Pancreatic exocrine function Flashcards

1
Q

What are the two functions of the pancreas?

A
  • Endocrine secretion
  • Exocrine secretion
    (aqueous bicarbonate secretion + enzyme secretion)
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2
Q

What is the pancreatic duct?

A

Runs along the inside of the pancreas and is very thin 1-4mm thick as it goes from tail to body

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3
Q

How much bicarbonate do we secrete a day?

A

1 L/day

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4
Q

Where is HCO3- produced ?

A

Epithelial cells in the pancreatic duct produces HCO3- and H2O

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5
Q

Why is bicarbonate secreted?

A
  • This secretion protects duodenal mucosa by neutralising stomach acid
  • Buffers duodenal contents to optimise pH for enzyme digestion
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6
Q

What initiates protein digestion?

A

Pepsin in the stomach

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7
Q

Where does the majority of protein digestion occur?

A

In the small intestine

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8
Q

What are some pancreatic proteases and how are they stored?

A
  • Trypsin
  • Chymotrypsinogen
    They are stored as trypsinogen and chymotrypsinogen
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9
Q

How are pancreatic proteases activated?

A
  • Trypsinogen activated by enterokinase
  • Trypsin activates chymotrypsinogen and additional trypsinogen
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10
Q

What do lipases hydrolyse and what aids this?

A

Triglycerides to monoglycerides and free fatty acids
- Bile salts helps aid this

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11
Q

What is orlistat?

A

It is a pancreatic lipase inhibitor so stops some of the fat you eat from being absorbed. So it is used with weight loss

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12
Q

What does amylase do?

A
  • Hydrolyses starch to maltose (glucose- glucose disaccharide) and maltotriose (trisaccharide) and limit dextrins (low molecule carbohydrate made from starch)
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13
Q

Where is amylase found?

A
  • Salivary amylase has a small role
  • But most is found and secreted by pancreas
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14
Q

What is the cephalic stage of enzyme secretion?

A

This is the low level stimulus of anticipating a meal. Sight, smell etc…
Occurs through vagal innervation and release of gastrin

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15
Q

What is the intestinal stage of enzyme secretion?

A

Secretin, Cholecystokinin, Gastrin are all secreted

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16
Q

What does Cholecystokinin (CCK) do?

A

It is a pancreatic enzyme which delays gastric emptying. It does this by inhibiting the gastric acid secretion when the gallbladder contracts

17
Q

How does pancreatic secretion reduce?

A

As proteins and fats are digested and absorbed, pH rises and stimuli for CCK and secretin disappear and so pancreatic secretion falls as there is no stimulus

18
Q

What 2 hormones are vital for carbohydrate and lipid metabolism?

A

Inuline an glucagon

19
Q

What are some consequences of pancreatic exocrine insufficiency?

A

Malnutrition
Osteoporosis
Increased cardiovascular morbiditiy
Symptom burden

20
Q

How do we assess for poor pancreatic function?

A

History, risk factors
Imaging
Faecal elastase
Markers of malnutrition

21
Q

How do you treat PEI (pancreatic exocrine insufficiency)

A

Pancreatic enzyme replacement therapy
STOP smoking
Bone health assessment
Treat the underlying cause