Week 7 - Disorders of the Pancreas Flashcards
list 3 disorders of the pancreas
- acute pancreatitis
- chronic pancreatitis
- pancreatic cancer
what are the 2 functions of the pancreas
- endocrine = produce hormones that regulate BG
2. exocrine = produce enzymes that help digest food into the duodenom
what is one of the pancreas’ protective mechanisms
- secretes proteases in an inactive form, which becomes activated once in the duodenom
what is protease
- enzyme that breaks down protein
what happens once the proteases enter the duodenom?
- trypinsogen is activated into trypsin by the enzyme enterokinase
what is the purpose of trypsin
- activates more trypsin & the other proteases
= activation of trypsin initiates a chain rxn resulting in the activation of many proteases
what is pancreatitis
- inflammation of the exocrine pancrease
what is pancreatitis characterized by
- intrapancreatic activation & release of destructive pancreatic enzymes
pancreatitis can be..
- acute or chronic
what is acute pancreatitis
- sudden inflammation of the pancreas due to autodigestion & injury to pancreatic cekks
what are the 3 most common causes of acute pancreatitis
- alcohol abuse
- cholelithiasis
- severe hyperlipidemia
alcohol abuse accounts for __% of all cases of acute pancreatitis & is usually precipitated by…
- 65%
- precipitated by an episode of heavy drinking
how does alcohol abuse cause acute pancreatitis (2)
- ethanol has a direct toxic effect on pancreatic cells
- decreased muscle tone in the sphincter of Oddi
what does the effect of alcohol on pancreatic cells cause?
- causes lysosomal activation of intracellular trypsin (still in the pancreas)
- this causes the activation of other digestive enzymes = autodigestion of the pancreas
what is the sphincter of Oddi
- a muscle in the body that controls the flow of bile & pancreatic juice from the pancrease to the small intestine
what does decreased muscle tone of the sphincter of Oddi cause
- reflux of duodenal contents into the pancreatic duct
cholelithiasis accounts for __% of cases of acute pancreatitis
18%
how do gallstones cause pancreatitis
- if a gallstone gets lodged in the sphincter of oddi, it blocks the pancreatic duct & release of pancreatic juices
= enzymes stuck in the pancrease
= inflammation & activation of trypsin
list 9 manifestations of pancreatitis
- severe pain
- hemorrhage, shock
- fever
- hyperamylasemia & hyperlipasemia
- hypocalcemia
- hyperglycemia
- pulmonary complication
- hyperkalemia
- peritonitis
what kind of pain is present in pancreatitis
- deep epigastric pain and/or LUQ pain that radiates to the back
what causes pain in pancreatitis (3)
- inflammation
- enzymatic breakdown of pancreatic tissue
- stimulation of peritoneal nerve endings
how does pancreatitis cause hemorrhage & shock
- due to enzymatic destruction of blood vessels
what kind of shock does peritonitis cause
- hypovolemia
- neurogenic
how can pancreatitis cause fever
- inflammatory cells release pyrogens which cause fever
what is hyperamylasemia and hyperlipasemia
excess pancreatic enzymes (amylase & lipase) in the blood
what cause hyperamylasemia & hyperlipasemia
- destruction of pancreatic cells = release of amylase & lipase into the interstitial space & is picked up by blood
what is the significance of hyperamylasemia & hyperlipasemia
- very imp diagnostic value
what causes hypocalcemia
- the release of pancreatic lipase into the interstitial fluid causes breakdown of mesentric adipose tissue & release of free fatty acids
what does the release of free fatty acids cause
- bind to free calcium in , the blood , causing hypocalcemia
what are 3 manifestations of hypocalcemia
- tetany
- prolonged QT interval with risk of VT
- convulsions
how does pancreatitis cause hyperglycemia
- inflammation of the pancreatic B cells can prevent insulin release = hyperglycemia
what can hyperglycemia cause
ketoacidosis
how does pancreatitis effect DM
- can cause DM if 70% of B cells are destroyed
how does pancreatitis cause pulmonary complication
- pancreatic inflammation & release of proteolytic enzymes = pleural effusion & pulmonary edema
- release of pancreatic phospholipase can destroy alveolar surfactant
what effect can hypotension have on the lungs
- can lead to “shock lung” or acute respiratory distress syndrome
how can pancreatitis cause hyperkalemia (3)
- tissue necrosis causes destruction of cells & their contents to be released (K+)
- correction of acidosis (H+ in, K+ out)
- after fluid repletion
how can pancreatitis cause peritonitis
- activated digestive enzymes can irritate the peritoneum
