Nu 735 GI I /Pancreatic Flashcards
Pancreatic Anatomy & Physiology
Role in Digestion
Pancreatic JUice - Enzymes
and
Release Hormones
- Role of Pancreas: plays important role in Digestion
- Located: Pancreas locating in upper abdomen, behind stomach size of the hand
- During digestion Pancreas release juices called **enzymes **
- Pancreatic enzymes released during digestion:
* lipase, protease and amylase
Lipase ?
***Lipase: (fat) - Fat w Bile ( in liver)
* **Enzyme that works together with bile that liver produces to breaks down fat in diet . **
i. When cells in pancreas are injured, increase amount of lipase enter blood steam and
ii. Resulting high level of Lipase concentration
iii. If you don’t have enough lipase, the body will have trouble observing fat and
And Important Fat Soluble Vitamins : A, B, E, & K
v. **How do we know that someone has poor fat absorption? **
Symptoms will include diarrhea and fatty bowel movements.
Amylase?
- *Amylase > Break Down > Startches INTO Sugar > Lacke of Carbohydrates
- Enzyme Breaks down starches into sugar which body can use for energy
- When you don’t have enough Amylase:
- Body may have diarrhea from undigested carbohydrates
- When you don’t have enough Amylase:
Protease
- Enzyme that break down proteins in diet
- Undigested Protein can cause allergic reaction in some people
- Also helps protect body from germs that may live in intestines like certain bacteria
Pancreatic Hormones
Pancreas helps digestion of producing hormones
A. Insulin:
B. Glucagon:
C. Amylin: supress glucagon
Ensymes:
Insulin
- Produced by pancreatic beta cells, insulin helps regulate blood sugar (glucose) levels.
- It promotes the uptake of glucose from the **bloodstream into cells, thereby lowering blood glucose levels.
- Without insulin, cells cannot efficiently use glucose for energy, leading to high blood sugar levels (hyperglyce
Enzymes
Glucagon
.
* Produced by pancreatic alpha cells
* It raises blood sugar levels
* by promoting the breakdown of **glycogen (stored glucose) into glucose in the liver. **
* This process is called glycogenolysis.
Enzymes
Amylin
* co-secreted with insulin from pancreatic B/cells. **
* Blood sugar regulation: It helps to slow down the rate at which glucose enters the bloodstream after meals, reducing spikes in blood sugar levels.
* Promotion of glucagon secretion:** Amylin can enhance the release of glucagon from pancreatic alpha cells, which helps to maintain blood sugar levels between meals.
* Delaying gastric emptying:
* Amylin slows down the emptying of the stomach after a meal, which helps to prevent sharp rises in blood glucose levels after eating
Pancreatic Injury
* Premature release of pancreatic enzymes
* Increased amounts of lipase & amylase enter bloodstream
o What happens when Pancreas becomes inflamed?
o Several mechanisms exist to limit Pancreatic enzyme activation after Procrit metabolism has occurred
o This is b/c premature pancreatic activation enzymes within pancreas leads to organ injury and pancreatitis
o Acute Pancreatitis occurs when factors involving maintaining cellular homeostasis become out of balance
o Digestion enzymes released in Pancreas
o Prematurely activated
o Than this enzymes start to digest Pancreas leading to inflammatory process
Pancreatitis Overview
Statistic
- **Most common inpatient GI diagnosis **
o Annual incidence ranges from 13-45 cases per 100,000 persons
o Results in 250,000 hospitalizations/year
o Most common nonsurgical abdominal condition for geriatric
o **Mortality up to 40% above the age of 70 **
o $2.6 billion per year cost to health care system
** Hospitalizations*
o Incidents of occurs : 200-fold after the age of 65
o 88% higher among Blacks
o Higher among males than females
Three Phases of
Acute Pancreatitis of Disease process
- Initial Phase
- Second Phase
- Thirtd Phase
1st Phase:
Initial Phase
Enzyme activation & acinar cell injury
> ** Enzyme Activation: **characterized by intra pancreatic Enzyme activation
** Acinar Cell is : **
functional unit of exocrine pancreas
- Responsible for producing and secreting digestive enzymes.
