Pancreatitis and Adrenal Insufficiency Flashcards
How are pancreas functions classified?
1) Exocrine
2) Endocrine
What are exocrine pancreatic functions?
Release of digestive enzymes and sodium bicarb into GI tract (85% of pancreas responsible for this)
Where are digestive enzymes and bicarbonate produced?
Pancreas in the acini cells
What does amylase, lipase, and trypsin break down?
Carbs, fats, and proteins respectively
What does the sphincter of Oddi do?
When food enters duodenum, sphincter of Oddi relaxes and releases digestive enzymes and sodium bicarb into the duodenum
What are endocrine pancreatic functions?
Release of substance into the blood, pancreatic cells clustered around blood capillaries (Islets of Langerhans) responsible for serum glucose regulation
Only 2% of gland responsible for this
What do beta cells do?
Release insulin into the blood, shifts sugar from blood into cells
What do alpha cells do?
Release glucagon into the blood, shifts glycogen (stored sugars) into the blood
Why is glycemic control important in ICU?
Reduces mortality by 42%, reduce renal failure and septicemia
What is the basic pathophys of pancreatitis?
In pancreatic, normally inactive digestive enzymes become activated and begin to digest pancreatic tissue (autodigestion)
What are the two main classifications of pancreatitis?
1) Chronic
2) Acute
(Mild acute, moderate acute, severe acute)
What is chronic pancreatitis?
Slow, gradual destruction of pancreas. Most common etiology is alcohol consumption.
Destruction persists despite removal of causative agent.
What is acute pancreatitis?
Sudden autodigestion of the pancreas due to a specific causative agent. Associated with inflammation, hemorrhage, necrosis.
Once causative agent addressed, complete resolution of disease usually occurs.
What are the most common etiologies of acute pancreatitis?
Alcohol consumption, gallstones
What is the difference between the 3 types of acute pancreatitis?
1) Mild acute pancreatitis (No organ failure)
2) Moderate acute pancreatitis (Organ failure resolves within 48hrs, some local / systemic complications but not persistent)
3) Severe acute pancreatitis (Persistent organ failure with systemic complications, requires ICU admission)
What is trypsinogen and why is it significant for pancreatitis?
Is a digestive enzyme produced in the pancreas, remains inactive while in pancreas normally. When it enters duodenum, it activates into trypsin and breaks down proteins in the GI tract. In pancreatitis, trypsinogen activates early into trypsin while still in the pancreas and starts auto-digestion
What are the phases of severe acute pancreatitis?
Phase 1)
Trypsinogen early activates into trypsin while in the pancreas and starts auto-digesting pancreatic proteins. Trypsin starts a cascade activating other pancreatic digestive enzymes
Phase 2)
Early activated enzymes cause localized damage to pancreas. Breakdown of blood vessels cause bleeding, breakdown of fatty acids necrotize the pancreas. Damaged cells release pro-inflammatory cytokines and cause inflammation.
Phase 3)
Enzymes and pro-inflammatory mediators spread to other organs in the body leading to systemic damage. Digestive enzymes leak to liver, stomach, spleen, diaphragm. Organs suffer from systemic inflammation
What are neuro manifestations of pancreatitis?
Restlessness, decreased LOC, coma