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Clinical Chem II spring > Pancreatic Function (After exam 2) > Flashcards

Pancreatic Function (After exam 2) Flashcards

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1
Q

What is included in the Gi system

A

mouth esophogus, stomach, small intestine/large

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2
Q

describe digestion in the small intestines

A

process which stomach degrades complex molcules for absorption and uses them in the body

ex starches/proteins/lipids

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3
Q

Pancreas function
involved in?
not in?

A

involved in digestion
not in GI

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4
Q

Exocrine tissues

A

production of enzymes used in digestive processes

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5
Q

Endocrine tissues

A

production of insulin and glucagon

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6
Q

Physiology of pancreas weight and size
7….
second in….
behind…
1/2

A

weight 70-105g

second in size to liver, behind periton cavity/1/2 lumbar vertabrae

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7
Q

Ampulla of vater
what combines?what does it create?
tucked into?

A

liver/pancrease combine bile/enzymes
tucked into duodenum

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8
Q

Endocrine
releases?
% of tissues?
key feature?

A

hormone releasing
2% total tissues
islets of langerhans

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9
Q

Exocrine
secretes?
tissues?
secretes how much digestive fluid a day?

A

enzyme secreting
98% tissues
secretes 1-2L a day of digestive fluids

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10
Q

islet cells (endocrine)
well….how many types?
a
b
d
g
e

A

well deliniated 5 cell types
alpha = glucagon
beta = insulin
delta = stomato
gamma = polypep
epsilon = ghrelin

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11
Q

Beta cells secrete?

A

insulin

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12
Q

Exocrine Acinar cells
clusters?
produce?
small….
normal person?

A

grape like clusters
produce digestive fluids
small ducts - join to large

normal person protein rich fluid

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13
Q

Bicarb/chloride concentration

vary?
alk…..

A

vary reciprocally

alkaline pH 8.3 increases conc of bicarb

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14
Q

Pancreatic activity

what control?

vagus nerve?

MOST UNDER? examples?

A

nervous and endocrine control

vagus nerve: secretes pancrease fluid when food is smelled/seen

MOST UNDER HORMONE CONTROL: secretin/CCK

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15
Q

Secretin

what kind of fluid? where?
synth…
few?

A

alkaline pancreatic fluid protects linning

synth in response to acid stomach contents

few digestive enzymes

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16
Q

CKK
produced by what cells
release?

A

produced by cells of intestinal mucosa

release enzymes from acinar cells

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17
Q

3 diseases that cause 95% of pancreatic disease/medical attention
c
pc
p

all result in?
compromise

A

Cystic fibrosis
pancreatic carcinoma
pancreatitis

all result in deminished pancreatic exocrine function

compromise digestion/absorbtion of nutrients

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18
Q

Cystic fibrosis
dysf of…
most in?
what genes?

A

dysfucntion of mucus exo glands

most in caucasians

CFTR genes - chrom 7

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19
Q

Initial presentation of cystic fibrosis

A

obstruction intestinal - newborns

excessive pulm. infections - childhood

pancreatic malabsorbtion - adults uncommon

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20
Q

Describe pathology of cystic fibrosis
s/l/a …..convert into….

prevents

A

small/large ducts/acini dilate and convert into cysts filled w fluids

prevents pancreatic secretions from reaching duodenum

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21
Q

Pancreatic carcinoma
4th….

more in what population

survival rates?

what symtom is earlier?

A

4th most cause of atal cancer

more in black males than females

5yr survival 6% most die in 1yr

head symptoms earlier

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22
Q

most common origin of pancreatic carcinoma
adeno…..
pain?

A

adenocarcinoma of ductal epithelial - very painful

23
Q

Islet cell tumors
affect?
hyperinsulin?
hyperg…

A

affect endocrine capability
hyperinsulin - low blood sugar
hyperglycemic shock

24
Q

Pancreatic tumors
what secreting?
zol.
gluc

eval with?

A

gastrin secreting
zollinger-ell syndrome
glucagon secreting rare

for evals: PP, glucagon/gastic levels

25
Q

Pancreatitis

inflm of by?
acutechronic?
relaspsing
common in
pain/associated with?

A

inflam of pancreas by autodigestion

acute no perm damage

chronic perm damage

relapsing: acute/chronic common in mid life painful assoc w alcoholism/biliar tract disease

26
Q

Sympt of acute pancreatitis

severe…..location?
inc a/l/t/h

A

severe abdom pain, generalized, lower back pain

inc amylase/lipids/trigly/hypercalcemia

27
Q

All three conditions have what in common
abn…
bulky
weight

A

abn bloating
bulky feces
weight loss

28
Q

Steatorrhea

A

unable to digest ats “greasy” stool appearance

29
Q

Malabsorbtion syndrome
abn digestion of?

vit B12 —-

can be caused by?

A

abn digestion of proteins/electrolytes

vit b12 - megaloblastic anemia

can be caused by biliary obstruction/small intestine diseases

30
Q

Endocrine tests
reflect?
examples?

A

reflect endocrine cells of pancreas
gastrin/insulin/glucose

31
Q

Exocrine tests
increased?
can be ?

