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Semester 4 (NME) > Pancreas + Gallbladder > Flashcards

Pancreas + Gallbladder Flashcards

1
Q

What are the 3 main causes of pancreatitis?

A

Gall stones
Alcohol (either damages acinar cells or sphincter of oddy)
Autoimmune

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2
Q

What is the main drug which causes a risk of pancreatitis?

A

Azothioprim (for Crohns)

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3
Q

Name a cause of jaundice which is painless and presents with a palpable mass in RUQ?

A

Cancer of head of pancreas

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4
Q

Which enzymes are raised in patients with pancreatitis?

A

Amylase and Lipase

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5
Q

What is the peritoneal covering of the pancreas?

A

It is retroperitoneal (except for tail)

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6
Q

What are the four parts of the pancreas?

A

Tail
Body
Head
Uncinate process

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7
Q

Which arteries supply the pancreas?

A

Branches of splenic art
Sup mesenteric art
Common hepatic art

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8
Q

Which veins drain the pancreas?

A

Pancreatic duodenal vein

from hepatic portal vein

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9
Q

What type of gland is the pancreas?

A

Mainly exocrine
A compound tuberoalveolar gland which branches from main pancreatic duct going into lobules then into individual pancreatic acini

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10
Q

Pancreatic acini are lined with what tupe of epithelium?

A

Simple cuboidal

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11
Q

What are islets of langerhans and how much of the pancreas do they make up?

A

Endocrine cells which secrete insulin and glucagon into the blood stream
Make up less than 1% of pancreatic cells

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12
Q

What are the exocrine cells of the pancreas?

A

Acinar cells and epithelial cells of the ducts

Secrete pancreatic juice (an alkaline mixture of water, enzymes and ions)

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13
Q

Which exocrine pancreatic cells are responsible for secreting which components?

A

Acinar cells- Enzymes

Epithelial (duct) cells (aka centroacinar)- Water and ions

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14
Q

Where does the gallbladder sit?

A

Just inf to liver in a fossa between two liver lobes (Right and quadrate lobes)

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15
Q

Where does the liver initially secrete bile to and how much is produced per day?

A

Into bile canaliculi

Done continuously around 1L per day

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16
Q

Where does bile travel on it’s way from the liver to the gallbladder?

A

Bile canaliculi > bile ductules > R+L hepatic duct > common hepatic duct > cystic duct > gallbladder

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17
Q

What is bile used for?

A

Breaking down lipids in the lumen of the duodenum by emulsification

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18
Q

What are the three regions of the gallbladder?

A

Fundus (most superior)
Body
Neck (most inferior)

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19
Q

The common bile duct is formed from which two ducts?

A

Cystic duct

Common hepatic duct

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20
Q

CCK is release from where and what does it do to the gallbladder?

A

Released by I-cells of duodenum when chyme enters

Stimulates gall bladder contraction, hepatopancreatic sphincter dilation

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21
Q

Which artery/ vein and nerve supply the gall bladder and billary tree?

A

Art: Cystic artery (from R hepatic)
Vein: Cystic vein (from hepatic portal vein)
Nerve: Celiac ganglia (from thoracic splanchnic)

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22
Q

What 4 things are secreated by pancreatic acinar cells?

A 
Pancreatic alpha amylase (Carbohydrase, breaks starch)
Pancreatic lipase (Lipids to FA's)
Nucleases (break down DNA and RNA)
Proteolytic enzymes (proteases and peptidases)
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23
Q

What is the main enzyme secreted from pancreatic acinar cells?

A

Proteolytic enzymes are 70% of secretions
Proteases (large protein > small protein)
Peptideass (small protein > AA’s)

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24
Q

Chyme and a low pH in the duodenum stimulates X cells to release Y, this has the effect of Z.

