Pancreas & GI System Flashcards
Pancreas endocrine functions
insulin
glucagon
somatostatin
pancreas exocrine functions
enzymes for digestion & bicarb ion to neutralize acids in intestine
amylase (CHO) & lipase (fats)
trypsin, chymotrypsin, elastase, collegenase, leucine aminopeptidase
pancreas nerve control
vagus nerve branches
stimulates small amount of secretions responding to food smell /view
pancreas endocrine control
CCK & Secretin
Secretin
made in response to HCL acid @ duodenum in small intestine
leads to pancreas release of bicarb ion
CCK
cholecystokinin from intestinal mucosa
causes pancreas to release digestive enzymes
pancreatic diseases
cystic fibrosis
pancreatic cancer
pancreatitis
Cystic fibrosis
dysfunction of mucous & exocrine glands throughout the body
see intestinal obstruction, pulmonary infections & pancreatic malabsorption
ch 7 gene CFTR
sweat chloride test
> 60 mEg/L is diagnostic
done at least twice
sweat chloride test
> 60 mEg/L is diagnostic
done at least twice
apply pilocarpine to skin, collect sweat, measure
Pancreatic Carcinoma
death w/in 1 yr for 90% of diagnosed cases
tumors in tail & body of pancreas missed until advanced
signs of pancreatic carcinoma
jaundice (post-hepatic), weight loss, anorexia, nausea
islets of pancreas make excess insulin
overproduction of gastrin in Zollinger-Ellison syndrome
Acute Pancreatitis
inflammation of pancreas (usually reversible)
autodigestion of gland due to reflux of bile &/or duodenal contents into pancreatic duct
causes of acute pancreatitis
alcohol abuse mumps obstruction of biliary tract gallstones pancreatic tumors atherosclerotic disease shock pregnancy hypercalecemia immunologic factors associated w/ transplantation
lab tests for acute pancreatitis
amylase 2-3x
lipase elevated but as much as amylase
increased triglycerides, variable calcium levels
decreased 02
Chronic pancreatitis most common cause
alcohol abuse
chronic pancreatitis signs/symptoms/things associated w/ it
edema & fluid buildup in peritoneal cavity w/ associated decrease in blood volume
acinar cells of pancreas become infiltrated by inflammation
can develop hemorrhage & necrosis
chronic pancreatitis labs
increased lipase, triglycerides, & calcium
decreased 02
‘give away’ for chronic pancreatitis
elevated lipase & normal amylase
hemorrhage is exclusively chronic
relapse/recurrent pancreatitis
causes similar to acute pancreatitis
either acute or chronic w/ similar labs
symptom/lab result that is common to all pancreatitis
steatorrhea - greasy feces >5g/24hr fecal fat
& malabsorption
pancreatic function testing
amylase & lipase
malabsorption using D-xylose
CCK, secretin, fecal fat, trypsin, chymotrypsin
bilirubin & ALP (biliary obstruction)
assays for gastrin, insulin, glucose
secretin clearance test
Secretin clearance testing
give IV secretin, follow w/ CCK
collect secretions for 30, 60, or 80 mins in either 10 min intervals or as a single pool
measure pH, secretion rate, enzyme activities, & bicarb ion
Fecal Fat analysis
qualitative testing: lipid stains such as Sudan III, Oil red O, nile blue sulfate
quantitative: collect stool for 3 days & use gravimetric, titrimetric, infrared & nuclear magnetic resonance spectroscopy
when is steatorrhea seen?
biliary obstruction
pancreatic insufficiency
disease of small intestine
gravimetric method
extract fatty acids into organic solvent aliquot in pre-weighed container evaporate solvent weigh residue take difference in weight 1-7 g/24 hr range
Titrimetric method
extract saponified lipids, evaporate solven, reconstitute in ethanol, titrate w/ NaOH
results are 20% less than gravimetric method
cases w/ amylase increases
75% of acute pancreatitis
burns
sepsis
diabetic ketoacidosis
parietal cells
produce HCl acid & intrinsic factor (facilitates absorption of vit B12 in ileum)
Chief cells
pepsin cells
make pepsinogen - converted by acid to pepsin to break down proteins
G cells
produce gastrin in antrum of stomach & duodenum
respond to stimulation from vegas nerve
Gastrin stimulation
neurogenic impulses= smell, sight, anticipation
distention of stomach w/ food/fluid
contact of protein- breakdown called secretagogues
Gastrin inhibited by
high gastric acidity
gastric inhibitory polypeptide (GIP) secreted in response to food
vasoactive intestinal polypeptide (VIP)- inhibits everything about gastrin
Gastric analysis
measure basal acid output (BAO) & peak acid output (PAO)
pentagastrin stimulation - synthetic peptide
gastric acid & pernicious anemia
no acid present
gastric acid & Zollinger-Ellison syndrome
hyperacid present
normal range: 50-150 pg/ml
Z-E : 1000-400000 pg/ml
Gastric ulcer
normal acid output
duodenal ulcer
increased output for BAO & PAO
Small intestine
20 feet
absorb nutrients & water through passive & active transport
Large intestine
5 feet long
water reabsorption & store feces
pathology of intestine
MALABSORPTION mostly
celiac’s disease, whipple’s disease, crohns disease, primary intestinal lymphangiectasia, ischema, amyloidosis, giardiasis, lactase deficiency, hartnup syndrome
Hartnup syndrome
defect in transport of phenylalanine & leucine
Tests for intestinal function
lactose tolerance test D-xylose absorption test serum carotenoids fat soluble vit assays albumin folate & vit B12 iron assays calcium & magnesium (decreases seen in vit D deficiency)
Lactose tolerance test
hydrogen ion breath test
acquired deficiency > genetic
cramps, diarrhea, abdominal discomfort
D- Xylose test
pentose sugar not found in foods
absorbed unaltered by the proximal small intestine & filtered out the kidney unchanged
heat urine to change D-xylose to furfural
react w/ p-bromoaniline
spectro
Serum Carotenoids
humans express carotenoids of lycopene, xanthophyll, & beta carotene
tell about human lipid absorption
