Cells (1%)

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3
Q

Composition

Consists of acinar cells (grape-like clusters) responsible for the production of pancreatic juices

A

Exocrine Glandular Cells (99%)

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4
Q

Composition (Exocrine)

These are rich in digestive enzymes capable of digesting carbohydrates (amylase), proteins (trypsin and elastase), and lipids (lipase)

A

Pancreatic Juices

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5
Q

Composition (Exocrine)

Pancreatic juices are made up of what 3 components?

A
  1. Water
  2. Sodium bicarbonate
  3. Other enzymes
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6
Q

Composition (Exocrine)

Sodium bicarbonate functions by:
1. Buffering the (acidic/alkaline) gastric juice
2. (Stopping/Starting) the action of pepsin
3. Producing the optimum (temperature/pH) at neutral levels for pancreatic and brush border enzymes

A
  1. Acidic
  2. Stopping
  3. pH
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7
Q

Regulation of Pancreatic Secretions

Secretin and Cholecystokinin are secreted by what cells?

A

Enteroendocrine Cells

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8
Q

Regulation of Pancreatic Secretions

  • This regulates the production of pancreatic juice by inhibiting gastrin secretion
  • Is stimulated by the acidic gastric content, wherein if present, the pancreas will be stimulated to release it
A

Secretin

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9
Q

Regulation of Pancreatic Secretions

  • Aka pancreozymin
  • Regulates the release of pancreatic enzymes by inhibiting gastric emptying and secretion
  • Stimulated by the presence of amino and fatty acids
A

Cholecystokinin (CKK)

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10
Q

Regulation of Pancreatic Secretions

Stimulated by acidic gastric contents:
A. Secretin
B. Cholecystokinin
C. Both
D. Neither

A

A. Secretin

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11
Q

Regulation of Pancreatic Secretions

Stimulated by amino acids and fatty acids:
A. Secretin
B. Cholecystokinin
C. Both
D. Neither

A

B. Cholecystokinin

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12
Q

Regulation of Pancreatic Secretions

Produced by enteroendocrine cells:
A. Secretin
B. Cholecystokinin
C. Both
D. Neither

A

C. Both

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13
Q

Pancreatic Diseases

If the head of the pancreas is the one affected, what effect does it have on the patient?

A

Mild and often no adverse effects

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14
Q

Pancreatic Diseases

If the body of pancreas is the one affected, what effect does it have on the patient?

A

Signs and symptoms are present

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15
Q

Pancreatic Diseases

  • Aka fibrocystic disease of the pancreas/mucoviscocidosis
  • The dysfunction of all mucus and exocrine glands throughout the body including sweat and sebaceous glands wherein they turn into small cysts
  • Affects the pancreas, liver, lungs, sinuses, skin, intestine, and reproductive organs
A

Cystic Fibrosis

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16
Q

Pancreatic Diseases

A systemic disease wherein all organs are mucus-filled

A

Cystic Fibrosis

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17
Q

Pancreatic Diseases

Symptoms of Cystic Fibrosis:
1. Pancreatic ducts are (constricted/dilated)
2. Acinar cells convert into (small/large cysts) filled with mucus
3. Maldigestion occurs as a result of a (increased/decreased) secretion of digestive enzymes

A
  1. Dilated
  2. Small
  3. Decreased
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18
Q

Pancreatic Diseases

  • A pancreatic alpha cell tumor that increases gastrin secretion
  • Aka gastrinoma and is associated with Zollinger-Ellison Syndrome
A

Pancreatic Carcinoma

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19
Q

Pancreatic Diseases

Alpha or Beta Pancreatic Cell Tumor?
A rare complication that often leads to insulinoma or hyperinsulinism which decreases blood glucose levels

A

Beta

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20
Q

Pancreatic Diseases

Alpha or Beta Pancreatic Cell Tumor?
The tumor increases gastrin secretion

A

Alpha

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21
Q

Pancreatic Diseases

Increased gastrin secretion
A. Pancreatic alpha cell tumor
B. Pancreatic beta cell tumor
C. Both
D. Neither

A

A. Pancreatic alpha cell tumor

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22
Q

Pancreatic Diseases

Increased insulin secretion
A. Pancreatic alpha cell tumor
B. Pancreatic beta cell tumor
C. Both
D. Neither

A

B. Pancreatic beta cell tumor

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23
Q

Pancreatic Diseases

The inflammation of the pancreas which can be acute with no permanent damage to the pancreas, or chronic with irreversible injury

A

Pancreatitis

24
Q

Pancreatic Diseases

In pancreatitis, autodigestion of the organ occurs with (increased/decreased) production of trypsin for protein digestion

A

Increased (it breaks down pancreatic cells)

25
Q

Pancreatic Diseases

Increased or Decreased in Pancreatitis?
AMS, LPS, TAGs, Calcium, and Parathyroid Hormone

A

ALL INCREASED (hypercalcemia and hyperparathyroidism)

26
Q

Pancreatic Diseases

  • Is related to pancreatic disease
  • There is diminished pancreatic exocrine function compromising digestion and absorption of ingested nutrients (abnormal absorption)
  • Manifests as abdominal bloating and discomfort, bulky and malodorous feces, and weight loss
A

General Malabsorption Syndrome

27
Q

Pancreatic Function Tests

  • A stimulation test that measures the secretory and exocrine function of the pancreas
  • It measures pH, secretory rate, enzyme activities, and sodium bicarbonate
A

Secretin or CKK Tests

28
Q

Pancreatic Function Tests

A decrease in sodium bicarbonate is an indication of what disorder?