A 
X= S cells       Y= Secretin
Z= Increases watery buffer (HCO3-) solution secretion from pancreatic centroacinar cells
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25
What effect does CCK have on the pancreas?
Causes release of digestive enzymes from the acinar cells
26
What nerve is active in the cephalic digestion phase and what effect does this have? Why is this important?
Vagal stimulation causes release of digestive enzymes from pancreatic acinar cells. Important as enzymes secretion needs head start as takes longer than buffer secretion
27
Release of bicarbonate ions from centroacinar cells is stimulated by which hormone?
Secretin
28
Release of enzymes from basophillic acinar cells is stimulated by which hormone?
CCK
29
What effects do SNS and PNS stimulation have on levels of secretion in the pancreas?
``` PNS = Increased secretion SNS= Decreased secretion ```
30
What are the main causes of pancreatitis?
1- Gallstones 2- Alcohol 3- Trauma | Drugs (steroids/ oestrogens)/ hyperlipidaemia/ infection/ tumours
31
What is the pathophysiology of acute pancreatitis?
Raised intracellular Ca2+ causes conversion of trypsinogen to trypsin and early activation of enzymes = cellular necrosis Impairs degradation of trypsin by chymotrypsin C
32
What is responsible for degradation of trypsin?
Chymotrypsin C
33
What is the pathophysiology of acute pancreatitis with alcohol as the causative agent?
Alcohol increases calcium levels in acinar cells
34
What is the pathophysiology of acute pancreatitis with gallstones as the cause?
Occlusion of drainage at ampulla leads to ductal hypertension This increases cystolic free ionized Ca2+
35
What treatment would be given to someone with acute pancreatitis?
Analgesia Nasogastric suction (reduce vomiting) Fluids and treat cause
36
What is the M/F ratio, main cause and most common presentation age of chronic pancreatitis?
M4:1F 70% causes by alcohol Most common age 45-54
37
What is the pathophysiology of chronic pancreatits?
Precipitation of protein in ducts (caused by alcohol) leads to ductal hypertension and raised Ca2+ levels. This increases trypsin activation and thus cellular necrosis and eventually fibrosis
38
Which tissues are affected first in chronic pancreatitis, endocrine or exocrine?
Exocrine
39
What are some of the RF's and causes of chronic pancreatitis?
Alcohol/ smoking/ autoimmune/ genetics/ trauma/ blocked ducts/ radiotherapy
40
Name two genes implicated in chronic pancreatitis?
PRSS1 and SPINK-1
41
What diagnostic tests can be used for chronic pancreatitis, additional to those for acute?
Fecal elastase Image for calcification Secretin stimulation test (+ve if >60% enzyme insufficiency)
42
What is the treatment for chronic pancreatitis?
Reduce dietary fat/ alcohol and smoking cessation Analegics (NSAID/ tramadol/ TCA) Pancreatin and PPI
43
What is the 10yr survival rate for chronic pancreatitis?
70%
44
What is a pancreatic pseudocyst?
75% of all pancreatic masses An accumulation of pancreatic enzymes/ blood and necrotic tissue- surrounded by granulation tissue (True cysts are surrounded by epithelium)
45
1 unit of alcohol is equal to what?
1oml pure ethanol 8g of ethanol Half a pint/ a small glass of wine
46
How is alcohol removed from the body?
10% excreted in breath | 90% metabolised in the liver
47
How is alcohol metabolised?
Ethanol > Acetaldehyde (Enzyme : Alcohol dehydrogenase) Acetaldehyde > Acetic acid (Enzyme: Aldelydehyrdogenase) - Both oxidise and reduce (NAD+ to NADH)
48
What happens to the livers of alcoholics in relation to fat and why?
Reduction of NAD+ is also needed for fatty acid oxidation so alcoholics have a fat accumulation in their liver (Hepatitis > fibrosis > cirrhosis)
49
What is alcohol dehydrogenase?
An enzyme which starts working in the stomach and continues to the liver, it converts ethanol to acetaldehyde NB: women/ Asians have lower levels so can't tolerate as much alcohol
50
How fast can we metabolise alcohol?
1unit per hour
51
What molecule is responsible for causing the 'hangover' effect?
Acetaldehyde (normally only a small amount escapes the liver however when excess consumption of ethanol the circulating volume increases)
52
Name two serum tests which can be done to indicate alcoholism?
Gamma-glutamyl transpeptidase MCV Both indicate excess alcohol intake when raised
53
What are the negative effects of alcohol?
Stimulant at low levels, depressant (especially of cardio/ resp) at high levels Neurotoxic (seizurers/ motor impairment)
54
What is Wenicke-Korsakoff syndrome and what is it associated with?
``` Low vitB1 (thiamine) Associated with alcohol consumption ```
55
What effects does ethanol have on blood vessels in the skin?
Cutaneous vasodilation | warm feeling but heat actually lost
56
Name 3 thinks which chronic ethanol consumption can lead to?
Immunosupression (inc cancer/ infection risk) Impotence Feminisation (in M)
57
What equation is used to calculate the number of units?
ABV x Vol (ml) /1000 = UNITS
58
Why could chronic alcohol consumption lead to pneumonia?
CNS depression increases risk of aspiration pneumonia
59
What is one of the reasons excess alcohol causes neurotoxicity?
Thiamine (vitB1) deficiency
60
Where is alcohol dehydrogenase mainly found?
Hepatocytes
61
What is the best treatment for alcohol dependance?
Benzodiazepines | Thiamine
62
What is the most abundant pancreatic enzyme?
Trypsin
63
What is the role of phospholipase?
Splits FA's from phospholipids
64
Trypsinogen is activated by what?
Enterokinase | release when chyme contacts intestinal mucosa
65
How do trypsin secreting cells stop themselves being broken down?
Cells that secrete proteolytic enzymes simultaneously secrete trypsin inhibitor. It prevents activation of trypsin both inside the secretory cells and in the acini and ducts of the pancreas.
66
Name two substances that can stimulate the acinar cells of the pancreas to produce digestive enzymes?
CCK | ACh from nerves
67
During which phase does most pancreatic secretion happen?
``` Cephalic = 20% mainly enzymes Gastric= 10% Intestinal= 70% due to more CCK/secretin ```
68
In what form is secretin released and how is it activated?
Released as prosecretin by S cells | Activated when pH goes lower than 4.5
69
What two substances are excreted in bile?
Cholesterol and bilirubin
70
What % of released bile salts are reabsorbed?
95%
71
Which pancreatic cells release ghrelin?
E-cells

Semester 4 (NME) (24 decks)

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