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Gastroenterology > The Pancreas and Small Bowel > Flashcards

The Pancreas and Small Bowel Flashcards

1
Q

What is the pancreatic embryology?

A

Posteriorly begins with dorsal pancreatic bud and duct

Anteriorly begins with ventral pancreatic bud and duct

The proximal duodenum rotates clockwise so the ventral pancreatic bud and duct rests posteriorly and fuse with dorsal bud and duct

Main pancreatic duct switches direction and the ventral pancrease becomes the main pancreatic duct

Bile and pancreatic ducts join to drain together at major papilla

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2
Q

Where is the pancreas?

A

Not within the abdomen

Retroperitineal

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3
Q

What are the three parts of the pancreas?

A

Pancreas is divided into the neck, body and tail

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4
Q

What is in front of the pancreas?

A

Stomach

Transverse colon

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5
Q

What is the vasculature surrouding the pancreas?

A

Common hepatic artery

Left gastric artery

Splenic artery

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6
Q

Where is the superior mesenteric vein?

A

Dives underneath the neck of the pancreas

Meets the splenic vein and then becomes the portal vein

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7
Q

How do you access the pancreas?

A

Divide the structure that connects the stomach and small bowel

Life the stomach superiorly and large bowel inferiorly

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8
Q

What is MRCP?

A

Scan

Magnetic resonance cholangiopancreatography

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9
Q

What is angiography? Why is it useful?

Where is the pancreas found in each of these images?

A

Placing dye into an artery to decipher how the artery is working - see if there is any bleeding

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10
Q

How is endocrine VS exocrine secretion defined?

A

Endocrine = secretion into the bloodstream, affect on distant organ = more widespread effect

Exocrine = secretion into a duct that has a direct local effect

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11
Q

What are the main secretions of the pancreas and their actions?

A

Insulin = anabolic hormone that lowers BGL, promotes transport of glucose COPY OFF SLIDE ; glucagon; and somatostatin

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12
Q

What are the endocrine functions of the pancreas?

A

Endocrine = 2% of the gland

  • Islets of Langerhans
  • Secrete hormones into blood - Insulin & Glucagon (also Somatostatin and Pancreatic Polypeptide)
  • Regulation of blood glucose, metabolism & growth effects - (Endocrine course)
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13
Q

What are acini?

What are islets? Where are they found?

A

Acini: Ducts that produce enzymes of the pancreatic juice

Grape like structures

Pro-ezymes secreted into the ducts that become activated

Islets = produce the hormones; more islets in the tail of the pancreas than the head.

If tail is removed during surgery more likely to beocme diabetic than if head is removed

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14
Q

What are the exocrine functions of the pancreas?

A

98% of g;and

Secretes pancreatic juice into duodenum via main pancreatic duct/sphincter of Oddi/ampulla

Digestive function

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15
Q

What is the compositon of the islets and what hormones do they produce?

A
  • α-cells form about 15-20% of islet tissue and secrete glucagon
  • β-cells form about 60-70% of islet tissue and secrete insulin
  • δ-cells form about 5-10% of islet tissue and secrete somatostatin
  • Acini
  • The islets are highly vascular, ensuring that all endocrine cells have close access to a site for secretion
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16
Q

The acini are the exocrine pancreatic units what are they composed of?

A

Secretory acinar cells: Large with apical secretion granules

Duct cells: Small & pale

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17
Q

What are the 2 components of pancreatic juice?

A
  1. Produced by acinar cells - low volume, high viscousity
  2. High volume, watery, alkaline rich, produced by duct and centroacinar cells
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18
Q

How does biarbonate secretion take place into the pancreatic juice?

A
  • Produced by duct & centroacinar cells
  • Pancreatic Juice = ↑ bicarbonate
  • ~ 120 mM (mmol/L) - (plasma ~25 mM)
  • pH 7.5-8.0
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19
Q

What is the purpose of the bicarbonate ions in the pancreatic juice?

A

Neutralises acid chyme from stomach

prevents damage to duodenal mucosa

Raises pH to optimum range for pancreatic enzymes to work

Washes low volume enzyme secretion out of pancreas into duodenum

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20
Q

How does duodenal pH effect bicarbonate secretion rate?

A

Duodenal pH < 5 → linear ↑ in pancreatic HCO3-secretion

Duodenal pH <3 → not much more ↑ in HCO3-secretion

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21
Q

What is the bicarbonate mechanism to neutralising the acidic chyme?

