Gastro 11 - Pancreas

Question 1

Where do both the biliary tree and the pancreatic duct empty to?

Answer 1

Ampulla of Vater.

Question 2

Where is the pancreas derived from?

Answer 2

Endoderm.

Question 3

What structure gives rise to the head of the pancreas?

Answer 3

The Hepatic diverticulum which gives rise to liver, gallbladder, biliary tree and the ventral pancreatic bud which gives rise to head of pancreas.

Question 4

What structure gives rise to the body and tail of the pancreas?

Answer 4

Dorsal pancreatic bud which develops on dorsal surface of the foregut.

Question 5

What is an annular pancreas?

Answer 5

When the ventral pancreatic bud encircles the duodenum and forms a ring around it and compresses it from the outside in, causing a stenosis.

Question 6

What are the symptoms of annular pancreas In children?

Answer 6

Two thirds of patients remain asymptomatic thru life. Symptom onset can occur at any age of life and depends on the severity of duodenal constriction. Children present w/ gastric outlet obstruction (bilious vomiting, feeding intolerance, abdominal distention).

Question 7

What is annular pancreas associated with in infants?

Answer 7

Polyhydramnios. Down syndrome. Esophageal and duodenal atresia. Imperforated anus. Meckel diverticulum.

Question 8

What are the symptoms of annular pancreas in adults?

Answer 8

Usually present at 20-50 y.o. Abdominal pain. Postprandial fullness and nausea. Peptic ulceration. Pancreatitis. Rarely biliary obstruction.

Question 9

What is Pancreas divisum?

Answer 9

When ventral and dorsal buds fail to fuse.

Question 10

Where does the spleen arise from?

Answer 10

From dorsal mesentery of stomach. It is a mesodermal structure, not endodermal.

Question 11

What is the blood supply of the spleen?

Answer 11

Artery of foregut (celiac trunk).

Question 12

What enzymes are secreted by the pancreas?

Answer 12

Lipase. Colipase. Phospholipase A. Proteases (Trypsinogen, chymotrypsin, Elastase, Carboxyopeptidases). Amylase.

Question 13

How is Trypsin converted to trypsinogen?

Answer 13

Pancreas releases trypsinogen and duodenum releases enterokinase and enteropeptidase that convert it to trypsin.

Question 14

What class of enzymes are the rate-limiting enzymes of carbohydrate digestion?

Answer 14

Sucrase. Maltase. Isomaltase. Lactase.

Question 15

What transporter is used to absorb monomers of carbohydrates into the enterocytes?

Answer 15

Sodium glucose co-transporter (SGLT-1).

Question 16

What is the difference b/w glucose absorption vs fructose absorption?

Answer 16

Glucose absorption is achived by Na-driven active transport. Fructose is absorbed by facilitated diffusion by GLUT-5.

Question 17

What is the main enzyme that stimulates pancreatic secretion?

Answer 17

Cholecystokinin (CCK). Also stimulates gallbladder contraction.

Question 18

What enzyme stimulates the pancreas to secrete bicarb?

Answer 18

Secretin.

Question 19

Why does the Cystic Fibrosis affect the pancreas?

Answer 19

Caused by a defect in the CFTR gene, it is unable to pump chloride into the pancreatic duct lumen (So Na won’t follow, therefore water won’t follow), causing thick pancreatic secretions.

Question 20

What are the GI symptoms of cystic fibrosis?

Answer 20

Malabsorption of fats and proteins and fat-soluble vitamins.

Question 21

What are the two most common causes of acute pancreatitis?

Answer 21

Gallstones and Alcohol.

Question 22

What are the common causes of acute pancreatitis?

Answer 22

[BAD HHITS]
Biliary (Stones). Alcohol. Drugs (didanosine, zalcitabine, stavudine, ritonavir, sulfa drugs). Hypertriglyceridemia. Hypercalcemia. Idiopathic. Trauma. Scorpio sting (found outside USA).

Question 23

What are the symptoms of acute pancreatitis?

Answer 23

Severe upper abdominal pain. Nausea and vomiting. Sitophobia (fear of eating). Elevated serum lipase.

Question 24

What are the complications of acute pancreatitis?

Answer 24

Multi-organ failure. DIC. Hemorrhage into the pancreas. Necrosis of the pancreas. Saponification. Hypocalcemia. Chronic pancreatitis.

Question 25

What is a pancreatic pseudocyst?

Answer 25

Caused by chronic pancreatitis, it is a cyst lined w/ fibrous scar and granulation tissue And filled w/ pancreatic juice and pancreatic enzymes. A true cyst is lined with epithelial cells.

Question 26

What are the symptoms of pancreatic cancer?

Answer 26

Weight loss. Abdominal pain. Sudden severe jaundice (often painless).

Question 27

What are the symptoms of Trousseau syndrome?

Answer 27

Hypercoagulability. Venous thrombosis. Migratory thrombophlebitis. Associated with pancreatic adenocarcinoma.

Question 28

What are the risk factors of pancreatic adenocarcinoma?

Answer 28

Chronic pancreatitis. Tobacco use. Age more than 50. Black or Ashkenazi Jew.

Question 29

What are the two most important tumor markers?

Answer 29

CA19-9 more specific than CEA.

Question 30

Which hormones stimulate pancreatic secretion?

Answer 30

CCk. Secretin. Actylcholine (from CN X).

Question 31

What is the treatment for pancreatic insufficiency?

Answer 31

Limit fat-intake. Pancreatic enzyme supplements. Fat-soluble vitamin supplements.

Question 32

RFF: Painless jaundice.

Answer 32

Pancreatic adenocarcinoma.

Question 33

RFF: most common cause of acute pancreatitis.

Answer 33

Gallstones and alcohol.

Question 34

RFF: Most common cause of chronic pancreatitis.

Answer 34

Alcohol abuse.