Pancreas

Question 1

Pancreas divisum

Answer 1

failure of the ventral and dorsal buds to fuse

Question 2

Exocrine pancreas enzymes

Answer 2

Lipase, colipases, phospholipase A - digest fats and lipids

Proteases digest proteins- secreted as zymogens and activated in duodenum
-trypsin by enterokinase and enteropeptidase
Trypsin activates:
-chymotrypsin
-elastase
-carboxypeptidases

Amylase - digests carbohydrates and starches

Question 3

Carbohydrate digestion and absorption

Answer 3

starts in mouth - salivary amylase

pancreatic amylase break down carbohydrates to simpler sugars

oligosaccharide hydrolases break down into monomers

• brush border enzymes
• rate limiting step

Enterocyte absorption of monomers

• SGLT1 - Na+/glucose cotransporter
• GLUT5 - frutose facilitated diffusion

Question 4

Oligosaccharide hydrolases

Answer 4

sucrase
maltase
isomaltase
lactase

Question 5

Annular pancreas

Answer 5

Ventral pancreas encircles duodenum, didn’t rotate
–> narrowing (stenosis) of that part of duodenum

2/3 asx - little stenosis

sx at any age depends on severity of constriction

Kids: gastric outlet obstruction - nonbilious vomiting, feeding intolerance, abdominal distention

Infants: polyhydraminos, Down syndrome, esophageal and duodenal atresia, imperforate anus, Meckel diverticulum

Adult: 20-50 yo - abd pain, postprandial fullness and nausea, peptic ulceration, pancreatitis, rarely biliary obstruction

Question 6

Cystic fibrosis effects on pancreas

Answer 6

defect in CFTR cannot pump Cl- into lumen of pancreatic duct, Na and water do not go into duct
–> thick pancreatic secretions

–> pancreatic insufficiency
malabsorption - fats, proteins, fat soluble vitamins

Tx: supplement pancreatic enzymes and ADEK vitamines

Question 7

Acute pancreatitis

Answer 7

Inflammation –> self digestion
Hospitalize

Causes: 75% gallstones, alcohol

severe upper abd pain, radiates to back
N/V
Sitophobia (food fear)

Lab: elevated serum lipase
CT to confirm

Complications:
Multiorgan failure
DIC
hemorrhage
necrosis
saponification --> hypocalcemia
pseudocyst

Other causes
"PANCREATITIS"
hyperParathyroidism (high calcium)
Alcohol
Neoplasm (block duct)
Cholelithiasis
Rx (HIV and Sulfa drugs)
Ercp (back flow of contrast)
Abd surgery
hyperTriglyceridemia
Infection (mumps)
Trauma
Idiopathic 20%
Scorpion sting

Question 8

Pancreatic pseudocyst

Answer 8

lined w/ fibrous scar tissue and granulation tissue

filled w/ pancreatic juice and enzymes

Question 9

Chronic pancreaitits

Answer 9

Alcohol abuse –> chronic pancreatic failure

malabsorption
steatorrhea
DM
Increased risk of pancreatic CA

Management: pancreatic enzymes, ADEK supplement

Question 10

Pnacreatic adenocarcinoma

Answer 10

aggressive, no sx until mets to liver

wt loss, abd pain, painless jaundice

Risk: chornic pancreatitis, tobacco use

over 50 yo, black and Ashkenazi Jew

Tumor markers: CA 19-9, CEA

Trousseau syndrome

Question 11

Trousseau syndrome

Answer 11

hyper coagulability
venous thrombosis
migratory thrombophlebitis