Pancreas Flashcards
What are the endocrine and exocrine functions of the pancreas
- Endocrine- products go directly to circulation- glands have no ducts- insulin and glucagon
- Exocrine- have ducts and enzymes pass from pancreas through ducts to small intestine - trypsin, chymotrypsin, elastase, lipase and amylase
What is cholecystokinin
-Secretin stimulates pancreatic enzymes and gall bladder contraction when there is acidic fluid in the duodenum - also stimulates alkaline fluid secretion
The gall bladder will empty bile into the duodenum to allow fat digestion- this is why biliary colic is brought on after a fatty meal
What are the symptoms and causes of acute pancreatitis
- Acute Abdominal pain -Shock-3rd space fluid loss
- Iatrogenic -Gall Stones -Ethanol -Trauma -Steroids -Mumps -Autoimmune -Scorpion sting -Hyperlipidaemia (large triglycerides obstruct flow to pancreas) -ERCP -Drugs (diuretics)
How is a diagnosis of pancreatitis made
And what are other causes of increased amylase
- Clinical diagnosis
- Elevated serum amylase or lipase- lipase just in pancreas, amylase is in salivary glands and pancreas
- CT scan - inflammation and oedema
Increased amylase
- Mild- salivary gland issues - mumps, calculi
- Moderate- Perforated duodenal ulcer, rupture AAA, DKA
- Severe- Acute pancreatitis (10x upper limit)
What is the diagnostic criteria in acute pancreatitis prognosis
- Glasgow criteria- APACHE 11
- Age -WCC -Blood glucose -Lactate dehydrogenase (cell breakdown)
- Urea (kidney dysfunction) -Albumin -Calcium -po2 (resp distress)
What are the causes of pancreatic insufficiency and how does it present
-How is it tested for
- Removal of necrotic areas of pancreas
- Chronic pancreatitis
Presents with features of malabsorption
- Weight loss -Anaemia -Diarrhoea -Steatorrhoea -Abdo discomfort
- Osteomalacia- low ca and vit d -Check plasma glucose/ HbA1c
Tests for insufficiency
-Faceal elasase and faecal chymotrypsin will be absent in insufficiency