How does the ion exhange take place?

A

Pancreatic HCO3- Secretion

  • Reaction is CO2 and H2O to H+ and HCO3- catalysed by carbonic anhydrase
  • Separation of H+ & HCO3-
  • Na+ moves down gradient via paracellular (“tight”) junctions
  • H2O follows

Chloride comes into the pancreatic duct and bicarbonate goes out via an ion transport exchange protein

Exchange driven by electrochemical gradient

Na/K pump exchanges

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22
Q

How does pancreatic bicarbonate secretion take place (2)?

A
  • Cl-/HCO3- exchange at lumen (anion exchanger [AE])
  • Na+/H+ exchange at basolateral membrane into bloodstream (sodium-hydrogen exchanger (antiporter) type 1 [NHE-1])

Exchange driven by electrochemical gradients

  • High EC (blood) Na+ compared to IC (duct cell)
  • High Cl- in lumen compared to IC (duct cell)
23
Q

Why are proteases inactive in the pancreas?

What is the protective mechanism incase the proteases are accidentally activated too early?

A
24
Q

What goes on int he duodenum with trypsinogen, trypsin and all that?

A
25
Q

How do pancreatic secretions adapt to diet?

How does the anti-obesity drug ‘orlistat’ work and what are some possible side effects?

A

lots of fibrosis?

26
Q

What are the 3 phases that control pancreatic juie secretion?

A

Cephalic phase - reflex response to sight / smell / taste of food

copy off slide

27
Q

How are the 2 components of the pancreatic juice controlled?

A

Completely separate control of the 2 components

Acini = vagus nerve - ACh , Islets secrete CCK in the duodenal cells causing ??

28
Q

How is bicarbonate secretion controlled in the acini and ducts?

A
29
Q

What is the classic negative feedback loop to control HCO3- secretions?

A
30
Q

missed stuff

What is the symbiotic relationship between CCK and secretin

A
31
Q

What is the process of the digestion when a meal has been ingested?

A
32
Q

What is the simple function of the small bowel?

A
33
Q

What is the structure of the small bowel? What are the lengths of the 3 parts of the small bowel?

A
34
Q

What is the mesentry and what is its function?

Fill in the covered labels on the diagram below:

A

Suspends the small and large bowels from the abdominal wall

Provides a passage for the blood, lymphatic and nerve supply

35
Q

What are the layers of the small bowel?

A

Mucosa, submucosa, muscularis and serosa

Bowel has villi and microvilli - projections

36
Q

Where are villi found? What…? villi fact slide

A
37
Q

What are the 2 cells types of the villi? What are their differences?

A
38
Q

What are enterocytes?

A
39
Q

What is the purpose of microvilli?

A
40
Q

What are goblet cells? Where are they found?

A

Produce mucus

Abundance of goblets cells increase across the bowels - low in the duodenum, high in the colon

41
Q

What are enteroendocrine cells?

What hormones do they secrete?

A
42
Q

What are paneth cells? What is their structure and how it is adapted to its function?

A
43
Q

What are stem cells and where do they exist in the small bowel?

A

In the crypts

Stem cells = pluripotent, can differentiate into any of those cells

44
Q

Why do goblet cells and enterocytes of the small bowel havesuch a short life span?

A

Short lived because: cells exposed ot many pathogens, so if they die unlikely to get infections from the diet and reduces chance of tumours

Affected by the toxins of the chyme

45
Q

Although the duodenum, jejunum and ileum are continuous with no major separations, what factors differ them from each other?

A

Smething has a thicker wall

left of the aorta ?

46
Q

smol bowel motility

A
47
Q

What are the 3 different functions of small bowel motility?

A
48
Q

How are carbohydrates digested and absorbed in the small bowel?

A

Pancreatic amylase secreted into the duodenum in response to a meal

split into 2 - luminal digestion and membrane digestion

Amylase breaks down long sugars into smaller ones

Smaller sugars digested on the membranes

49
Q

Digestion of catds - all the transport proteins and carrier proteins involved?

A
50
Q

Digestion of proteins - summary, 2 slides

A
51
Q

digestion of lipids - bile salts emusify them

A
52
Q

Whats the difference between protein and carbohydrate absorption, and lipid absorption?

A
53
Q

By which structure is the small bowel separated from the large bowel?

Why is what important?

A

Gastroenterology (12 decks)

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