A

inc amylase/lipase
indirect or direct

32
Q

Indirect testing
used for detection of?
qual…f/e

A

used for detection of malabsorption

qualitiative fecal fat anayalsis.elastase…etc

33
Q

Direct testing
more s…..than
…. needed for test
endo….after stim w

A

most sensitive actual pancreatic secretions

MRI/ARCP reduced need for tests

endoscopy after stim w secretim/cck

34
Q

how do you assess ductal/secretory capacity

A

combined secretin/cck

35
Q

CCK test
what sec by….
stimulate release…..and sec of
direct determ of….

panc obsrtuction:

low bicarb/enzymes:

A

hormone sec by cells in stomach
stimulate release of bile into enzymes and sec of enzymes by the pancrease

direct determ of exocrine sec capacity of pancreas

Panc obstruct: dec flow inc enzymes

low bicarb,enzmes: CF, chronic pan edema

36
Q

Fecal fat analysis
how many souces?
unabsorbed
lipids…
cells…
met. intest..

A

4 sources
unabsorbed ingested lipids
lipids excreted into intestine
cells shed into intestines
met. intestineal bacteria

37
Q

fecal fat of lipid free diet vs rich diet?
free?
rich?
increased fecal fat can be from?
severe….assoc w….

A

free 1-4g

rich <7g

increased fecal fat can be from obstriction
severe steatorrhea assoc w exocrine insuff

38
Q

normal fecal lipids composed of
60%
30%
10%
small #

A

60% fatty acids
30% sterols/alc/carot
10% triglyerides
small # cholest/phopho

39
Q

Fecal fat testing stains/skills
fat soluble stains

what do they do to lipid droplets
skill?

A

fat sol stains (sudan III/IV, oil red, nile blue)

dissolve/color lipid droplets
techincal skill important

40
Q

Sudan staining
what stains yellow/orange with sudan III
must be?
normal range?

Steatorrhea range?

A

neutral fats/lipids stain yellow orange w sudan III
must be heated
40-50 normal

steatorrhea >100

41
Q

Definitive or steatorrhea
quant….
stool collection?
diet?
results?

A

quant fecal fat
72hr stool collection
lipid diet 2 days
20% lower results

42
Q

Gravimetric method
what do you do to the sample?
fatty acid soaps…..
excretion of m…..

A

emulsify sample in water
fatty acid soaps conv to free fatty acids - excretion of most lipids to organic solvents

43
Q

Fecal enzymes
how much exocrine funct is lost before 72 hr fecal fat is pos?

non invasive/indirect test?
inc…..dec

normal range?

A

90% of exocrine func lost before 72 hr fecal fat is positive

Fecal elastase non invasive/indirect
inc fecal fat dec enzymes

norm >200

44
Q

Fecal chymotrypsin
less

affected by?

A

less sensitive/specific affected by suppliments

45
Q

Sweat chloride
CF pts reduced….

dysfunct of…..
easy?

what increase in CF kids?

doesnt determin?

A

CF pts reduced ability to reabsorb cl from sweat

dysfunction of cl transporter

difficult test

2-5 fold increase in CF kids

doesnt determin hetero/homo

46
Q

Lipase
tests?

more?

increases with

persists for?

not cleared like?

A

pancreatic test

more sens/spec/accurate

inc w 24hr acute pancreatitis
persists 8-14 days

not cleared like amylase

47
Q

Amylase

sign increase within?
peak?
cleared by….normal after?

more sensitive test?
measured in?

A

alternate test

sign increase in 75% pt within 3-6hr

peak at 24hr

cleared by kidneys norm after 3-5 days

urine amylase more sensitive

measured in saliva/pancreatic fluid

48
Q

Renal clearance amylase
serum level changes/

RR?

significant increase in?

both…..increase in?

A

minor/interm increase in serum levels

RR <3.1

sign increase 8-9 in acute pancreatitis/burns/sepsis

both amylase/lipase inc in opiat admin/carcinom

49
Q

Amylase renal clearance test diseases

Lipase

A

mumps/cholest/hep

lipase: bone fract/fat embolism

50
Q

Gastrin
what kind of hormone? enhances?

cells of ….

typically to diagnose….

A

peptide hormone, enhances gastric growth/motility

cells of gastirc antrum/duodenum

typically to diagnose Zollinger-Ell sydrome (inc stomach acid = ulcers)

51
Q

Intestinal function
focuses on eval of….

includes?

A

clin chem focuses on eval of absorb and disease states
includes: celliac/whipplpe..etc

52
Q

lactose
what type of sugar/examples found where?

Lactase:

loss of def lactase…

Lactose intol

A

dissach sugar of glucose/galactose in milk

Lactase: small intestine digests lactose

loss of def lactase in adults normal

lactose intol: abn cramps/bloating - breath test

53
Q

D-Xylose
exogenous admin of…
presence?
doesnt require?

A

exogen admin simple monosacc sugar

not norm present in blood

doesnt require pancreatic enzymes

54
Q

Carotenoids
what kind of chemical?
main precursor of?
how many most common account for 90%

dec in?

A

phytochemicals
main precursor of vit A
6 most common carot account for 90%

dec in malabsorb/starvation/fever

Clinical Chem II spring (16 decks)

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