Pancreatitis Flashcards
What is the normal function of the pancreas?
Exocrine function - enzyme release.
Endocrine function - hormone release (insulin & glucagon)
Where are the enzymes released to from the pancreas?
the glands of the pancreas excrete digestive enzymes via the pancreatic duct and into the duodenum
What are the islets of Langerhans?
tiny clusters of cells scattered throughout the pancreas - they contain alpha cells which produce glucagon and beta cells which produce insulin
What enzymes does the pancreas produce?
digestive enzymes such as pancreatic proteases - trypsin & chymotrypsin. Pancreatic amylase. Pancreatic lipase.
What does the pancreatic duct do?
Transports pancreatic juices to duodenum
What are the 2 types of ductal cell?
interlobar & interlobular
What are interlobar ductal cells?
Branch from pancreatic duct (lots of them) - visually look like the trachea
What are the interlobular ductal cells?
Branch from the interlobar cells - visually like left and right bronchus
What are acini cells?
Branch off interlobular cells, visually resemble capillaries, look like a mushroom
What is trypsin?
The active form of trypsinogen
What is the common bile duct?
Where the liver and gall bladder bile ducts meet, it moves bile
What is the Ampulla of Vater?
Where the 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 enters-endocrine cells?
Entero = GI
Endocrine - hormone
they live in the duodenum
2 main hormones - secretin, stimulated by acid & cholecystokinin, stimulated by food stuffs
What does cholecystokinin do?
Goes to acini cells and stimulates the release of pancreatic juices (proteases, amylase & lipase)
What is enterokinase?
Also released by the entero-endocrine cells, activates the inactive protein/fats/carbs
What does ‘ogen’ mean
means the molecule is inactive. So trypsinogen in the pancreases becomes active when it meets enterokinase cells in the duodenum and becomes trypsin, trypsin can then break down the protein molecules
Why are the pancreatic juices not active in the pancreas itself?
So they don’t digest the pancreas itself
What are the causes of acute pancreatitis?
Main causes - acinar cell degeneration & ductal obstructions
Abdominal trauma
Medications
Infections
Tumors
High triglyceride levels
High calcium levels
What is acinar cell degeneration
Where enzymes are activated within the pancreas itself leading to a breakdown of the tissue
What happens when there is a ductal obstruction?
Blockage of the pancreatic or bile duct, ampulla of vater or sphincter of ODDI, this caused accumulation of pancreatic enzymes which can trigger activation
What is usually the culprit of acute pancreatitis?
gall stones (ductal obstruction) and/or excess alcohol consumption (acinar cell degeneration) - typically 6-12 hours after a heavy drinking session
What happens in the pancreas when we drink excess alcohol?
Increased pancreatic juice secretion, increased viscosity of pancreatic juice - these can both lead to stone and protein plug formation and also increases fatty acids in acing cells leading to necrosis
What happens if the inflammation becomes severe?
Part 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, this can lead to shock, respiratory failure, kidney failure, it is a very serious situation which can be fatal
What happens when necrosis of the pancreas 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 a bruise will appear around the flank area (Cullen’s sign and grey turner’s sign)
What are the symptoms of acute pancreatitis?
Abdominal pain through to back - aggravated by eating
nausea and vomiting
abdomina distension - ascites
later symptom - hypotension
What are the main causes of chronic pancreatitis?
Alcohol - about 7 in 10 cases
Smoking
Genetic conditions e.g cystic fibrosis
Autoimmune conditions
What happens as chronic pancreatitis progresses?
Over time the inflammation causes scarring and damage to parts of the pancreas, this can lead to a lack of enzymes and insulin being made. A lack of enzymes causes poor digestion or food and a lack of insulin causes diabetes Over time, clumps of calcium are deposited and can form stones in the pancreas. Calcium stones and/or scarring of the pancreatic tubes (ducts) may block the flow of enzymes along the ducts leading to obstruction.
What are the symptoms of chronic pancreatitis?
Similar to those of acute however as there can be reduced production of digestive enzymes, the patient may present with symptoms of malabsorption, should this be essential electrolytes a pt might see abnormalities with heart conduction function & diabetes may occur due to reduced beta cell function
What is the pre-hospital treatment for pancreatitis?
Pain relief
Anti-emetics (ondansetron)
