Pancreatic Diseases

Question 2

Pancreas

What are the 2 exocrine funcions?

Answer 2

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

Question 3

Pancreas

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

Answer 3

1. Trypsin
2. Chymotrysin

Question 4

Pancreas

Enzyme produced to digest carbs?

Answer 4

Amylase

Question 5

Pancreas

Enzyme produced to breakdown lipids

Answer 5

Lipase

Question 6

Pancreas

Where are these enzymes produced?

Answer 6

Acinar cells

Question 7

Pancreas

Endocrine fuction of pancreas?

Answer 7

Production of pancreatic hormones

Question 8

Pancreas

what are the 2 key pancreatic hormones and their function?

Answer 8

1. Insulin
2. Glucagon
   Involved in blood sugar regulation

Question 9

Pancreas

where are these pancreatic hormones produced?

Answer 9

Islet cells

Question 10

Pancreatitis

what is pancreatitis?

Answer 10

Inflammation of the pancreas

Question 11

Pancreatitis

Description of acute pancreatitis

Answer 11

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

Question 12

Pancreatitis

Description of chronic Pancreatitis

Answer 12

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

Question 13

Acute Pancreatitis

Symptoms (8)

Answer 13

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

Question 14

Acute Pancreatitis

Most common causes (2)

Answer 14

1. Gallstones
2. Excessive alcohol intake

Question 15

Causes of gallstones (2)

Answer 15

1. Too much cholestrol
2. Too much bilirubin
3. Too much bile salts

Question 16

What does having gallstones prevent?

Answer 16

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

Question 17

What is the name for gallstones in gallbladder

Answer 17

Cholelithiasis

Question 18

Name for gallstones in bile duct

Answer 18

Choledocholithiasis

Question 19

cause of cholesterol stones (3)

Answer 19

1. Decreased bile production
2. Increased cholesterol output
3. Both

Question 20

Causes of pigment stones (2)

Answer 20

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

Question 21

Risk factors of pigment stones (3)

Answer 21

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

Question 22

Gallstones treatment (2)

Answer 22

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

Question 23

Acute Pancreatitis

How does alcohol intake contribute?

Answer 23

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

Question 24

Acute Pancreatitis

Diagnosis (3)

Answer 24

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

Question 25

Diagnosis of Alcoholic acute pancreatitis

Answer 25

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

Question 26

# Acute Pancreatitis Treatment (5)

Answer 26

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

Question 27

# Chronic Pancreatitis What is it characterised by?

Answer 27

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

Question 28

# Chronic Pancreatitis Symptoms (6)

Answer 28

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

Question 29

# Chronic Pancreatitis Diagnosis (4)

Answer 29

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

Question 30

# Chronic Pancreatitis If left untreated? (3)

Answer 30

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

Question 31

# Chronic Pancreatitis Risk factors (3)

Answer 31

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

Question 32

# Chronic Pancreatitis What is the most common progenitor of CP?

Answer 32

Development of **calcium and protein stones**(lithiasis)

Question 33

# Chronic Pancreatitis Pathogenesis?

Answer 33

Persistant **destruction of pancreatic tissue and replacement w/ fibrotic tissue**

Question 34

# Chronic Pancreatitis Complications (5)

Answer 34

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

Question 35

# Chronic Pancreatitis Treatment - Medical (5)

Answer 35

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

Question 36

# Chronic Pancreatitis Treatment - Surgical (4)

Answer 36

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

Question 37

# DM What is DM characterised by?

Answer 37

Lack of / insufficiency of insulin

Question 38

# T1DM What is T1DM characterised by?

Answer 38

Complete / almost complete insulin deficiency

Question 39

# T1DM Clinical features (3)

Answer 39

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

Question 40

# T1DM Aetiology-Autoimmunity Explain

Answer 40

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

Question 41

# T1DM Aetiology - What do the genetic factors include? (2)

Answer 41

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

Question 42

# T1DM Aetiology - Viruses and Vaccinations (2)

Answer 42

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

Question 43

# T1DM Aetiology - Diet and Gut Microbiota (2)

Answer 43

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

Question 44

# T1DM Pathogenesis

Answer 44

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**

Question 45

# T1DM What does a decrease in insulin mean ?

Answer 45

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

Question 46

# T1DM Initial symptoms (8)

Answer 46

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

Question 47

# T1DM Chronic symptoms (6)

Answer 47

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