Pancreatitis

Question 1

What are the four known types of cells found in the

islets of Langerhans?

Answer 1

Alpha cells, beta cells, delta cells, and PP cells.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 939.

Question 2

What are the two major tissues of the pancreas and

what function do they perform?

Answer 2

The acini, which secrete digestive enzymes into the duodenum,
and the islets of Langerhans, which secrete insulin into the
blood stream.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 939.

Question 3

What are the two most common causes of acute
pancreatitis? Name some other causes of acute
pancreatitis.

Answer 3

Cholelithiasis and alcohol abuse account for 60-80% of all
patients who develop acute pancreatitis. Acute pancreatitis is
also seen frequently in patients with acquired immunodeficiency
syndrome. The hypercalcemia associated with
hyperparathyroidism is another frequent cause.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 298.

Question 4

What function do the beta cells in the islets of

Langerhans perform?

Answer 4

The beta cells secrete insulin and amylin.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 939.

Question 5

What function do the alpha cells in the islets of

Langerhans perform?

Answer 5

They secrete glucagon
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 939.

Question 6

What function do the delta cells in the islets of

Langerhans perform?

Answer 6

They secrete somatostatin
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 939.

Question 7

What function do the PP cells in the islets of

Langerhans perform?

Answer 7

They secrete a hormone called pancreatic polypeptide, but the
purpose of this hormone is unknown.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 939.

Question 8

How does the release of insulin by the beta cells

influence the activity of the alpha cells?

Answer 8

The secretion of insulin by the beta cells inhibits the release of
glucagon by the alpha cells.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 939.

Question 9

How does the release of somatostatin by the delta

cells affect the activity of the alpha and beta cells?

Answer 9

The release of somatostatin by the delta cells inhibits the
release of insulin by the beta cells and inhibits the release of
glucagon by the alpha cells.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 939.

Question 10

What surgical procedures are associated with the

development of acute pancreatitis postoperatively?

Answer 10

Pancreatitis may occur postoperatively in association with
abdominal and thoracic surgery, particularly after
cardiopulmonary bypass.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 298.

Question 11

What is the most common cause of chronic
pancreatitis? What factors increase the risk for
developing chronic pancreatitis?

Answer 11

Chronic alcohol abuse is responsible for 80-90% of cases of
chronic pancreatitis. Alcoholic patients with a high protein
intake have a higher risk for developing the condition.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 299.

Question 12

What are the signs and symptoms of chronic

pancreatitis?

Answer 12

Epigastric pain that radiates to the back, diabetes mellitus, and
ketoacidosis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 299-300.

Question 13

How is chronic pancreatitis diagnosed?

Answer 13

The presence of chronic alcoholism and pancreatic
calcifications are the typical findings that lead to a diagnosis of
chronic pancreatitis. CT scan, ultrasound, and endoscopic
retrograde cholangiopancreatography may be used to help
confirm the diagnosis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 300.

Question 14

What laboratory finding is characteristic of acute

pancreatitis?

Answer 14

An elevated serum amylase. Serum lipase levels are also often
elevated.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 300.

Question 15

Besides bloodwork, what other diagnostic tests can

be used to confirm the presence of pancreatitis?

Answer 15

CT scan and endoscopic retrograde cholangiopancreatography.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 299.

Question 16

What is the treatment for the patient with acute

pancreatitis?

Answer 16

Aggressive hydration with IV fluids is of the utmost importance.
Because of the hypovolemia that is associated with pancreatitis,
patients may need as much as 10L of IV fluids. The patient is
placed on NPO status to rest the pancreas. H2-receptor
antagonists are administered to help suppress pancreatic
secretion even further. Opioids may be required to control
abdominal pain. If the patient exhibits necrotizing pancreatitis,
prophylactic antibiotics are administered. If the cause is
cholelithiasis, the gallstones should be removed within the first
1-3 days of the onset of symptoms.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 299.

Question 17

What are the signs and symptoms of acute

pancreatitis?

Answer 17

Acute pancreatitis manifests as mid-epigastric pain that radiates
to the back, nausea, vomiting, and abdominal distention.
Dyspnea may become evident if ascites is present. Psychosis
may also develop if the patient experiences alcohol withdrawal.
Most cases of acute pancreatitis are self-resolving.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 298-299.

Question 18

What percentage of patients with acute pancreatitis

develop severe complications?

Answer 18

Although most cases of acute pancreatitis are benign, 25% of
patients will experience severe complications such as shock,
arterial hypoxemia, renal failure, or acute respiratory distress
syndrome. Hypotension occurs due to sequestration of fluid
around the pancreas, hemorrhage, and decreased SVR.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 298-299.

Question 19

How is chronic pancreatitis treated?

Answer 19

Pain, gastrointestinal malabsorption, and diabetes mellitus are
the most common factors that have to be addressed. Lipase is
administered to aid in fat digestion. Stone removal may be
performed to relieve pancreatic duct obstruction. A
pancreaticojejunostomy may also be performed to allow
drainage of the pancreatic fluids.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 300.

Question 20

How do serum amylase levels differ between

patients with acute and chronic pancreatitis?

Answer 20

Serum amylase levels are elevated in patients with acute
pancreatitis, but are typically normal in patients with chronic
pancreatitis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 298-300.