Gastro 11 - Pancreas Flashcards
Where do both the biliary tree and the pancreatic duct empty to?
Ampulla of Vater.
Where is the pancreas derived from?
Endoderm.
What structure gives rise to the head of the pancreas?
The Hepatic diverticulum which gives rise to liver, gallbladder, biliary tree and the ventral pancreatic bud which gives rise to head of pancreas.
What structure gives rise to the body and tail of the pancreas?
Dorsal pancreatic bud which develops on dorsal surface of the foregut.
What is an annular pancreas?
When the ventral pancreatic bud encircles the duodenum and forms a ring around it and compresses it from the outside in, causing a stenosis.
What are the symptoms of annular pancreas In children?
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).
What is annular pancreas associated with in infants?
Polyhydramnios. Down syndrome. Esophageal and duodenal atresia. Imperforated anus. Meckel diverticulum.
What are the symptoms of annular pancreas in adults?
Usually present at 20-50 y.o. Abdominal pain. Postprandial fullness and nausea. Peptic ulceration. Pancreatitis. Rarely biliary obstruction.
What is Pancreas divisum?
When ventral and dorsal buds fail to fuse.
Where does the spleen arise from?
From dorsal mesentery of stomach. It is a mesodermal structure, not endodermal.
What is the blood supply of the spleen?
Artery of foregut (celiac trunk).
What enzymes are secreted by the pancreas?
Lipase. Colipase. Phospholipase A. Proteases (Trypsinogen, chymotrypsin, Elastase, Carboxyopeptidases). Amylase.
How is Trypsin converted to trypsinogen?
Pancreas releases trypsinogen and duodenum releases enterokinase and enteropeptidase that convert it to trypsin.
What class of enzymes are the rate-limiting enzymes of carbohydrate digestion?
Sucrase. Maltase. Isomaltase. Lactase.
What transporter is used to absorb monomers of carbohydrates into the enterocytes?
Sodium glucose co-transporter (SGLT-1).
What is the difference b/w glucose absorption vs fructose absorption?
Glucose absorption is achived by Na-driven active transport. Fructose is absorbed by facilitated diffusion by GLUT-5.
What is the main enzyme that stimulates pancreatic secretion?
Cholecystokinin (CCK). Also stimulates gallbladder contraction.
What enzyme stimulates the pancreas to secrete bicarb?
Secretin.
Why does the Cystic Fibrosis affect the pancreas?
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.
What are the GI symptoms of cystic fibrosis?
Malabsorption of fats and proteins and fat-soluble vitamins.
What are the two most common causes of acute pancreatitis?
Gallstones and Alcohol.
What are the common causes of acute pancreatitis?
[BAD HHITS]
Biliary (Stones). Alcohol. Drugs (didanosine, zalcitabine, stavudine, ritonavir, sulfa drugs). Hypertriglyceridemia. Hypercalcemia. Idiopathic. Trauma. Scorpio sting (found outside USA).
What are the symptoms of acute pancreatitis?
Severe upper abdominal pain. Nausea and vomiting. Sitophobia (fear of eating). Elevated serum lipase.
What are the complications of acute pancreatitis?
Multi-organ failure. DIC. Hemorrhage into the pancreas. Necrosis of the pancreas. Saponification. Hypocalcemia. Chronic pancreatitis.