- These enzymes, such as amylase, lipase, and proteases (like trypsinogen and chymotrypsinogen), are essenisl got breaking down carbohydrates, fats, and proteins in the small intestine ( duodenum )
Second Phase
**Cytokine Activation **
Resulting Inflammatory Injury
Cytokines ( IL interluekins, Interfersons) cell responsible to inhibits (prevent) T and B cells immune responses
Thirst Phase
- **Leads to clinical findings: **
like edema, interstitial hemorrhage, vascular damage, fat, cellular necrosis.
Pancreatitis Etiology
o Acute pancreatitis is an inflammatory condition of the pancreas, and while the exact cause of the initial event that triggers it is not fully understood,
o it is believed that an initial cellular injury can impair the secretion of digestive enzymes.
o This leads to the premature activation of zymogen granules (inactive enzyme precursors) within the pancreas, causing the pancreas to digest itself
o** Zymogen (inactive Enzyme Precursors)**: Special storage organs regulates secretion of digestion of enzymes
Most Common Causes
***Gallstones: **
Gallstones and Alcohol counts of 80% of all cases Pancreatitis in USA.
Amont those two, Gallstones, still leading cause of Pancreatitis. Than falling Alcohol.
Alcohol use:
During alcohol metabolism, toxic byproducts such as acetaldehyde and reactive oxygen species (ROS) are formed.
o These byproducts can cause cellular damage and oxidative stress within the pancreas.
o Enzymes **
usually released in digested track released in pancreas itself. Then damage pancreatic tissue promotes inflammation leads to further damage of pancreas
o Hypertriglyceridemia: mechanism not fully understood.
o But thought that high TG increase blood viscosity which may* induce ischemia in pancreatic tissue.
> inflammatory process
o Most of these pt showing derangement of lipid potassium.
o This pt prone to recurring episodes of pancreatis *
o ERCP procedure: **
**o Drugs: **due to hypersensitivity reaction or generation of metabolism
o Trauma: trauma and post up causes essentially direct insult to pancreas to some degree **
o P*ost operative
The Revised Atlanta Criteria
*** Phases: **Defines phases of Acute Panreatitis
<Early></Early>
* Severity: Outlines Severity of Actute Pancratitis
* Based on Calssification: Mild, Moderate, Sever
*
* **Imaging: **Clarifiies imaging defenitions
The Revised Atlanta Criteria
Phases of Acute Pancreatitis
EArly phase
<2 weeks
o Last 1 – 2 weeks
o Severity defined by clinical parameters (i.e. SIRS) rather than pathologic findings
o Organ failure occur if untreated **
o Occurs when inflammation mediators like neutrophils, macrophages are excreted into circulation
o Systemic complication can arrise like bacteremia , acute respiratory distress syndrome, pleural effusions, gastrointestinal hemorrhage, renal failure.
o Organ assessment system should me assessed at this point like RR, Cardiac, renal systems
The Revised Atlanta Criteria
Late Phase
> 2 wks
Protracted Illness (progress over time )
Persistant organ demage
**Acute Pancreatis
Clinical Findings **
- Abdomimal pain, N/V, Fever, ST
- Elevated S.Amylase& Lipase
- Leukocytes: 15 - 20,000
- Hematocrit >44% (severe disease process (i.e Pancreatic Necrosis )
- Azotemia (significan riks factors for mortality)
- Hyperglycemia
- Hyperbilirubinemia (with transient jaundice)
- Elevaed AST and ALT ( consider Gallbladder or Inflammation in Pancratic Head)
**Hematocrit : volume of red blood cells to the total volume of blood. *
Revised Atrlanta Criteria
BAsed of what ?
**Dignosis Based on 2 out 3 Criteria
and
**Classification **
Revised Atrlanta Criteria
Diagnosis
**Dignosis Based on 2 out 3 Criteria **
1)Epigastric Abdominal Pain
2)>3 -Fold Eleavation in Lipase and Amylase
Lipase 140 Normal ( elevated 360’s)
Amylase 30-110 Normal ( elevated 220’s -330)
3)AND /OR Confirmation Finding on Imaging
THe Revised Atlanta Creteria
Severity: Classifation
*
* **Mild
* Without local Complications or organ Failure
* Subsides in 3 t 7 days after TX*
- ** Moderate Severtiy **
- Transient organ Failure
- Resoved <48 Hrs
*** Severe **
Persistan rgan Failure >48 hrs
Single or multiple organ failure
CT Abdmen Acute Panreatitis
Interstitial or Necrotizing
