module 13 pancreas

Question 1

duct cells

Answer 1

secrete aqueous NaHCO3 solution

Question 2

acinar cells

Answer 2

secrete digestive enzymes

Question 3

exocrine pancreas

Answer 3

acinar and duct cells

Question 4

endocrine pancreas

Answer 4

islets of langerhorn

Question 5

pancreas exocrine enzymes for carb digestion

Answer 5

salivary amylase: mouth
pancreatic amylase: SI
dextrinase, glucoamylase, lactase, maltase, sucrase: SI endothelium

Question 6

pancreas exocrine enzymes for protein digestion

Answer 6

pepsin: stomach
trypsin, chymotrypsin, carboxypeptidase: SI
aminopeptidase, carboxypeptidase, dipeptidase: SI endothelium

Question 7

pancreas exocrine enzymes for fat digestion

Answer 7

lingual lipase: mouth
gastric lipase: stomach
pancreatic lipases: SI
Bile Salts from liver: SI

Question 8

pancreas exocrine enzymes for nucleic acid digestion

Answer 8

pancreatic ribonuclease and deoxyribonuclease: SI

nucleosidases and phosphatases: SI endothelium

Question 9

Endocrine pancreas cells

Answer 9

Islet of langerhans
alpha cell: glucagon
beta cell: insulin
delta cell: somatostatin
- inhibits A & B cells

Question 10

common problems in geriatric patients r/t GI

Answer 10

constipation 
fecal incontinence
diarrhea
reflux disease
swallowing disorders

Question 11

age related changes in GI

Answer 11

dec motility 
dec. visceral sensitivity 
liver sensitivity to stress
dec. immunity 
dec. colonic function 
hormone responsiveness 
drug metabolism changes
pancreas structure and function 
- change in glucose insensitivity, degradation
dec. chief and parietal cells 
-> dec. acid and pepsin 
-> inc. pH (alkaline) 
dec. absorption 
dec. smooth muscle
-> delayed emptying time, dec. anal sphincter tone, dec. peristalsis

Question 12

geriatric and dec. food intake

Answer 12

mobility imparment
ability to obtain food
loss of taste/olfaction 
poor dentition 
dec. appetite
anorexia of aging 
depression

Question 13

pediatric changes in GI

Answer 13

hydrochloric acid: low acidity, high pH
-> impaired bacteria destruction, impaired protein digestion
-> inc. risk infection
Dec. amylase/lipase
-> unable to break down complex carbs and fats
Inc. lactase in SI
immature LES
-> dec. sphincter pressure/ inappropriate relaxation -> regurgitation
Short esophagus
-> regurgitation
immature muscles of intestine
-> rapid peristaltic and nonperistaltic wave
-> delayed gastric emptying
-> inc. intragastric pressure
-> regurgitation

Question 14

dysphagia

Answer 14

difficulty swallowing
3 categories
- problem delivering bolus d/t neuromuscular incoordination 
- altered peristaltic activity
- LES dysfunction/obstruction 
Mechanical/functional obstructions

Question 15

achalasia

Answer 15

denervation of smooth muscle in esophagus and LES

Question 16

GERD

Answer 16

relux of chyme from stomach to esophagus

role of the lower esophageal sphincter

Question 17

hiatal hernia

Answer 17

sliding hernia

paraesophageal hernia

Question 18

pyloric obstruction

Answer 18

blocking or narrowing of the opening between the stomach and the duodenum

Question 19

Intestinal obstruction and ileus

Answer 19

chyme flow prevented through the intestinal lumen or failure of normal intestinal motility in the absence of an obstruction lesion

Question 20

gastric motility and control

Answer 20

swallowing 
gastrin
cholecystokinin
motilin 
secretin 
gastric emptying

Question 21

chyme

Answer 21

ingested food that has been crushed, ground, and mixed

Question 22

gastric emptying

Answer 22

chyme forced through the pyloric canal into SI

Question 23

GI motility and preg

Answer 23

hormonal effects
- gallbladder enlarges and slows emptying in response to meals
- small bowel transit slowed
- resting pressure of lower esophageal sphincter reduced
Motility reverts toward normal postpartum

Question 24

pancreatits

Answer 24

inflammation of pancreas

• injury to pancreatic cells and ducts -> leakage of enzymes into pancreatic tissue
• > auto-digestion of pancreatic tissue and leak into blood stream -> injury to blood vessels and other organs

Question 25

acute pancreatitis causes

Answer 25

duct obstruction 
acinar cell injury 
defective intracelluar transport 
- acinar cell apoptosis/necrosis 
- leukocyte infiltration

Question 26

acute pancreatitis s/s

Answer 26

steady pain: epigastric/LUQ
- gradually inc., radiates to back 
N/V
tender on palitation
dec. bowel sounds
abd. distention 
fever

Question 27

risk factors acute pancreatitis

Answer 27

galstones
ampullary obstruction 
alcohol 
hypertriclyceridemia 
hypercalcemia
drugs
infection and toxins
trauma
vascular diseas
preg
sphincter of oddi dysfunction 
main pancreatic duct abnormal

Question 28

chronic pancreatitis

Answer 28

presence of chronic inflammatory lesions in pancreas
key element: necrosis of exocrine parenchyma followed by fibrosis
-> calcification- obstructed flow of pancreatic juices
associated with:
- alcohol
- idopathic
- hereditary
- inc. PTH/Ca
- trauma

Question 29

chronic pancreatitis s/s

Answer 29

bouts of acute pancreatitis
pain radiates to back 
sequelae
- DM
- malabsorption 
- wt loss

Question 30

complcations of chronic pancreatitis

Answer 30

pseudocyst
pancreatic ascities 
obstruction of common bile duct 
-> inc. LFT
peptic ulcer

Question 31

insulin secretion

Answer 31

glucose uptake by GLUT2 trasporter in pancreatic cell
-> ATP production -> blocks K+ channel, keeping K+ in
-> depolarization and voltage gated Ca+ channels: influx
-> exocytotic release of insulin from storage granule
PERIPHERAL:
- GLUT4 receptor binds insulin, facilitated diffusion of glucose
-

Question 32

effects of hyperglycemia (inc. insulin)

Answer 32

dec. appetite
dec. glucagon
inc. glucose uptake into cells
inc. glycolysis
inc. glycogen synthesis
inc. triglyceride synthesis
inc. amino acid uptake
inc. protein synthesis

Question 33

effects of lack of insulin

Answer 33

inc. appetite
inc. glucagon
dec. glucose uptake by cells
inc. blood glucose
inc. gluconeogenesis
inc. lipolysis
inc. protein breakdown
inc. glycogenlysis
inc. ketone body production -> ketoacidosis
dec. protein synthesis