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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
Q

What effect does CCK have on the pancreas?

A

Causes release of digestive enzymes from the acinar cells

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26
Q

What nerve is active in the cephalic digestion phase and what effect does this have? Why is this important?

A

Vagal stimulation causes release of digestive enzymes from pancreatic acinar cells. Important as enzymes secretion needs head start as takes longer than buffer secretion

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27
Q

Release of bicarbonate ions from centroacinar cells is stimulated by which hormone?

A

Secretin

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28
Q

Release of enzymes from basophillic acinar cells is stimulated by which hormone?

A

CCK

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29
Q

What effects do SNS and PNS stimulation have on levels of secretion in the pancreas?

A 
PNS = Increased secretion
SNS= Decreased secretion
30
Q

What are the main causes of pancreatitis?

A

1- Gallstones 2- Alcohol 3- Trauma

Drugs (steroids/ oestrogens)/ hyperlipidaemia/ infection/ tumours

31
Q

What is the pathophysiology of acute pancreatitis?

A

Raised intracellular Ca2+ causes conversion of trypsinogen to trypsin and early activation of enzymes = cellular necrosis
Impairs degradation of trypsin by chymotrypsin C

32
Q

What is responsible for degradation of trypsin?

A

Chymotrypsin C

33
Q

What is the pathophysiology of acute pancreatitis with alcohol as the causative agent?

A

Alcohol increases calcium levels in acinar cells

34
Q

What is the pathophysiology of acute pancreatitis with gallstones as the cause?

A

Occlusion of drainage at ampulla leads to ductal hypertension
This increases cystolic free ionized Ca2+

35
Q

What treatment would be given to someone with acute pancreatitis?

A

Analgesia
Nasogastric suction (reduce vomiting)
Fluids and treat cause

36
Q

What is the M/F ratio, main cause and most common presentation age of chronic pancreatitis?

A

M4:1F
70% causes by alcohol
Most common age 45-54

37
Q

What is the pathophysiology of chronic pancreatits?

A

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
Q

Which tissues are affected first in chronic pancreatitis, endocrine or exocrine?

A

Exocrine

39
Q

What are some of the RF’s and causes of chronic pancreatitis?

A

Alcohol/ smoking/ autoimmune/ genetics/ trauma/ blocked ducts/ radiotherapy

40
Q

Name two genes implicated in chronic pancreatitis?

A

PRSS1 and SPINK-1

41
Q

What diagnostic tests can be used for chronic pancreatitis, additional to those for acute?

A

Fecal elastase
Image for calcification
Secretin stimulation test (+ve if >60% enzyme insufficiency)

42
Q

What is the treatment for chronic pancreatitis?

A

Reduce dietary fat/ alcohol and smoking cessation
Analegics (NSAID/ tramadol/ TCA)
Pancreatin and PPI

43
Q

What is the 10yr survival rate for chronic pancreatitis?

A

70%

44
Q

What is a pancreatic pseudocyst?

A

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
Q

1 unit of alcohol is equal to what?

A

1oml pure ethanol
8g of ethanol
Half a pint/ a small glass of wine

46
Q

How is alcohol removed from the body?

A

10% excreted in breath

90% metabolised in the liver

47
Q

How is alcohol metabolised?

A

Ethanol > Acetaldehyde (Enzyme : Alcohol dehydrogenase)
Acetaldehyde > Acetic acid (Enzyme: Aldelydehyrdogenase)
- Both oxidise and reduce (NAD+ to NADH)

48
Q

What happens to the livers of alcoholics in relation to fat and why?

A

Reduction of NAD+ is also needed for fatty acid oxidation so alcoholics have a fat accumulation in their liver
(Hepatitis > fibrosis > cirrhosis)

49
Q

What is alcohol dehydrogenase?

A

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
Q

How fast can we metabolise alcohol?

A

1unit per hour

51
Q

What molecule is responsible for causing the ‘hangover’ effect?

A

Acetaldehyde
(normally only a small amount escapes the liver however when excess consumption of ethanol the circulating volume increases)

52
Q

Name two serum tests which can be done to indicate alcoholism?

A

Gamma-glutamyl transpeptidase
MCV
Both indicate excess alcohol intake when raised

53
Q

What are the negative effects of alcohol?

A

Stimulant at low levels, depressant (especially of cardio/ resp) at high levels
Neurotoxic (seizurers/ motor impairment)

54
Q

What is Wenicke-Korsakoff syndrome and what is it associated with?

A 
Low vitB1 (thiamine) 
Associated with alcohol consumption
55
Q

What effects does ethanol have on blood vessels in the skin?

A

Cutaneous vasodilation

warm feeling but heat actually lost

56
Q

Name 3 thinks which chronic ethanol consumption can lead to?

A

Immunosupression (inc cancer/ infection risk)
Impotence
Feminisation (in M)

57
Q

What equation is used to calculate the number of units?

A

ABV x Vol (ml) /1000 = UNITS

58
Q

Why could chronic alcohol consumption lead to pneumonia?

A

CNS depression increases risk of aspiration pneumonia

59
Q

What is one of the reasons excess alcohol causes neurotoxicity?

A

Thiamine (vitB1) deficiency

60
Q

Where is alcohol dehydrogenase mainly found?

A

Hepatocytes

61
Q

What is the best treatment for alcohol dependance?

A

Benzodiazepines

Thiamine

62
Q

What is the most abundant pancreatic enzyme?

A

Trypsin

63
Q

What is the role of phospholipase?

A

Splits FA’s from phospholipids

64
Q

Trypsinogen is activated by what?

A

Enterokinase

release when chyme contacts intestinal mucosa

65
Q

How do trypsin secreting cells stop themselves being broken down?

A

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
Q

Name two substances that can stimulate the acinar cells of the pancreas to produce digestive enzymes?

A

CCK

ACh from nerves

67
Q

During which phase does most pancreatic secretion happen?

A 
Cephalic = 20% mainly enzymes
Gastric= 10%
Intestinal= 70% due to more CCK/secretin
68
Q

In what form is secretin released and how is it activated?

A

Released as prosecretin by S cells

Activated when pH goes lower than 4.5

69
Q

What two substances are excreted in bile?

A

Cholesterol and bilirubin

70
Q

What % of released bile salts are reabsorbed?

A

95%

71
Q

Which pancreatic cells release ghrelin?

A

E-cells

Semester 4 (NME) (24 decks)

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