A

Cystic Fibrosis

29
Q

Pancreatic Function Tests (Secretin/CKK Test)

How many hours of fasting is required alongside an intubation of the duodenum?

30
Q

Pancreatic Function Tests (Secretin/CKK Test)

Secretin and CKK are administered via what?

Note: The patient can be stimulated with either or both

31
Q

Pancreatic Function Tests (Secretin/CKK Test)

Duodenal aspirate is collected and analyzed at what time intervals?

A

30, 60, and 80 minutes

32
Q

Pancreatic Function Tests (Secretin/CKK Test)

Male or Female Value?
15 mM per hour

33
Q

Pancreatic Function Tests (Secretin/CKK Test)

Male or Female Value?
12 mM per hour

34
Q

Pancreatic Function Tests

  • Used for diagnosis of lipid malabsorption
  • Can be qualitative or quantitative
A

Fecal Fat Analysis

35
Q

Pancreatic Function Tests (Fecal Fat Analysis)

Interpret the results:
1 to 4 grams per day

A

Lipid-free diet

36
Q

Pancreatic Function Tests (Fecal Fat Analysis)

Interpret the results:
Less than 7 grams per day

A

Lipid-rich diet

37
Q

Pancreatic Function Tests (Fecal Fat Analysis)

This screening test uses Sudan II and IV, Oil Red O, and Nile Blue Sulfate

A

Qualitative Screening

38
Q

Pancreatic Function Tests (Fecal Fat Analysis)

Sudan III and IV stains TAGs (neutral fats) what color?

Note: For qualitative screening

A

Yellow-orange to red

39
Q

Pancreatic Function Tests (Fecal Fat Analysis)

What is the normal value for the qualitative screening test?

A

40 to 50 small lipid droplets in a HPF (diameters of 1 to 5mm)

40
Q

Pancreatic Function Tests (Fecal Fat Analysis)

  • Refers to the the failure to absorb fats
  • Indicated by more than (>) 50 small lipid droplets per HPF with a diameter of 50 to 100mm fat globules
A

Steatorrhea

Note: For qualitative screening

41
Q

Pancreatic Function Tests (Fecal Fat Analysis)

This requires a 72-hour stool sample

A

Quantitative Screening

42
Q

Pancreatic Function Tests (Fecal Fat Analysis)

In Quantitative Screening, this method uses fatty acid soap converted to free fatty acids

A

Gravimetric Method

43
Q

Pancreatic Function Tests (Fecal Fat Analysis)

In Quantitative Screening, this method incorporates saponification of lipids by hydroxide

A

Titration Method

44
Q

Pancreatic Function Tests

  • The measurement of sodium and chloride concentration in sweat to diagnose cystic fibrosis in children
  • A traditional method of sweat collection is done by using plastic bags or wrapping the patient in blankets
A

Sweat Electrolyte Determination

45
Q

Pancreatic Function Tests (Sweat Electrolyte Determination)

This is the method of choice for sweat collection wherein an electric current is used causing a migration of pilocarpine to skin in the forearm

A

Pilocarpine Iontophoresis Technique

46
Q

Pancreatic Function Tests (Sweat Electrolyte Determination)

A result of more than how many mmol/L is indicative of cystic fibrosis?

47
Q

Pancreatic Enzymes

  • A measurement for acute pancreatitis
  • Not a specific measure of pancreatic function because these are also produced by the salivary glands
  • It detects pancreatic disease, such as acute pancreatitis in adults
  • Is freely filtered by the glomerular capillaries
A

Serum Amylase of > 600 SU/dL (Somogyi Units)

48
Q

Pancreatic Enzymes

  • A sensitive marker of acute pancreatitis wherein values of 1000 SU/dL indicates it
  • There is intermittent or minor increase in serum concentration
A

Amylase Clearance

49
Q

Pancreatic Enzymes

  • This is an enzyme that hydrolyzes glycerol esters of TAG
  • This is normally absent in the urine because it is freely filtered but reabsorbed
  • A more sensitive indicator of acute pancreatitis compared to the other technique since this is only produced in the pancreas
A

Serum Lipase

50
Q

Diseases Associated with AMS and LPS

Increased AMS, LPS, or BOTH?
- Opiate administration
- Pancreatic carcinoma
- Intestinal infarction
- Intestinal obstruction
- Intestinal perforation
- Pancreatic trauma
- Mumps

A

Both increased

51
Q

Diseases Associated with AMS and LPS

Increased AMS, LPS, or BOTH?
- Cholecystitis
- Hepatitis
- Cirrhosis
- Ruptured ectopic pregnancy
- Macroamelysia

52
Q

Diseases Associated with AMS and LPS

Increased AMS, LPS, or BOTH?
- Fractured bones
- Fat embolism

53
Q

Pancreatic Enzymes

  • A chymotrypsin-like enzyme secreted by the pancreas
  • Sensitive marker of pancreatic function
  • A non-invasive method performed using a random stool sample
A

Fecal Elastase

54
Q

Pancreatic Enzymes (Fecal Elastase)

Interpret results:
Greater than 200 µg/g

55
Q

Pancreatic Enzymes (Fecal Elastase)

Interpret results:
100-200 µg/g

A

Pancreatic insufficiency

56
Q

Pancreatic Enzymes (Fecal Elastase)

Interpret results:
< 100 µg/g

A

Severe pancreatic insufficiency

Clinical Chemistry (CC 1) (33 decks)

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