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Clinical Chemistry > Pancreatic function > Flashcards

Pancreatic function Flashcards

1
Q

List endocrine tests

A
  • Gastrin
  • Insulin
  • Glucose
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2
Q

List exocrine pancreatic function tests

A

Amylase and lipase

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3
Q

List indirect tests

A
  • Qualitative fecal fat analysis
  • Fecal elastase
  • Fecal chymotrypsin
  • Bilirubin
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4
Q

Which pancreatic function test is the most sensitive, uses actual pancreatic secretions, endoscopy/Dreiling tube method after stimulation with secretin and/or cholecystokinin (CCK)?

A

Direct

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5
Q

CCK

A
  • Hormone secreted by intestinal mucosal cells
  • Causes acinar cells to secrete enzymes and bile
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6
Q

CCK test measures

A
  • pH
  • Secretory rate
  • Enzyme activity
  • Bicarb
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7
Q

How does pancreatic obstruction affect pancreatic flow and enzymes?

A
  • Decreased pancreatic flow
  • Increased enzymes
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8
Q

Which diseases show reduced bicarb and enzymes

A
  • CF
  • Chronic pancreatitis
  • Pancreatic cysts
  • Calcification
  • Edema of pancreas
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9
Q

4 sources of fecal lipids

A
  1. Unabsorbed ingested lipids
  2. Lipids excrete into intestine
  3. Cells shed into the intestine
  4. Metabolism of intestinal bacteria
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10
Q

Normal fecal lipid composition

A
  • 60% fatty acids
  • 30% sterols, higher alcohols, and carotenoids
  • 10% triglycerides
  • small amounts of cholesterol and phospholipids
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11
Q

Increased fecal fat can be caused by

A

Biliary obstruction

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12
Q

Severe steatorrhea associated with

A

Exocrine pancreatic insufficiency or disease of small intestine

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13
Q

Fecal fat qualitative screening test uses which fat soluble stains?

A
  • Sudan III
  • Sudan IV
  • Oil Red O
  • Nile blue sulfate
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14
Q

Is technical skill important in Fecal fat qualitative screening test?

A

Yes

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15
Q

How do fat soluble stains work?

A

Dissolve in and color lipid droplets

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16
Q

Sudan staining colors which fats? Which colors?

A
  • Neutral fats (triglycerides) and other lipids
  • Yellow-orange to red with Sudan III
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17
Q

Which type of fat stain requires heating?

A

Sudan

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18
Q

Steatorrhea features how many lipid droplets?

A

> 100 small/large may be present

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19
Q

Definitive test for steatorrhea

A

Quantitative fecal fat analysis

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20
Q

How many hr stool specimen for Quantitative fecal fat analysis?

A

72 hr

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21
Q

Diet for Quantitative fecal fat analysis

A

Lipid-rich diet for at least 2 days

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22
Q

Quantitative fecal fat analysis measures which fats?

A

Only saponifiable fatty acids

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23
Q

Gravimetric method for fecal fat determination

A
  • Emulsify entire fecal sample in water
  • Fatty acid soaps (Ca and Mg salts of fatty acids) are converted to free fatty acids
  • Extract lipids into organic solvent
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24
Q

How much exocrine pancreatic function is lost before a 72 hr fecal fat test becomes positive?

A

90%

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25
Q

Fecal elastase-1 is what type of indicator?

A

Non-invasive indirect indicator of moderate and severe exocrine pancreatic dysfunction (secreted by pancreas)

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26
Q

Fecal elastase-1 is similar to which proteolytic enzyme?

A

Chymotrypsin

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27
Q

Fecal fat and fecal enzyme levels in exocrine pancreatic insufficiency

A
  • Fecal fat increased
  • Fecal enzymes decreased
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28
Q

Fecal chymotrypsin sensitivity/specificity and what affects it

A
  • Less sensitive and less specific
  • Can be affected by supplements
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29
Q

Patients with which disease have reduced ability to reabsorb Cl- from sweat and why?

A

Cystic fibrosis because chloride transporter (CFTR gene product) not functioning

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30
Q

Sweat chloride testing level of difficulty to perform

A

High difficulty

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31
Q

How to diagnose CF in kids

A

2-5x increase in sweat Na and Cl

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32
Q

Can sweat chloride testing differ btwn heterozygous and homozygous carriers?

A

NO

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33
Q

Almost exclusively pancreatic test that is more sensitive, specific, and accurate

A

Lipase

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34
Q

Lipase increases within 24 hr of ___ and persists for how many days from reabsorption

A
  • Acute pancreatitis
  • 8-14 days
35
Q

Is lipase cleared?

36
Q

Pancreatic test cleared by kidneys

37
Q

Which amylase test is more sensitive indicator?

A

Urine amylase

38
Q

Amylase measured in

A
  • Urine
  • Saliva
  • Pancreatic fluid
39
Q

Does amylase magntitude correlate with severity?

