Pathophysiology of the Pancreas Flashcards
What opioid should be avoided in treating acute pancreatic pain due to its contractile effects on the sphincter of Oddi?
Morphine
What are the ionic laboratory findings in acute pancreatitis?
Hypocalcemia, hypomagnesemia, hyperkalemia, hyperglycemia
What is the function of cholecystokinin?
Simulates release of bile from the gallbladder and digestive enzymes from the pancreas into the duodenum
The endocrine portion of the pancreas contains Islets of Langerhans. What molecules are secreted from these Islets?
Insulin, glucagon, somatostatin
What is the gold-standard imaging for diagnosis of acute pancreatitis?
CT
How does excessive alcohol use increase the risk of pancreatitis?
Increases contraction of the sphincter of Oddi, promotes cholecystokinin secretion, causes calcium dysregulation, oxidative stress
In chronic pancreatitis, there is fibrosis and permanent destruction of the exocrine and endocrine pancreatic functions. Which functions are lost first?
Exocrine functions lost first, endocrine function lost in late stages
How are serum amylase and lipase levels affected during acute pancreatitis?
Increased at least 3x
What is the clinical presentation of acute pancreatitis?
Sudden, severe pain that beings in the epigastrium and radiates to the back, anorexia, nausea, vomiting
Where are most pancreatic digestive enzymes synthesized and stored?
Acinar cells
True/False. Decreased calcium levels promote the activation of trypsinogen and acute pancreatitis.
False - hypercalcemia promotes trypsinogen activation
Autoimmune pancreatitis is responsible for chronic pancreatitis. What is the difference between Types 1 & 2?
Type 1 - IgG4 with plasma cells
Type 2 - neutrophils without IgG4
True/False. The prognosis of pancreatitis is related to the amount of pancreatic necrosis.
True. Increased necrosis = poorer prognosis
What transcription factor plays a primary role in the progression of local inflammation to systemic inflammatory response syndrome?
NF-kB
Serum amylase and lipase are elevated in acute pancreatitis. What are their levels in chronic pancreatitis?
Amylase and lipase may be elevated or low due to the destruction of acinar cells.
What is the clinical presentation of chronic pancreatitis?
Episodic abdominal pain triggered by alcohol or overeating, weight loss, steatorrhea, diabetes, jaundice
How are inactive pancreatic digestive enzymes activated?
Enteropeptidase cleaves trypsinogen to trypsin. Active trypsin cleaves and activates other digestive enzymes
What is the most specific and sensitive laboratory marker for acute pancreatitis?
Serum lipase - however, it is difficult to measure
What cytokines are persistently produced in chronic pancreatitis?
TGF-b & platelet-derived growth factor (PDGF)
What is the recommended treatment for acute pancreatitis?
NPO, IV fluids, opioids for pain management
What is the most common cause of chronic pancreatitis?
Chronic alcohol use
The exocrine portion is responsible for most of the pancreas’s function. What enzymes does it secrete?
Digestive enzymes
What is the mechanism of colocalization of pancreatic enzymes and lysosome hydrolases?
Pancreatic enzymes are trafficked to lysosomes and activated by hydrolases. This causes apoptosis of lysosomes and the release of activated enzymes into acinar cells
Acute pancreatitis can have many etiologies. What factors are most responsible for metabolic acute pancreatitis?
Alcohol overuse, hypertriglyceridemia
In acute hemorrhagic pancreatitis, these signs may be present.
Ecchymoses of the flank (Grey Turner’s Sign) and periumbilical region (Cullen’s Sign)
Vascular fluid is lost during acute pancreatitis due to inflammation. What effect will this have on hematocrit?
Hematocrit is elevated in acute pancreatitis.
What is the leading cause of death within the first week for patients with acute pancreatitis?
Multi-organ failure. After the first week, sepsis becomes the leading cause of death
What factors increase the risk of systemic inflammatory response syndrome due to acute pancreatitis?
Obesity, chronic alcohol use
True/False. Hereditary factors are responsible for a majority of chronic pancreatitis cases.
False - Chronic alcohol use is the leading cause of chronic pancreatitis, but hereditary factors are responsible for 25% of cases
What four mechanisms promote premature activation of trypsinogen?
Duct obstruction, acinar cell injury, calcium dysregulation, colocalization of pancreatic enzymes and lysosomal hydrolases
What is the etiology of cholelithiasis in causing acute pancreatitis?
Mechanical obstruction
What enzyme is responsible for cleaving trypsinogen to trypsin?
Enteropeptidase
