GI 2C - Anatomy, Physiology and Pathology of the Pancreas

Question 1

Enzymes included in the pancreas juice:

Answer 1

pancreatic amylase, pancreatic lipase, colipase, trypsinogen, chymotripsinogen, procarboxypeptidase (A/B), proelastase, ribonuclease, deoxyribonuclease.

Question 1

____ is the only potentially curative treatment for exocrine pancreatic cancer but because of the late presentation of the disease, only 15-20% of patients are candidates for pancreatectomy.

Answer 1

Surgical resection

Question 1

Characteristics of cystic fibrosis include malfunction of ____ resulting in increased viscosity of mucus and increased chloride concentration in sweat and tears.

Answer 1

exocrine glands

Question 2

How do gallstones cause pancreatitis?

Answer 2

biliary tract obstruction, pancreatic duct obstruction or biliary reflux is believed to activate the enzymes in the pancreatic duct system.

Question 3

There is some evidence for a _____ reflex secretion of pancreatic juice in response to the sight or smell of food.

Answer 3

vagally-mediated conditioned

Question 4

____ deficiency can occur as a congenital abnormality, which leads to protein malnutrition.

Answer 4

Enterokinase

Question 4

Although a number of factors are associated with the development of acute pancreatitis, most cases result from ___ or ____.

Answer 4

gallstones or alcohol abuse.

Question 5

Releasing trypsin in its active form can lead to a chain reaction of producing several active enzymes capable of digesting the pancreas. Hence, pancreatic tissue normally contains ____.

Answer 5

trypsin inhibitors

Question 6

____ – production of pancreatic juice. Source of HCO3 to neutralize gastric acid. Source of many digestive enzymes

Answer 6

Exocrine pancreas

Question 6

____% of patients with pancreatic cancer have a first degree relative with the disease.

Answer 6

5-10%

Question 7

The most common lethal genetic diseases among whites is ____.

Answer 7

cystic fibrosis

Question 9

Common symptoms of acute pancreatitis.

Answer 9

• Epigastric and abdominal pain (aggravated when supine) - Abdominal distention - Hypoactive bowel sounds - Loss of a large volume of fluid into the abdominal cavity - Tachycardia - hypotension - cool clammy skin - Fever - Signs of hypocalcemia (result of serum calcium precipitation in fat necrosis) - Mild jaundice (due to biliary obstruction)

Question 10

____ is a severe, life-threatening disorder associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues.

Answer 10

Acute pancreatitis

Question 10

Compared to tumors in the body and tail of the gland, pancreatic head tumors more often present with ____, ____ and ____.

Answer 10

jaundice, steatorrhea and weight loss

Question 11

In pancreatitis, enzymes cause ____, or auto digestion, of the pancreas and produce deposits in the abdominal cavity with hemorrhage from the necrotic vessels.

Answer 11

fat necrosis

Question 12

The commonly used term “pancreatic cancer” usually refers to a _____ of the pancreas.

Answer 12

ductal adenocarcinoma

Question 12

Clinical manifestations of cystic fibrosis include:

Answer 12

chronic pulmonary disease, pancreatic insufficiency, meconium ileus

Question 14

Measurement of plasma ____ or pancreatic lipase is of value in diagnosing problems associated with inflammation and necrosis of pancreatic acinar cells.

Answer 14

pancreatic amylase, pancreatic lipase

Question 16

____ – production of insulin & glucagon; plasma glucose regulation.

Answer 16

Endocrine pancreas

Question 17

___ acts on the pancreas to cause copious secretion of a very alkaline pancreatic juice that is rich in HCO3 and low in enzymes.

Answer 17

Secretin

Question 18

Trypsin then converts 3 zymogens to their active forms. What are they?

Answer 18

Chymotripsinogen –> Chymotrypsin Procarboxypeptidase –> Carboxypeptidase Proelastase –> Elastase

Question 19

Bile, intestinal juices and pancreatic juice are all ___ solutions that help neutralize gastric acid, raising the duodenal contents to a pH of ____.

Answer 19

alkaline, 6.0-7.0

Question 20

The 5 year survival following pancreaticoduodenectomy is about 25-30% for ____ and 10% for ___ tumors.

Answer 20

node-negative, node-positive

Question 22

How does alcohol cause pancreatitis?

Answer 22

Precise mechanisms are largely unknown. Alcohol is known to be a potent stimulator of pancreatic secretions. It also causes contraction of the sphincter of iddi to the pancreatic duct.

Question 23

Stimulation of ____ nerve fibers within the vagus nerves causes secretion of a small amount of pancreatic juice rich in ___.

Answer 23

parasympathetic, enzymes

Question 24

Pancreatic juice (pH ____) travels from the pancreas to the duodenum via the ____.

Answer 24

7.6-8.2 main pancreatic duct

Question 25

The most common presenting symptoms in patients with exocrine pancreatic cancer are:

Answer 25

pain, jaundice and weight loss

Question 26

The ___ test is an important diagnostic procedure in cystic fibrosis.

Answer 26

sweat

Question 28

Trypsinogen is converted to the active enzyme trypsin by the brush border enzyme ____ when the pancreatic juice enters the duodenum.

Answer 28

enterokinase (aka enteropeptidase)

Question 29

Secretion of pancreatic juice is primarily under ___ control

Answer 29

hormonal

Question 31

What are the 2 types of regulation of pancreatic juice secretion?

Answer 31

hormonal and neural

Question 32

Most common initial symptom of pancreatitis is ___ and ___ pain.

Answer 32

epigastric and abdominal

Question 33

Major risk factors for pancreatic cancer are:

Answer 33

cigarette smoking, high body mass and lack of physical activity, history of chronic pancreatitis

Question 34

___ stimulates production of pancreatic juice rich in enzymes and low in HCO3

Answer 34

CCK

Question 35

Approximately ___% of exocrine pancreatic cancers are localized to the head of the pancreas while ___% are in the body/tail. The remainder involve the whole organ

Answer 35

60-70% 20-25%

Question 36

Cystic fibrosis results from a defect in ___ channels that is caused by a mutation in the ____ gene

Answer 36

Cl-, cystic fibrosis transmembrane conductance regulator