Pathophysiology of the Exocrine Pancreas

Question 1

In addition to making the pancreas secrete exocrine hormones, cholecystokinin also ____________.

Answer 1

stimulates the gallbladder to contract

Question 2

Describe the differences between acute and chronic pancreatitis.

Answer 2

Acute:

• acute inflammation
• acute pain
• elevated pancreatic enzymes in serum
• self-limited

Chronic:

• chronic inflammation
• chronic pain and malabsorption
• ductal obstruction
• permanent damage to or loss of pancreatic function

Question 3

The most common worldwide cause of acute pancreatitis is ___________, while in America it is ___________.

Answer 3

alcohol (which induces release of zymogens); gallstone obstructions

There are rarer causes of pancreatitis, also: hypercalcemia, hypertriglyceridemia, or medications.

Question 4

In acute pancreatitis, _____________ are prematurely activated in the pancreas.

Answer 4

zymogens

Question 5

In order of most-to-least common, what are the presenting signs/symptoms of acute pancreatitis?

Answer 5

Abdominal pain
Nausea/vomiting
Tachycardia
Fever
Jaundice

Question 6

Describe pseudocysts.

Answer 6

• a collection of pancreatic fluid surrounded by granulation tissue –not epithelium
• results from ductal obstruction or necrosis
• most resolve with time
• 10% - 30% of cases of acute pancreatitis

Question 7

ARDS is associated with _______________.

Answer 7

necrotizing pancreatitis (from severe pancreatitis)

Question 8

How is acute pancreatitis treated?

Answer 8

• IV fluids
• NPO then slow advancement of diet
• IV narcotics
• consult surgery for stone removal

Question 9

True or false: diabetes is an early manifestation of chronic pancreatitis.

Answer 9

False. Diabetes can result from chronic pancreatitis, but it is usually a late manifestation of the disease.

Question 10

The most common cause of chronic pancreatitis is ____________.

Answer 10

alcohol

Question 11

You need to lose about ______ percent of your pancreas before you have steatorrhea.

Answer 11

85

Question 12

Why can hypoglycemia result from chronic pancreatitis?

Answer 12

Because glucagon is also lost in chronic pancreatitis

Question 13

Haptocorrin is another name for ______________.

Answer 13

protein R

Question 14

Jaundice, dark urine, and pruritus are manifestations of adenocarcinomas in the ___________.

Answer 14

head of the pancreas

Question 15

True or false: back pain is a symptom of late-development pancreatic cancer.

Answer 15

True

Question 16

Neuroendocrine tumors originate from ____________ cells.

Answer 16

islet of Langerhans

Question 17

Describe autoimmune pancreatitis.

Answer 17

IgG+ lymphocytes infiltrate the parenchyma of the pancreas, causing pancreatitis symptoms similar to pancreatic cancer (weight loss; abdominal pain; jaundice); more common in males 40 - 70 (weirdly, for autoimmune diseases); presents as the “sausage pancreas” on CT

Treatable with steroids!

Question 18

Most of the saliva comes from which gland?

Answer 18

The submandibular

Question 19

With slow salivary flow, the saliva becomes quite _____________.

Answer 19

hypotonic (because the NaCl gets pumped out)

Question 20

True or false: some pancreatic acinar cells produce trypsinogen and others produce chymotrypsin and the other zymogens.

Answer 20

False. Each cell makes the whole complement.

Question 21

The zymogens are released by ______________.

Answer 21

exocytosis

Question 22

How does pancreatic blockage lead to pancreatitis?

Answer 22

A small amount of trypsin can get activated randomly (i.e., without enterokinase) and then activate the protease cascade.

Question 23

At low flow rates of pancreatic secretions, the predominant ion is _________.

Answer 23

chloride

Question 24

At high flow rates of pancreatic secretions, the predominant ion is __________.

Answer 24

bicarb (because the exchanger doesn’t have time to work)

Question 25

Elevated levels of _____________ indicate acute pancreatitis.

Answer 25

serum amylase

Question 26

What are clinical clues that indicate gallstone pancreatitis?

Answer 26

• history of gallstones
• gallstone risk factors
• dilated bile duct
• elevated liver enzymes
• absence of alcohol abuse or other risk factors

Question 27

True or false: ductal strictures are associated with acute pancreatitis.

Answer 27

False. Chronic.

Question 28

Describe the secretin test.

Answer 28

• (1) suck out all of the gastric acid
• (2) give secretin intravenously
• (3) measure the increase in bicarb concentration; if the increase is less than 80 mEq, then that indicates pancreatic failure

Question 29

How is chronic pancreatitis treated?

Answer 29

• surgical correction of the blocked duct
• pancreatic enzyme supplementation
• ETOH avoidance

Question 30

___________ is the fourth leading cause of cancer death in the U.S.

Answer 30

Pancreatic adenocarcinoma