Pancreatic Function (After exam 2) Flashcards
What is included in the Gi system
mouth esophogus, stomach, small intestine/large
describe digestion in the small intestines
process which stomach degrades complex molcules for absorption and uses them in the body
ex starches/proteins/lipids
Pancreas function
involved in?
not in?
involved in digestion
not in GI
Exocrine tissues
production of enzymes used in digestive processes
Endocrine tissues
production of insulin and glucagon
Physiology of pancreas weight and size
7….
second in….
behind…
1/2
weight 70-105g
second in size to liver, behind periton cavity/1/2 lumbar vertabrae
Ampulla of vater
what combines?what does it create?
tucked into?
liver/pancrease combine bile/enzymes
tucked into duodenum
Endocrine
releases?
% of tissues?
key feature?
hormone releasing
2% total tissues
islets of langerhans
Exocrine
secretes?
tissues?
secretes how much digestive fluid a day?
enzyme secreting
98% tissues
secretes 1-2L a day of digestive fluids
islet cells (endocrine)
well….how many types?
a
b
d
g
e
well deliniated 5 cell types
alpha = glucagon
beta = insulin
delta = stomato
gamma = polypep
epsilon = ghrelin
Beta cells secrete?
insulin
Exocrine Acinar cells
clusters?
produce?
small….
normal person?
grape like clusters
produce digestive fluids
small ducts - join to large
normal person protein rich fluid
Bicarb/chloride concentration
vary?
alk…..
vary reciprocally
alkaline pH 8.3 increases conc of bicarb
Pancreatic activity
what control?
vagus nerve?
MOST UNDER? examples?
nervous and endocrine control
vagus nerve: secretes pancrease fluid when food is smelled/seen
MOST UNDER HORMONE CONTROL: secretin/CCK
Secretin
what kind of fluid? where?
synth…
few?
alkaline pancreatic fluid protects linning
synth in response to acid stomach contents
few digestive enzymes
CKK
produced by what cells
release?
produced by cells of intestinal mucosa
release enzymes from acinar cells
3 diseases that cause 95% of pancreatic disease/medical attention
c
pc
p
all result in?
compromise
Cystic fibrosis
pancreatic carcinoma
pancreatitis
all result in deminished pancreatic exocrine function
compromise digestion/absorbtion of nutrients
Cystic fibrosis
dysf of…
most in?
what genes?
dysfucntion of mucus exo glands
most in caucasians
CFTR genes - chrom 7
Initial presentation of cystic fibrosis
obstruction intestinal - newborns
excessive pulm. infections - childhood
pancreatic malabsorbtion - adults uncommon
Describe pathology of cystic fibrosis
s/l/a …..convert into….
prevents
small/large ducts/acini dilate and convert into cysts filled w fluids
prevents pancreatic secretions from reaching duodenum
Pancreatic carcinoma
4th….
more in what population
survival rates?
what symtom is earlier?
4th most cause of atal cancer
more in black males than females
5yr survival 6% most die in 1yr
head symptoms earlier
most common origin of pancreatic carcinoma
adeno…..
pain?
adenocarcinoma of ductal epithelial - very painful
Islet cell tumors
affect?
hyperinsulin?
hyperg…
affect endocrine capability
hyperinsulin - low blood sugar
hyperglycemic shock
Pancreatic tumors
what secreting?
zol.
gluc
eval with?
gastrin secreting
zollinger-ell syndrome
glucagon secreting rare
for evals: PP, glucagon/gastic levels
Pancreatitis
inflm of by?
acutechronic?
relaspsing
common in
pain/associated with?
