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Y1&2 Medicine Zoe Veary > GI 122 Pancreas and Gall Bladder > Flashcards

GI 122 Pancreas and Gall Bladder Flashcards

1
Q

What hormones are produced in the islet cells and are they endocrine or exocrine?

A

Insulin and glucagon - endocrine

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2
Q

What is the function of the acinar cells and are they exocrine or endocrine?

A

Produce digestive enzymes in an alkaline solution for neutralisation - exocrine

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3
Q

Name the three different cell types of the Islets of Langherhans and the enzymes that they produce

A

alpha cells secrete glucagon
beta cells secrete insulin
delta cells secrete somatostatin

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4
Q

Where does venous blood from the pancreas drain into?

A

The portal vein

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5
Q

Except for the head of the pancreas, what artery supplies most of the pancreas?

A

The splenic artery - branch of the coeliac artery

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6
Q

From what plexus does the pancreas receive sympathetic and parasympathetic stimulation?

A

The coeliac plexus

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7
Q

What, broadly speaking, controls exocrine function?

A

It is neurohormonal: vagus nerve and hormones

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8
Q

Describe the cephalic phase

A

The sight, taste and smell of food stimulates the hypothalamus via the vagus nerve and thus stimulates up to 40% of secretion by the pancreas and salivary glands

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9
Q

Describe the gastric phase

A

Stomach distension stimulates vagovagal reflex, protein digestion products promote release of gastrin

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10
Q

What does gastrin do and where is it released from?

A

Gastrin is released from G-cells in the antrum and stimulates the Parietal cells to produce acid (HCl)
Has wide range of actions including stimulating release of pepsinogen from chief cells and stimulating pancreatic and gallbladder contraction

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11
Q

What is the action of somatostatin?

A

Reduces acid secretion by parietal cells

Reduces secretin excretion

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12
Q

What is secretin released in response to and what is its function?

A

Low pH in the duodenum and causes pancreas to secrete watery bicarbonate solution to neutralise the pH in the duodenum

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13
Q

What is CCK release in response to and what is its function?

A

Released in response to lipids and proteins in the duodenum and causes gallbladder contraction/sphincter of oddi relaxation and the acinar cells to secrete enzymes

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14
Q

Name the main aetiologies for acute pancreatitis

A

Gallstones (block ampulla of vater), alcohol (makes pancreatic secretions more viscous), pregnancy and autoimmune causes

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15
Q

What is the diagnostic range for acute pancreatitis of serum amylase, when is it raised and what could a lesser increase indicate

A

> 3x the normal range raised within 24hrs of pain onset and a lesser increase could indicate cholecystitis

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16
Q

How would you treat mild acute pancreatitis

A

Fluids to maintain BP/HR and urine output
02
NG tube to relieve pressure on the ileus
Analgesia

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17
Q

Name the main aetiologies for chronic pancreatitis

A

Alcohol ( 80% in the developed world), malnutrition, hereditary causes, CF,

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18
Q

What is the basic structure of a triglyceride?

A

Glycerol backbone and fatty acids attached by ester bonds

19
Q

What are two essential FA’s that must be gained through the diet?

A

Linoleic acid and Linolenic acid

20
Q

How do lipids enter the duodenum?

A

As emulsion droplets

21
Q

What are the 4 lipolytic enzymes that are secreted into the duodenum?

A

Lipase, collipase, phospholipase A2 and cholesterol esterase

22
Q

What does collipase do?

A

Attach to TG molecule on surface of emulsion droplet.

Anchor for lipase

23
Q

What does lipase do?

A

Hydrolyzes ester bonds to release FA’s and monoglyceride

24
Q

What does phospholipase A2 do?

A

act on phospholipid (lecithin) to produce lysolecithin and FA’s

25
Q

What does cholesterol esterase do?

A

Hydrolyzes FA’s from cholesterol ester –> cholesterol

26
Q

What are lipolytic products transferred to?

A

Mixed micelles

27
Q

Name the two features of a micelle and give an example one in the blood stream?

A

Lipid core and amphipathic bile acid skin

Chylomicrons

28
Q

What are bile acids conjugated with to form bile salts? And what does this allow them to do?

A

Taurine or glycine

Allows them to be fully ionized at physiological pH

29
Q

What do bile salts do and why are they better than bile acids?

A

They are more effective detergents than bile acids, they emulsify lipids, form mixed micelles and are an excretion route for cholesterol

30
Q

Where is heme found

A

RBC’s

31
Q

Where does breakdown of RBC’s occur

A

Macrophages in the liver and spleen (reticuloendothelial system)

32
Q

What enzyme performs the first two cleavages of the heme molecule in its breakdown? And what does it release?

A

Microsomal heme oxygenase

Releases CO and Fe3+ –> Green pigment biliverdin

33
Q

What is biliverdin, what is it reduced by and what does it become?

A

Biliverdin is the green pigment of RBC breakdown, it is reduced by biliverdin reductase and it becomes bilirubin

34
Q

What cells does bilirubin enter? And what occurs here?

A

Hepatocytes - conjugated with glucaronic acid

35
Q

Where is the glucaronic acid removed?

A

In the intestine

36
Q

What provides the colour of urine and faeces?

A

Urobillinogen and stercobillingogen

37
Q

What are the three different types of f gallstones?

A

Cholesterol stones: cholesterol supersaturation and reduced bile salts
Black pigment stones: Calcium billirubinate - assoc. with haemolytic disease
Brown pigment stones: calcium/FA salts + calcium billirubinate layers - bile stasis/infection

38
Q

What are the risk factors for gallstones?

A

5 F’s: fair, fat, fertile, female and forty

Also drugs, crohns and diabetes

39
Q

What is a mucocoele?

A

When GB exit is blocked, bile acid is absorbed and the GB becomes distended and full of mucus

40
Q

When do you get biliary colic?

A

When gallstone is lodged in the cystic duct or common bile duct

41
Q

What are the common presentations of gallstones?

A

RUQ pain that is constant and crescendoing, radiates to shoulder and subscap and precipitated by fatty food
Restless, nausea and vomiting
Guarding and tenderness (poss +ve murphys sign)
Fever, high inflammatory markers - CRP and ESR

42
Q

When does empyema occur?

A

When the ducts that are obstructed become infected

43
Q

What is acute cholecystitis?

A

Inflammation due to obstruction of GB/cystic ducts

44
Q

What is obstructive jaundice?

A

Obstruction of the hepatic or common bile duct e.g. a stone or mass in pancreatic head, leading to jaundice

Y1&2 Medicine Zoe Veary (60 decks)

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