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Pancreatic Diseases Flashcards

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1
Q
A
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2
Q

Pancreas

What are the 2 exocrine funcions?

A
  1. Production of enzymes that are essential for digestion
  2. Pancreatic juices released to duodenum help body digest food and ultimately release energy
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3
Q

Pancreas

What are the enzymes produced by the pancreas to digest proteins (2)

A
  1. Trypsin
  2. Chymotrysin
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4
Q

Pancreas

Enzyme produced to digest carbs?

A

Amylase

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5
Q

Pancreas

Enzyme produced to breakdown lipids

A

Lipase

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6
Q

Pancreas

Where are these enzymes produced?

A

Acinar cells

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7
Q

Pancreas

Endocrine fuction of pancreas?

A

Production of pancreatic hormones

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8
Q

Pancreas

what are the 2 key pancreatic hormones and their function?

A
  1. Insulin
  2. Glucagon
    Involved in blood sugar regulation
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9
Q

Pancreas

where are these pancreatic hormones produced?

A

Islet cells

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10
Q

Pancreatitis

what is pancreatitis?

A

Inflammation of the pancreas

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11
Q

Pancreatitis

Description of acute pancreatitis

A

Sudden inflammation
Short lived
Return to normal function if resolved
May cause serious complications including death

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12
Q

Pancreatitis

Description of chronic Pancreatitis

A

Long lasting inflammation
Periodically symptomatic
Can lead to permanent damage -> scarring

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13
Q

Acute Pancreatitis

Symptoms (8)

A
  1. Sudden severe pain + cramping in abdomen
  2. Nausea and/or vomiting
  3. Fever
  4. Diarrhoea
  5. Jaundice
  6. Tachycardia (raised heartbeat)
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14
Q

Acute Pancreatitis

Most common causes (2)

A
  1. Gallstones
  2. Excessive alcohol intake
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15
Q

Causes of gallstones (2)

A
  1. Too much cholestrol
  2. Too much bilirubin
  3. Too much bile salts
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16
Q

What does having gallstones prevent?

A

Prevents passage of pancreatic enzymes to small intestine. They are forced back to pancreas

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17
Q

What is the name for gallstones in gallbladder

A

Cholelithiasis

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18
Q

Name for gallstones in bile duct

A

Choledocholithiasis

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19
Q

cause of cholesterol stones (3)

A
  1. Decreased bile production
  2. Increased cholesterol output
  3. Both
20
Q

Causes of pigment stones (2)

A
  1. Disruption of bilirubin by bacterial enzymes
  2. Precipitation of a calcium product that is then aggregated into stones
21
Q

Risk factors of pigment stones (3)

A
  1. Pre existing liver disease
  2. Obesity
  3. Chronic alcohol consumption
22
Q

Gallstones treatment (2)

A
  1. Medical: oral dissolution therapies to break down the stones. They can reoccur, only works for cholesterol stones.
  2. Surgery: definitive treatment, key hole surgery that removes connections betweeen gallbladder, bile ducts and liver
23
Q

Acute Pancreatitis

How does alcohol intake contribute?

A

Causes precipitation and inceased viscosity of pancreatic secretions. This leads to protein plugs in small ducts which develop into calculi, causing inflammation and fibosis -> chronic pancreatitis

24
Q

Acute Pancreatitis

Diagnosis (3)

A
  1. Using biomarkers that indicate panceatic dysfunction-> including serum Amylase and Lipase
  2. CT scan
  3. Endoscopy
25
Q

Diagnosis of Alcoholic acute pancreatitis

A

Same biomarkers as Acute Pancreatitis.
Accompanied with liver panel tests, calcium detemination and measurement of triglycerides

26
Q

Acute Pancreatitis

Treatment (5)

A
  1. IV fluids -> dehydration
  2. Oxygen
  3. Painkillers and antibiotics
  4. Liquid diet -> alleviate stomach pain
  5. Address underlying cause -> gallstones/ alcohol
27
Q

Chronic Pancreatitis

What is it characterised by?

