Pancreas Physiology

Question 1

Pancreas Exocrine Cells name

Answer 1

Acinar
-> With zymogen granules (enzyme precursors)

Question 2

Acute Pancreatitis cause

Answer 2

Injury to acinar cells -> autodigestion + immune inflammation
- Itself due to several causes: alcohol, gallstones main

Question 3

Severity of acute pancreatitis

Answer 3

Spectrum: 30-40% cases are severe with 20-30% mortality (ie quite high)

Question 4

Autodigestive Proteases cause

Answer 4

Destruction of pancreas acini

Question 5

Autodigestive Lipases cause

Answer 5

Necrosis of fat in pancreas and other sites

Question 6

Autodigestive elastases cause

Answer 6

Blood vessel destruction = internal haemorrhage

Question 7

Why is acute pancreatitis so severe

Answer 7

Standard inflammatory response is compounded by activation of digestive enzymes leading to autodigestion

Question 8

Clinical signs of acute pancreatitis

Answer 8

Epigastric pain
Nausea, vomiting, fever, abdominal tenderness

(Non specific)

Question 9

How to diagnose acute pancreatitis

Answer 9

Initially neutrophil count to see if inflammation

Then to specify pancreatitis:
1 Elevated serum amylase and lipase
2 CT scan

Question 10

How to manage acute pancreatitis

Answer 10

IV fluids

Nasogastric suction to remove the pancreatic enzymes

Question 11

Chronic Pancreatisis presentation

Answer 11

Fibrotic due to repeated inflammation

Atrophy = smaller pancreas

Question 12

Chronic Pancreatisis cause

Answer 12

Repeated inflammation of pancreas (often due to heavy alcohol intake)

Question 13

Chronic Pancreatisis complications

Answer 13

Loss of exocrine function = malabsorption

If very severe spreads from acini to islets of langheran = endocrine complications (diabetes)

Question 14

Pancreatic Carcinoma deaths

Answer 14

Very high despite actual cancer being uncommon (as high fatality due to late presentation)

Question 15

Pancreatic cancer, what is the type of cancer

Answer 15

Adenocarcinoma as glandular tissue

Question 16

Where are pancreatic carcinomas most common

Answer 16

Head of pancreas

Question 17

Complications of head of pancreas cancer

Answer 17

Biliary obstruction

Question 18

Diagnosis of pancreatic cancer

Answer 18

Imaging (CT US) confirmed by biopsy

Question 19

Endocrine pancreatic tumour name

Answer 19

Insulinoma (Rare)

Question 20

Ductal cell of pancreas secretion

Answer 20

Bicarbonate

Question 21

Acinar cell secretion

Answer 21

Digestive enzymes

Question 22

Bicarbonate secretion steps

Answer 22

1. HCO3- from blood into ductal cells, and HCO3- made in ductal cells from H2O and CO2
2. Secreted via activate transport (CFTR and Cl-/HCO3- exchanger)

Question 23

How does secretin increase bicarbonate secretion from the pancreas

Answer 23

Secretin -> cAMP -> CFTR -> HCO3-

Question 24

How does vagal stimulation increase bicarbonate secretion from the pancreas

Answer 24

Vagal afferents -> Calcium -> increased HCO3- secretion

Question 25

Acinar cells high in which organelle

Answer 25

Endoplasmic reticulum to make lots of enzymes

Question 26

What mediates release of pancreatic enzymes

Answer 26

CCK

Question 27

How does CCK stimulate pancreatic enzyme secretion

Answer 27

1. Hormone in blood -> acinar cells stimulated 2. Activates vagus Efferents next to I cell -> brainstem -> vagus afferents stimulate acinar cells

Question 28

Trypsinogen -> trypsin enzyme

Answer 28

Enterokinase

Question 29

Trypsin cleaves which enzymes

Answer 29

Trypsinogen (auto catalytic) Chymotrypsingen Carboxypeptidase + others

Question 30

Protease

Answer 30

Enzyme that digests protein

Question 31

Lipase function

Answer 31

Triglycerides -> monoglycerides / free fatty acids

Question 32

Amylase function

Answer 32

Starch -> sugar

Question 33

What pre-empts the pancreas to begin releasing enzymes into the duodenum

Answer 33

Gastrin release during gastric phase of digestion

Question 34

Inhibitors of pancreatic enzyme secretion

Answer 34

Glucagon Somatostatin Pancreatic polypeptide Peptide YY (from colon ie further down)

Question 35

What happens with Cystic Fibrosis disease

Answer 35

Defective CFTR -> thick mucus clogs things eg ducts

Question 36

Impact of defective CFTR on pancreatic secretion thickness

Answer 36

Inc Cl- accumulation in cells -> inc Na+ accumulation from lumen -> inc H2O absorbed from lumen = Pancreatic secretions less water = thick (hyperviscous)

Question 37

Impact of defective CFTR on pancreatic enzymes in the pancreas

Answer 37

Accumulation of enzymes in the pancreas (as clogged duct from thick secretion) = autodigestion of pancreas = Pancreatisis

Question 38

Pancreas divisum

Answer 38

Failure of the pancreatic ducts to fuse = small flow as two ducts but one exit = blockage = Pancreatisis from autodigestion due to accumulation of enzymes

Question 39

Pancreatic insuffiency how much loss of exocrine function needed

Answer 39

>90%

Question 40

Which enzyme is most critically lost during pancreatic insufficiency

Answer 40

Lipase = fat malabsorption

Question 41

Impacts of fat malabsorption (eg loss of lipase)

Answer 41

Weight loss Steatorrhoea (fat in stool)