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1.2 Lectures > Week 4 (Acute and Chronic Pancreatitis and Complications) > Flashcards

Week 4 (Acute and Chronic Pancreatitis and Complications) Flashcards

1
Q

What is the primary function of the exocrine pancreas?

A

To secrete digestive enzymes and bicarbonate-rich fluid

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2
Q

What are the two main components of the pancreas?

A
  • Endocrine (Islet)
  • Exocrine (acinar and duct)
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3
Q

When should the pancreatic enzymes be inactivated?

A

They should stay inactive until reaching the intestine

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4
Q

Name the major pancreatic enzymes.

A
  • Trypsin
  • Chymotrypsin
  • Carboxypeptidase
  • Lipase
  • Amylase
  • RNase
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5
Q

What do duct cells secrete?

A

Bicarbonate-rich fluid to buffer and transport acinar zymogens

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6
Q

What channels allow water to enter the duct?

A

Aquaporin channels

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7
Q

What is the cephalic phase of pancreatic stimulation?

A

Stimulated by seeing or smelling food, initiating enzyme secretion

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8
Q

What percentage of total pancreatic secretion occurs during the cephalic phase?

A

~25%

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9
Q

What is the main mediator of the cephalic and gastric phase of pancreatic stimulation?

A

Vagus nerve efferents (cholinergic)

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10
Q

What is the primary hormone discovered by Bayliss and Starling?

A

Secretin

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11
Q

What was the significance of Bayliss and Starling’s experiments?

A

They demonstrated that pancreatic secretion can occur without vagal innervation

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12
Q

What is the main risk factor for chronic pancreatitis?

A

Heavy alcohol use (~70% of cases)
Risk also increases with combined smoking

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13
Q

What are the common causes of acute pancreatitis?

A

*Idiopathic (15-20%)
* Gallstones (45%)
* Ethanol (35%)
* Trauma
* Steroids
* Mumps or malignancy
* Autoimmune
* Scorpion stings
* Hyperlipidemia
* Hypercalcemia
* ERCP
* Drugs (increased incidence with GLP-1 agonist use)

I GET SMASHED

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14
Q

What is the annual incidence of acute pancreatitis in the US?

A

~50 per 100,000

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15
Q

What is the annual incidence of chronic pancreatitis in the US?

A

~8 per 100,000

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16
Q

What are the genetic causes of recurrent acute/chronic pancreatitis?

A

ACINAR:
* PRSS1 (gain of function of trypsin; hyperactive/hyperstable)
* SPINK1 (loss of function of trypsin via allosteric trypsin inhibitor)
* CTRC (loss of function of trypsin via increase in this protease that cleaves and inhibits trypsin)

DUCT:
*CFTR (loss of function of chloride and bicarbonate channel)

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17
Q

What is the effect of trypsin activation in pancreatitis?

A

It may amplify or exacerbate effects of other insults, intrinsic and extrinsic

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18
Q

What is the potential target for ameliorating acute pancreatitis and preventing progression to chronic disease?

A

Trypsin-independent inflammatory pathways

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19
Q

True or False: Many cases of chronic pancreatitis are idiopathic.

A

True

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20
Q

What is the relationship between acute pancreatitis and pancreatic cancer?

A

Increased risk associated with chronic pancreatitis

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21
Q

What are the two types of inflammatory pathways mentioned in relation to acute pancreatitis?

A

Trypsin-dependent injury and trypsin-independent inflammation

Trypsin-independent pathways could be targets for ameliorating acute pancreatitis.

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22
Q

What are common symptoms of acute pancreatitis?

A
  • Severe epigastric pain
  • Nausea
  • Vomiting
  • Tenderness
  • Tachycardia
  • Fever
23
Q

What clinical evidence is used for diagnosing acute pancreatitis?

A
  • Elevated serum lipase and amylase
  • Imaging (CT, possibly endoscopic ultrasound)
24
Q

What is required for the diagnosis of acute pancreatitis?

A

2 out of 3 criteria: severe epigastric pain, elevated serum lipase/amylase, and/or imaging findings

Criteria are outlined in red.

