Pancreas and Gall bladder Flashcards
What are the different roles the pancreas play?
- Exocrine - produce digestive enzymes (amylase, protease, lipase)
- Endocrine - produce insulin, glucagon in response to changes in blood glucose levels.
Where do pancreatic secretions drain?
Common bile duct
How are digestive enzymes secreted?
As pro-enzymes and converted to active enzymes in duodenum. Otherwise pancreas would digest itself (pancreatitis).
Why is a problem if the common bile duct gets obstructed?
The liver, gall bladder and pancreas drain into the duodenum via the common bile duct. So if it gets obstructed, we get obstruction of the bile and pancreatic secretions.
This means pancreatic enzymes can build up in the pancreas causing auto-digestion of pancreas.
What can commonly cause obstruction in the common bile duct?
Gall stones
What is pancreatitis?
Inflammation of the pancreas.
Obstruction of the secretions (amylase, protease, lipase) causes auto-digestion of the pancreas.
What are some of the risk factors for pancreatitis?
Gall stones
Direct trauma to pancreas - causes leakage and scarring which obstructs drainage
Diabetes
Gall bladder surgery
Alcohol
Pancreatic cancer
Drugs (immunosuppressants)
What are the signs and symptoms of pancreatitis?
Severe upper abdominal pain that radiates to the back
Vomiting, weight loss, feeling very unwell
Steatorrhoea (pale poo floating in toilet - fatty)
Jaundice - liver can’t process bilirubin
Diabetes Mellitus develops/gets worse
What blood test can you do to check for pancreatitis?
Check for serum amylase. If high - means amylase is not being sent into duodenum to help in digestion.
How do we manage pancreatitis?
Mainly supportive - correct risk factors, manage if in shock, support if they have circulatory collapse
Give fluids
Manage diabetes
Correct glucose/electrolyte imbalances
Give antibiotics if necessary (if signs of sepsis)
Surgery to remove obstruction (gall stones)
What causes gall bladder disease?
Gall stones that get lodged in the common bile duct obstruct the gall bladder (as well as the pancreas).
How do gall stones develop?
The bile secreted by the liver includes fats including cholesterol.
Cholesterol is deposited in the gall bladder which can crystallise and become gall stones.
What are teh risk factors for developing gall stones?
Fat Female Forty Fair
Age
Gender
BMI
Affluence
Diet (high fat)
What are the signs of gall bladder disease?
Abdominal pain; upper right quadrant = Biliary colic pain, worse at meal times bc GB contracting against obstruction = pressure
N&V
Fever - if gall bladder becomes infected
Jaudice (inc serum bilirubin)
How do you manage gall bladder disease?
- Prevention - RFs
- Stop high fat diet
- Treat acute infection
- Remove GB by surgery
