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GI/Liver > Lec 14 Pancreas > Flashcards

Lec 14 Pancreas Flashcards

1
Q

What are components of bile?

A

bile acids (a.k.a bile salts) + bilirubin + cholesterol + lecithin + water + electrolytes.

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2
Q

What is function of biliary tract?

A
  • 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
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3
Q

What is venous drainage of pancreas?

A

portal vein and splenic vein

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4
Q

How does pancreas form?

A

forms 6-7 wks; rotates so ventral pancreas comes near dorsal pancreas and ducts fuse week 8

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5
Q

What is sphincter of oddi?

A

sphincter around bile duct and pancreatic duct as they come together

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6
Q

Is most of pancreas exocrine or endocrine?

A

90% exocrine

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7
Q

Where is pain of pancreas often referred?

A

referred to the back

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8
Q

What happens to activity of digestive enzymes if the pH of duodenum decreases

A

activity of enzymes is decreased

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9
Q

What regulates bicarb secretion?

A

secretin from S cells in duodenum cause release of bicarb by pancrea

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10
Q

What regulates pancreatic enzyme release?

A

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

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11
Q

Where are pancreatic enzymes synthesized?

A

in the RER of pancreatic acinar cells

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12
Q

Is pancreatic amylase secreted as zymogen or active form?

A

secreted in active form

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13
Q

Which pancreatic enzymes are secreted as zymogens vs active form?

A
  • proteases secreted as zymogens,

amylase, lipase, nucleases as active form

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14
Q

What are 2 most common causes of acute pancreatitis?

A

gallstones and alcohol

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15
Q

Who is likely to get pancreatitis from gallstones?

A
  • female, forty, fertile, fat
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16
Q

Who is likely to get pancreatitis from alcohol?

A

alcoholics; younger patients 30-35 yo; more likely male

17
Q

What is pathogenesis of acute pancreatitis?

A

some sort of insult cause inappropriate activation of zymogens in pancreas -> autodigests itself

18
Q

What are some meds that predispose to acute pancreatitis?

A
  • sulfa drugs
  • HIV meds
  • diuretics
19
Q

What are some infectious causes of acute pancreatitis?

A
  • mumps, HIV, influenza, CMV
20
Q

What is opie1 vs opie2 gallstone?

A

opie1 = common channel blocked

opie2 = obstructed pancreatic duct

21
Q

How does alcohol cause acute pancreatitis?

A
  • intracellular accumulation of pancreatic enzymes
  • increased permeability of ductules
  • increased tendency to form protein plugs causing obstruction
22
Q

What is pancreas divisum?

A

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

23
Q

What are clinical features of acute pancreatitis?

A
  • severe pain radiating to the back
  • N/V
  • fever

if severe can lead to organ failure

24
Q

What lab tests for acute pancreatitis?

A
  • high serum amylase
  • high serum lipase [more specific]
  • hypocalcemia
25
Q

What is treatment for interstitial pancreatitis?

A
  • strict NPO, fluid resuscitation
  • pain control
  • antibiotics if evidence of infection
26
Q

What are some local complications of pancreatitis?

A
  • pseudocyts
27
Q

What is a pseudocyt with acute pancreatitis?

A
  • 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
28
Q

What are common etiologies of chronic pancreatitis?

A 
#1 = alcohol
also: hyperparahthyroid, hereditary, pancreas divisum, neoplastic, autoimmune
29
Q

What are signs of chronic pancreatitis?

A
  • severe ab pain radiating to the back
  • steatorrhea and weight loss
  • calcifications on flat plate
30
Q

What is secretin test for chronic pancreatis?

A

give secretin and measure how much bicarb pancreatic juice released post-secretin

31
Q

What are some complications of chronic pancreatitis?

A
  • chronic pain
  • pseudocyts
  • pancreatic ascites
  • pancreatic abscess
  • bile duct obstruction
  • duodenal obstruction
  • diabetes
32
Q

What kind of neoplasms in pancreas?

A

mostly adenocarcinomas

33
Q

Who gets pancreatic adenocarcinoma?

A
  • men in 60s
  • smokers
  • usually in head of pancreas
  • hereditary risk
34
Q

What are clinical features of pancreatic adenocarcinoma?

A
  • painless jaundice
  • ab pain, anorexia, N/V, new onset diabetes
  • jaundice, courvosier’s sign

GI/Liver (36 decks)

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