25
What percentage of acute pancreatitis cases are classified as 'uncomplicated pancreatitis'?
90-95%
26
What is the mortality rate associated with severe (necrotizing) pancreatitis?
10-30%
27
What are some complications of severe pancreatitis?
* Acute respiratory distress syndrome * Acute renal failure * Sepsis Much worse with infection of pancreatic abscesses
28
What is the primary management strategy for mild pancreatitis?
Supportive treatment: aggressive rehydration, pain relief Mortality Rate <1%
29
What are common symptoms of chronic pancreatitis?
* Epigastric pain, worse after eating * Fatty stool (exocrine insufficiency) * Weight loss * Diabetes (with longstanding disease)
30
What diagnostic imaging methods are used for chronic pancreatitis?
* CT, EUS imaging (duct dilation, calcifications) [Distinguish between pancreatic adenocarcinoma] *Lipase, amylase may or may not be elevated *Impaired pancreatic function (secretin test) *Fat soluble vitamin Deficiencies
31
In chronic pancreatitis, what is a potential treatment for exocrine insufficiency?
Pancreatic enzyme supplementation
32
What lifestyle changes are recommended for managing chronic pancreatitis?
Alcohol and smoking cessation
33
What is a significant treatment exception for chronic pancreatitis?
Autoimmune pancreatitis can be reversed by corticosteroid treatment; otherwise there is no good treatment for chronic pancreatitis
34
What is the annual incidence rate of acute pancreatitis (non-gallstone) per 100,000?
25
35
What is the role of acinar cells in the pancreas?
Secrete enzymes as inactive zymogens
36
What is the function of duct cells in the pancreas?
Produce bicarbonate-rich fluid to carry zymogens to intestine
37
What is the relationship between acute pancreatitis and pancreatic cancer?
Acute pancreatitis -> recurrent acute pancreatitis -> chronic pancreatitis increases risk for pancreatic ductal adenocarcinoma
38
True or False: Most acute pancreatitis resolves without complications.
True
39
Fill in the blank: The job of the pancreas is to produce enzymes to break down ______, fat, and starch.
protein
40
What do Acinar cells secrete?
Protein Secretion
41
What ion channel is important in the bicarbonate transport by pancreatic duct cells?
CFTR (cystic fibrosis gene)
42
What anion transporter is important in the bicarbonate transport by pancreatic duct cells?
SLC26A6
43
What percentage of total pancreatic secretion occurs during the gastric phase?
10%
44
What stimulates the gastric phase of pancreatic secretion?
Stomach distension; food nearing intestine, stimulate start of major enzyme release
45
What stimulates the intestinal phase?
Food in the intestine; major enzyme release
46
What percentage of total pancreatic secretion occurs during the intestinal phase?
60%
47
The intestinal phase of pancreatic secretion is mediated by......
a combination of vagus nerve and gastrointestinal hormones
48
What regulates pancreatic acinar cell functions?
Neural/hormonal signals CCK (from fat and protein; signaling from I cells) and ACh stimulates Calcium release from ER; Calcium induces zymogen granule exocytosis
49
What regulates pancreatic duct cell functions?
Neural/hormonal signals Hormonal (secretin- from H+; signaling from S-cells) and neuronal (ACh) inputs are semi-redundant
50
Besides heavy alcohol use and smoking, what are other causes of chronic pancreatitis?
Autoimmune attack, gallstones, hypertriglyceridemia, specific genetic disorders, idiopathic (25%)
51
What mutations are associated with an increased risk of pancreatic cancer?
PRSS1 and CFTR
52
What are characteristics of mild pancreatitis?
Usually interstitial Most often resolve spontaneously, with edema resolving or developing into pseudocyst
53
How would you treat severe pancreatitis?
Treat in ICU with aggressive rehydration, antibiotics (if sepsis is suspected), surgical debridement (if symptoms persist >2 weeks), pain management, lifestyle changes (alcohol/smoking cessation), pancreatic enzyme supplementation, stenting or dilating duct to relieve obstruction, nerve block, partial or total pancreatecomy (last resort)

1.2 Lectures (9 decks)

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