Pancreatitis Flashcards
What is the normal function of the Pancreas?
- Exocrine function enzyme release
- Endocrine function hormone release
What is the gland in the pancreas called?
Pancreatic Acinam
What do the glands in the pancreas do?
Excrete digestive enzymes via the pancreatic duct and into the Duodenum
What is the Islets of Langerhans and what do they contain?
- Tiny clusters of cells scattered throughout the pancreas.
- Alpha cells = produce glucagon
- Beta cells = produce insulin
What are the three different digestive enzymes?
Pancreatic proteases:
- Helps digest protein
- Break down protein
- Tryspin/trypsinogen and chymotryspin = help digest proteins
Pancreatic amylase:
- Helps digest sugars (carbohydrates)
- P-type amylase
- Heps break down carbohydrates
Pancreatic lipase:
- Helps digest fats
- Does not happen until the duodenum
- Lipase such as triglyceride
What is the role of the Pancreatic Duct?
- Transports pancreatic juices to dueodenum
Role of the Ductal cell (interlobar)?
- Branches from Pancreatic duct (lots of these)
- Visually like the trachea
- Branches from interlobar cell
- Visually like left and right bronchus
What are Acini Cells?
- Branch off interlobular cell
- Look like a mushroom
- Resemble capillaries
Where is the bile duct and what does it do?
- Liver and gall bladder - bile duct meets
- Move bile
What is Trypsin?
Active form or trypsinogen
Where is the Common Bile Duct?
- Liver and hall bladder bile ducts meet
- Moves bile
What is the Ampulla of Vater?
- Where Pancreatic duct and common bile duct meet
What is the Sphincter of ODDI?
- Bile and pancreatic juices push through here into the duodenum
What are Entero-endocrine cells?
- Live in duodenum
- Entero - GI
- Endocrine - hormone
2 main hormones:
- Secretin (stimulated by acid)
- Cholecystokinin (stimulated by food stuff)
What is Cholecystokinin?
- Goes to acini cells and stimulate the release of pancreatic juices (proteases, amalyse, lipase)
What is Enterokinase?
- This is also released
- Enterokinase activates the inactive protein/fats/carbs
When does trypsinogen become active?
- The ‘ogen’ means the molecule is inactive
- Trypsinogen in the pancreases (inactive) becomes active when it meets enterokinase cells in the duodenum and becomes Trypsin
- Trypsin can then break down the fat molecules
What are the two main causes of Acute Pancreatitis?
- Acinar cell degeneration
- Ductal obstructions
What is Acinar Cell Degeneration?
- Enzymes are released and activated within the pancreas itself leading to a breakdown of tissue (auto digestion)
What is Ductal Obstructions
- Blockage of pancreatic or bile duct, ampulla of vater or sphincter of ODDI
- Accumulation of pancreatic enzymes which can trigger activation
What is the culprit of acute pancreatitis?
Gall stones - ductual obstructions
Excess alcohol consumptions - acinar cell degeneration
Other causes are rare
What happens when there is excess alcohol consumption in the pancreas?
- Increase pancreatic juice secretion
- Increase viscosity of pancreatic juice
- Both can lead to stone and protein plug formation
- Also increases fatty acids in acinar cells leading to necrosis
- Onset 6-23 hours following heavy drinking
What is theory in relation to excess alcohol consumption and why is effects the pancreas?
Toxic agents, like alcohol, after pancreatic secretion rates and change metabolic reaction.
Reflux from the duodenum containing activated enzymes enters the pancreatic duct.
What happens during gall stones?
- A gallstone can pass through the bile duct and out into part of the gut just after the stomach (the duodenum) - usually does not cause a problem
- In some people, gallstone becomes stuck in the bile duct and pancreatic duct open into the duodenum.
- This can affect the chemicals int he pancreatic duct and trigger pancreatitis
What happens to the rest of the body in Acute Pancreatitis?
- In some cases (1 in 5) the inflammation quickly becomes severe
- Parts of the pancreas and surrounding tissues may die (necrosis)
- Pancreatic enzymes and chemicals may get into the bloodstream and cause inflammation and damage to other organs in the body
- This can lead to shock, resp. failure, kidney failure and other complications
What are the signs for Pancreatitis?
Cullen’s Sign - bruising around the umbilicus
Grey Turner’s Sign - bruising to the flank areas
When Necrosis occurs, the pancreas will begin to bleed. As the pancreas is outside the peritoneum, the blood will fall down around the umbilicus and if the patient is laid down, around the flank areas, and a bruise will appear.
What are some symptoms of Acute Pancreatitis?
- Abdo pain through to back - aggravated by eating
- Nausea and vomiting
- Abdominal distention - ascites (condition that occurs when fluid in spaces in your abdomen)
- Later symptom - hypotension
What is related to Chronic Pancreatiis?
Alcohol:
- Common cause (7 in 10)
- Men ages 40 - 50 most common group of people affected
- In most cases the person has been drinking heavily for 10 years or more before symptoms first begin
Smoking:
- Recently been found to be linked to chronic pancreatitis
Generic Conditions:
- Some rare genetic conditions which can lead to chronic pancreatitis developing
- Cystic fibrosis can be one cause
Autoimmune conditions:
- Own immune system attacks the pancreas
- Can be associated with other autoimmune diseases - Sjogrens syndrome and primary biliary cirrhosis
What is the progression of Chronic Pancreatitis?
- The inflammation causes scarring and damage to parts of the pancreas
- This can then lead to not enough chemicals and insulin being made
- A lack of enzymes causes poor digestion over food
- A lack of insulin causes diabetes
- Overtime, clumps of calcium are deposited and can form stones in the pancrease
- Calcium stones and/or scarring of the pancreatic tubes (ducts) may block flow of enzymes along the ducts leading to obstruction
What are symptoms of Chronic Pancreatitis?
- Similar to the acute state
- Degree of reduced production of digesting enzymes - present with symptoms of malabsorption:
- essential electrolytes = abnormalities with heart conduction function, diabetes due to reduced B-cell function
What pre-hospital treatment would we give those with pancreatitis?
- Pain relief
- Anti-emetics (Ondansetron)
