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.

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.

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.

Question 4

What function do the beta cells in the islets of Langerhans perform?

Answer 4

The beta cells secrete insulin and amylin.

Question 5

What function do the alpha cells in the islets of Langerhans perform?

Answer 5

They secrete glucagon

Question 6

What function do the delta cells in the islets of Langerhans perform?

Answer 6

They secrete somatostatin

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.

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.

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.

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.

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.

Question 12

What are the signs and symptoms of chronic pancreatitis?

Answer 12

Epigastric pain that radiates to the back, diabetes mellitus, and ketoacidosis.

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.

Question 14

What laboratory finding is characteristic of acute pancreatitis?

Answer 14

An elevated serum amylase. Serum lipase levels are also often elevated.

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.

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.

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.

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.

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.

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.