The Pancreas

Question 1

Describe the duct system of the pancreas

Answer 1

2 major ducts:
- Accessory duct (of Santorini) - carries secretions into duodenum at minor papilla

• Pancreatic duct (of wirsung) - joins with common bile duct to form hepatopancreatic duct of vater and enters duodenum at major papilla

Question 2

What is the parasympathetic function of pancreas?

Answer 2

Supplied by vagus nerve to stimulate secretion of pancreatic juice

Question 3

What is the sympathetic function of the pancreas?

Answer 3

Suplies by coeliac ganglion, superior mesenteric and hepatix plexuses - enhibit production of pancreatic enzymes

Question 4

Describe the products of the exocrine pancreas and their relative functions

Answer 4

• Amylase - starch digestion
• Lipase - lipid digestion
• Trypsinogen - activated by enterokinase (intestinal brush-border enzyme) to digest proteins and activate other enzymes
• Chymotrypsin - activated by trypsin to break down proteins
• Procarboxypeptidase - activated by trypsin to digest proteins
• Proelastase - activated by trypsin to digest proteins
• Trypsin inhibitor - bind to any prematurely activated trypsin to prevent self-digestion

Question 5

Describe the regulatory process involved in pancreatic secretions

Answer 5

1. Dephalic Phase (20%) - Vagal stimulation for enzyme secretion
2. Gastric phase (10%) - stomach distension and peptide presence cause gastrin release and vago-vagal reflex
3. Inestinal phase (70%) - acidic chyme causes secretin release which stimulates bicarbonate secretionin pancreas, whilst peptides and fatty acids cause CCK release which causes production of enzyme risch fluid from pancreatic acinar

Question 6

What is chronis pancreatitis

Answer 6

On-going inflammation of pancreas

Question 7

How can chronis pancreatitis be caused?

Answer 7

Most likely through alcohol abuse, but also throughtypsinogen and inhibitory defects, cystic fibrosis, trauma or hypercalcaemia.

Can also be caused by genetics

Question 8

How do genetics play a role in chronic pancreatitis?

Answer 8

• SPINK-1 mutation - trypsin inhibitor so mutation allows trypsin to breakdown pancreas
• PRSS1 gene encodes for cationic trypsin, the maor form of trypsinogen, so mutation can cause trypsin defect
• Chymotrypsin C - inactivates trypsin so mutation allows for trypsin to breakdown pancreas

Question 9

How can chronic pancreatitis be treateD?

Answer 9

treat unerlyign cause and manage complications such as DM, pain, enzyme deficiency and steattorhoea etc.