40
Q

Test useful in detecting minor or intermittent increases in serum amylase levels

A

Renal clearance of amylase

41
Q

Amylase renal clearance signif increased in

A
  • Acute pancreatitis
  • Burns
  • Sepsis
  • Diabetic ketoacidosis
42
Q

Both amylase and lipase increased in

A
  • Opiate administration
  • Pancreatic carcinoma
  • Intestinal infarction
  • Obstruction or perforation
  • Pancreatic trauma
43
Q

Only amylase increased in

A
  • Mumps
  • Cholecystitis
  • Hepatitis
  • Cirrhosis
  • Ruptured ectopic pregnancy
  • Macroamylasemia
44
Q

Only lipase increased in

A
  • Bone fractures
  • Fat embolism
45
Q

Gastrin

A
  • Peptide hormone
  • Enhances gastric growth/motility
  • Secretion of HCl
46
Q

Gastrin present in which cell type?

A

G cells of gastric antrum and duodenum

47
Q

Gastrin tested to diagnose

A

Zollinger-Ellison syndrome

48
Q

Zollinger-Ellison syndrome

A

Gastrinoma- increased stomach acid leading to ulcers

49
Q

List tests for gastric secretion and intestinal function

A
  • Gastrin
  • Intestinal function
  • Lactose
  • D-xylose
  • Carotenoids
50
Q

Lactose

A

Disaccharide sugar composed of glucose and galactose present in mammalian milk

51
Q

Lactase

A

Produced in small intestine to digest lactose

52
Q

Loss or deficiency of this enzyme in adults is normal

53
Q

Lactose intolerance symptoms

A

Cramps, bloating, diarrhea

54
Q

Lactose measurement methods

A
  • Lactose intolerance test
  • Breath test
55
Q

D-xylose test

A
  • Exogenously given simple monosaccharide sugar
  • Not normally present in blood
  • Doesn’t require pancreatic lytic enzymes
56
Q

Carotenoid

A

Phytochemicals that are main Vit A precursors

57
Q

Decrease in carotenoids seen

A
  • Malabsorption
  • Starvation
  • Diet
  • Fever
58
Q

Which organ involved in digestion is not in the GIT?

59
Q

Ampulla of Vater

A

Liver and pancreas combine enzymes and bile here

60
Q

Pancreas what percent endocrine and exocrine tissue?

A

2% endocrine
98% exocrine

61
Q

Alpha, beta, gamma, delta, and epsilon cells of Islets of Langerhans secrete what

A

Alpha = glucagon
Beta = insulin
Gamma = pancreatic polypeptide hormone
Delta = somatostatin
Epsilon = ghrelin

62
Q

Bicarb and chloride vary ____

A

Reciprocally

63
Q

Vagus nerve

A

Secretes pancreatic fluid when food seen or smelled

64
Q

Secretin

A

Functions to make alkaline pancreatic fluid in response to acid stomach contents -> protects intestinal lining

65
Q

3 big pancreatic diseases (account for 95% of them)

A
  • Pancreatitis
  • Pancreatic carcinoma
  • Cystic fibrosis
66
Q

Cystic fibrosis

A
  • Autosomal recessive
  • Mucous exocrine gland dysfunction
  • High freq Brittany, France
  • CFTR gene
67
Q

Newborn screening standards for which pancreatic disease?

68
Q

Initial CF presentation in newborns

A

Intestinal obstruction

69
Q

CF initial presentation in childhood

A

Excessive pulmonary infections

70
Q

CF initial presentation in adults (uncommon)

A

Pancreatogenous malabsorption

71
Q

CF mechanism

A

Small and large ducts of acini dilate and convert into mucous-filled cysts, which can cause a plug/bowel obstruction

72
Q

4th most fatal form of cancer

A

Pancreatic carcinoma

73
Q

Pancreatic carcinoma more common in which sex/race?

A

Males and blacks

74
Q

Most common pancreatic carcinoma origin

A

Adenocarcinoma of ductal epithelium

75
Q

Pancreatic cell islet cell tumor effects

A

Hyperinsulinism and hypoglycemic shock

76
Q

Two types of pancreatic tumors

A
  • Gastrin-secreting
  • Glucagon-secreting (rare)
77
Q

Pancreatitis

A
  • Inflammation of pancreas due to autodigestion
  • Bile or duodenal contents spill into pancreatic duct
78
Q

Pancreatitis extent of damage in acute and chronic

A

Acute = no permanent damage
Chronic = irreversible injury

79
Q

Pancreatitis lab findings

A

Elevated amylase, lipase, triglycerides, hypercalcemia

80
Q

3 conditions essence of malabsorption syndrome

A
  1. Abdominal bloating/discomfort
  2. Freq bulky smelly poo
  3. Weight loss
81
Q

Steatorrhea

A

Failure to digest or absorb fats (gives greasy appearance)

82
Q

Malabsorption syndrome involves

A
  • Abnormal digestion/absorption of carbs, lipids, proteins
  • Can’t absorb/metabolize electrolytes, water, fat soluble vit (ADEK), and minerals
  • Can involve single substance (B12)
83
Q

Malabsorption syndrome can be caused by

A

biliary obstruction or diseases of small intestine

Clinical Chemistry (21 decks)

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