A

Long term damage to organ characterised by fibrosis, calcification and inflammation of ducts

28
Q

Chronic Pancreatitis

Symptoms (6)

A
  1. Vomiting
  2. Dull relentless pain in abdomen
  3. Epigastric tenderness
  4. Steatorrhea
  5. Glucose intolerance
  6. Weight loss
29
Q

Chronic Pancreatitis

Diagnosis (4)

A
  1. Serum enzymes -> Amylase and Lipase not raised as much as in acute pancreatitis
  2. Determination of DM status
  3. Xray
  4. Exocrine function test by endoscopy
30
Q

Chronic Pancreatitis

If left untreated? (3)

A
  1. Complications w/ fat malabsorption
  2. Malnutrition
  3. Increased risk of diabetes
31
Q

Chronic Pancreatitis

Risk factors (3)

A
  1. High, prolonged alcohol intake
  2. Diet high in fat and protein
  3. Tobacco consumption
32
Q

Chronic Pancreatitis

What is the most common progenitor of CP?

A

Development of calcium and protein stones(lithiasis)

33
Q

Chronic Pancreatitis

Pathogenesis?

A

Persistant destruction of pancreatic tissue and replacement w/ fibrotic tissue

34
Q

Chronic Pancreatitis

Complications (5)

A
  1. Biliary obstruction: repeated inflammation causes scarring and restriction of bile ducts
  2. Pseudocysts: pancreatic fluids collects o/s ducts
  3. Duodenal obstruction: same cause as no. 1
  4. Pancreatic fistula: abnormal opening from pancreas/ pancreatic duct
  5. Pancreatic ascites: abnormal collection of pancreatic fluid in abdominal space
35
Q

Chronic Pancreatitis

Treatment - Medical (5)

A
  1. Nerve treatments
  2. Pain relief medications
  3. Enzyme therapies: control diarrhoea and weight loss due to improved absorption
  4. High protein and calorie specialised diet
  5. Endoscopic therapies: stent to open narrowed area and removal of stones if present
36
Q

Chronic Pancreatitis

Treatment - Surgical (4)

A
  1. Clearing blocked pancreatic duct
  2. Removal of pancreas and islet transplantation to liver
  3. Whipple Procedure: removal of part of pancreas, duodenum, bile duct, gallbladder, stomach. remaining intestines connected
    Partial removal of pancreas
37
Q

DM

What is DM characterised by?

A

Lack of / insufficiency of insulin

38
Q

T1DM

What is T1DM characterised by?

A

Complete / almost complete insulin deficiency

39
Q

T1DM

Clinical features (3)

A
  1. Onset in youth (usually)
  2. Usually a normal BMI
  3. Family history (usually)
40
Q

T1DM

Aetiology-Autoimmunity
Explain

A

Immune cells attack insulin producing cells (Beta cells) in pancreas

41
Q

T1DM

Aetiology - What do the genetic factors include? (2)

A
  1. Genes encoded with the Human Leukocyte Antigen (HLA)
  2. Common mutations include those on the genes that code for insulin gene itself
42
Q

T1DM

Aetiology - Viruses and Vaccinations (2)

A
  1. Children exposed to rubella have an increased risk of T1DM
  2. Enterovirus plays important role in development of T1DM
43
Q

T1DM

Aetiology - Diet and Gut Microbiota (2)

A
  1. Early intro of cow milk to infants diet: protein in cows milk similar to protein in Beta-cells of pancreas, hence the autoimmunity
  2. Difference in microbiota of people w/ T1DM vs w/o T1DM
44
Q

T1DM

Pathogenesis

A
  1. Development of auto antigens
  2. These are presented by antigen presenting cells
  3. This results in activation of T-helper cells
  4. Resulting in activation of autoantibodies that attack beta cells of pancreas
  5. This results in decreased insulin secretion
45
Q

T1DM

What does a decrease in insulin mean ?

A

Decrease in insulin = reduced ability of cellular uptake of glucose from circulation

46
Q

T1DM

Initial symptoms (8)

A
  1. Excessive urination and thirst
  2. Weight loss (dehydration)
  3. Weakness
  4. Fatigue
  5. Confusion
  6. Nausea
  7. Vomiting
  8. Ketoacidosis
47
Q

T1DM

Chronic symptoms (6)

A
  1. Eye damage
  2. Nerve damage
  3. Foot problems
  4. Kidney disease
  5. Heart disease
  6. Hypoglycaemia

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