Lec 14 Pancreas Flashcards
What are components of bile?
bile acids (a.k.a bile salts) + bilirubin + cholesterol + lecithin + water + electrolytes.
What is function of biliary tract?
- excrete metabolic products from liver
- excrete molec not filtered by kidney
- excrete cholesterol form liver
- deliver bile acids for absorption of fats and vit ADEK
What is venous drainage of pancreas?
portal vein and splenic vein
How does pancreas form?
forms 6-7 wks; rotates so ventral pancreas comes near dorsal pancreas and ducts fuse week 8
What is sphincter of oddi?
sphincter around bile duct and pancreatic duct as they come together
Is most of pancreas exocrine or endocrine?
90% exocrine
Where is pain of pancreas often referred?
referred to the back
What happens to activity of digestive enzymes if the pH of duodenum decreases
activity of enzymes is decreased
What regulates bicarb secretion?
secretin from S cells in duodenum cause release of bicarb by pancrea
What regulates pancreatic enzyme release?
I cells in duodenum secrete CCK in response to peptides and amino acids in the lumen and induce secretion of enzymes from pancrease
vagus also stimulates release
Where are pancreatic enzymes synthesized?
in the RER of pancreatic acinar cells
Is pancreatic amylase secreted as zymogen or active form?
secreted in active form
Which pancreatic enzymes are secreted as zymogens vs active form?
- proteases secreted as zymogens,
amylase, lipase, nucleases as active form
What are 2 most common causes of acute pancreatitis?
gallstones and alcohol
Who is likely to get pancreatitis from gallstones?
- female, forty, fertile, fat
Who is likely to get pancreatitis from alcohol?
alcoholics; younger patients 30-35 yo; more likely male
What is pathogenesis of acute pancreatitis?
some sort of insult cause inappropriate activation of zymogens in pancreas -> autodigests itself
What are some meds that predispose to acute pancreatitis?
- sulfa drugs
- HIV meds
- diuretics
What are some infectious causes of acute pancreatitis?
- mumps, HIV, influenza, CMV
What is opie1 vs opie2 gallstone?
opie1 = common channel blocked
opie2 = obstructed pancreatic duct
How does alcohol cause acute pancreatitis?
- intracellular accumulation of pancreatic enzymes
- increased permeability of ductules
- increased tendency to form protein plugs causing obstruction
What is pancreas divisum?
major duct through minor papilla and minor duct through major papilla
so major duct more likely to get obstructed
due to failure to fuse of ventral and dorsal pancreas
What are clinical features of acute pancreatitis?
- severe pain radiating to the back
- N/V
- fever
if severe can lead to organ failure
What lab tests for acute pancreatitis?
- high serum amylase
- high serum lipase [more specific]
- hypocalcemia
What is treatment for interstitial pancreatitis?
- strict NPO, fluid resuscitation
- pain control
- antibiotics if evidence of infection
What are some local complications of pancreatitis?
- pseudocyts
What is a pseudocyt with acute pancreatitis?
- see it > 4 wks after acute pancreatitis = collection of pancreatic fluid surrounded by fibrous wall
- most are asymptomatic
- can cause early satiety if compresses stomach
What are common etiologies of chronic pancreatitis?
#1 = alcohol also: hyperparahthyroid, hereditary, pancreas divisum, neoplastic, autoimmune
What are signs of chronic pancreatitis?
- severe ab pain radiating to the back
- steatorrhea and weight loss
- calcifications on flat plate
What is secretin test for chronic pancreatis?
give secretin and measure how much bicarb pancreatic juice released post-secretin
What are some complications of chronic pancreatitis?
- chronic pain
- pseudocyts
- pancreatic ascites
- pancreatic abscess
- bile duct obstruction
- duodenal obstruction
- diabetes
What kind of neoplasms in pancreas?
mostly adenocarcinomas
Who gets pancreatic adenocarcinoma?
- men in 60s
- smokers
- usually in head of pancreas
- hereditary risk
What are clinical features of pancreatic adenocarcinoma?
- painless jaundice
- ab pain, anorexia, N/V, new onset diabetes
- jaundice, courvosier’s sign
