Pancreatitis

Question 1

What is the norm`l function of the pancreas?

Answer 1

Exocrine function - enzyme release.
Endocrine function - hormone release (insulin & glucagon)

Question 2

Where are the enzymes released to?

Answer 2

the glands of the pancreas excrete digestive enzymes via the pancreatic duct and into the duodenum

Question 3

What are the islets of Langerhans?

Answer 3

tiny clusters of cells scattered throughout the pancreas - they contain alpha cells which produce glucagon and beta cells which produce insulin

Question 4

What enzymes does the pancreas produce?

Answer 4

digestive enzymes such as pancreatic proteases - trypsin & chymotrypsin. Pancreatic amylase. Pancreatic lipase.

Question 5

What does the pancreatic duct do?

Answer 5

Transports pancreatic juices to duodenum

Question 6

What are the 2 types of ductal cell?

Answer 6

interlobar & interlobular

Question 7

What are interlobar ductal cells?

Answer 7

Branch from pancreatic duct (lots of them) - visually look like the trachea

Question 8

What are the interlobular ductal cells?

Answer 8

Branch from the interlobar cells - visually like left and right bronchus

Question 9

What are acini cells?

Answer 9

Branch off interlobular cells, visually resemble capillaries, look like a mushroom

Question 10

What is trypsin?

Answer 10

The active form of trypsinogen

Question 11

What is the common bile duct?

Answer 11

Where the liver and gall bladder bile ducts meet, it moves bile

Question 12

What is the Ampulla of Vater?

Answer 12

Where the pancreatic duct and common bile duct meet

Question 13

What is the sphincter of ODDI?

Answer 13

Bile and pancreatic juices push through here into the duodenum

Question 14

What are enters-endocrine cells?

Answer 14

Entero = GI
Endocrine - hormone
they live in the duodenum
2 main hormones - secretin, stimulated by acid & cholecystokinin, stimulated by food stuffs

Question 15

What does cholecystokinin do?

Answer 15

Goes to acini cells and stimulates the release of pancreatic juices (proteases, amylase & lipase)

Question 16

What is enterokinase?

Answer 16

Also released by the entero-endocrine cells, activates the inactive protein/fats/carbs

Question 17

What does ‘ogen’ mean

Answer 17

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

Question 18

Why are the pancreatic juices not active in the pancreas itself?

Answer 18

So they don’t digest the pancreas itself

Question 19

What are the causes of acute pancreatitis?

Answer 19

Main causes - acing cell degeneration & ductal obstructions
Abdominal trauma
Medications
Infections
Tumors
High triglyceride levels
High calcium levels

Question 20

What is acinar cell degeneration

Answer 20

Where enzymes are activated within the pancreas itself leading to a breakdown of the tissue

Question 21

What happens when there is a ductal obstruction?

Answer 21

Blockage of the pancreatic or bile duct, ampulla of vater or sphincter of ODDI, this caused accumulation of pancreatic enzymes which can trigger activation

Question 22

What is usually the culprit of acute pancreatitis?

Answer 22

gall stones (ductal obstruction) and/or excess alcohol consumption (acinar cell degeneration) - typically 6-12 hours after a heavy drinking session

Question 23

What happens in the pancreas when we drink excess alcohol?

Answer 23

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

Question 24

What happens if the inflammation becomes severe?

Answer 24

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

Question 25

What happens when necrosis of the pancreas occurs?

Answer 25

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)

Question 26

What are the symptoms of acute pancreatitis?

Answer 26

Abdominal pain through to back - aggravated by eating
nausea and vomiting
abdomina distension - ascites
later symptom - hypotension

Question 27

What are the main causes of chronic pancreatitis?

Answer 27

Alcohol - about 7 in 10 cases
Smoking
Genetic conditions e.g cystic fibrosis
Autoimmune conditions

Question 28

What happens as chronic pancreatitis progresses?

Answer 28

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.

Question 29

What are the symptoms of chronic pancreatitis?

Answer 29

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

Question 30

What is the pre-hospital treatment for pancreatitis?

Answer 30

Pain relief
Anti-emetics (ondansetron)