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
Sympt of acute pancreatitis
severe…..location?
inc a/l/t/h
severe abdom pain, generalized, lower back pain
inc amylase/lipids/trigly/hypercalcemia
All three conditions have what in common
abn…
bulky
weight
abn bloating
bulky feces
weight loss
Steatorrhea
unable to digest ats “greasy” stool appearance
Malabsorbtion syndrome
abn digestion of?
vit B12 —-
can be caused by?
abn digestion of proteins/electrolytes
vit b12 - megaloblastic anemia
can be caused by biliary obstruction/small intestine diseases
Endocrine tests
reflect?
examples?
reflect endocrine cells of pancreas
gastrin/insulin/glucose
Exocrine tests
increased?
can be ?
inc amylase/lipase
indirect or direct
Indirect testing
used for detection of?
qual…f/e
used for detection of malabsorption
qualitiative fecal fat anayalsis.elastase…etc
Direct testing
more s…..than
…. needed for test
endo….after stim w
most sensitive actual pancreatic secretions
MRI/ARCP reduced need for tests
endoscopy after stim w secretim/cck
how do you assess ductal/secretory capacity
combined secretin/cck
CCK test
what sec by….
stimulate release…..and sec of
direct determ of….
panc obsrtuction:
low bicarb/enzymes:
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
Fecal fat analysis
how many souces?
unabsorbed
lipids…
cells…
met. intest..
4 sources
unabsorbed ingested lipids
lipids excreted into intestine
cells shed into intestines
met. intestineal bacteria
fecal fat of lipid free diet vs rich diet?
free?
rich?
increased fecal fat can be from?
severe….assoc w….
free 1-4g
rich <7g
increased fecal fat can be from obstriction
severe steatorrhea assoc w exocrine insuff
normal fecal lipids composed of
60%
30%
10%
small #
60% fatty acids
30% sterols/alc/carot
10% triglyerides
small # cholest/phopho
Fecal fat testing stains/skills
fat soluble stains
what do they do to lipid droplets
skill?
fat sol stains (sudan III/IV, oil red, nile blue)
dissolve/color lipid droplets
techincal skill important
Sudan staining
what stains yellow/orange with sudan III
must be?
normal range?
Steatorrhea range?
neutral fats/lipids stain yellow orange w sudan III
must be heated
40-50 normal
steatorrhea >100
Definitive or steatorrhea
quant….
stool collection?
diet?
results?
quant fecal fat
72hr stool collection
lipid diet 2 days
20% lower results
Gravimetric method
what do you do to the sample?
fatty acid soaps…..
excretion of m…..
emulsify sample in water
fatty acid soaps conv to free fatty acids - excretion of most lipids to organic solvents
Fecal enzymes
how much exocrine funct is lost before 72 hr fecal fat is pos?
non invasive/indirect test?
inc…..dec
normal range?
90% of exocrine func lost before 72 hr fecal fat is positive
Fecal elastase non invasive/indirect
inc fecal fat dec enzymes
norm >200
Fecal chymotrypsin
less
affected by?
less sensitive/specific affected by suppliments
Sweat chloride
CF pts reduced….
dysfunct of…..
easy?
what increase in CF kids?
doesnt determin?
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
Lipase
tests?
more?
increases with
persists for?
not cleared like?
pancreatic test
more sens/spec/accurate
inc w 24hr acute pancreatitis
persists 8-14 days
not cleared like amylase
Amylase
sign increase within?
peak?
cleared by….normal after?
more sensitive test?
measured in?
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
Renal clearance amylase
serum level changes/
RR?
significant increase in?
both…..increase in?
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
Amylase renal clearance test diseases
Lipase
mumps/cholest/hep
lipase: bone fract/fat embolism
Gastrin
what kind of hormone? enhances?
cells of ….
typically to diagnose….
peptide hormone, enhances gastric growth/motility
cells of gastirc antrum/duodenum
typically to diagnose Zollinger-Ell sydrome (inc stomach acid = ulcers)
Intestinal function
focuses on eval of….
includes?
clin chem focuses on eval of absorb and disease states
includes: celliac/whipplpe..etc
lactose
what type of sugar/examples found where?
Lactase:
loss of def lactase…
Lactose intol
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
D-Xylose
exogenous admin of…
presence?
doesnt require?
exogen admin simple monosacc sugar
not norm present in blood
doesnt require pancreatic enzymes
Carotenoids
what kind of chemical?
main precursor of?
how many most common account for 90%
dec in?
phytochemicals
main precursor of vit A
6 most common carot account for 90%
dec in malabsorb/starvation/fever
