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GIR Test 3 > B5-066 Pancreas > Flashcards

B5-066 Pancreas Flashcards

1
Q

islets of langerhans

endocrine or exocrine?

A

endocrine

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2
Q

a-cell
b-cell
d-cell

endocrine or exocrine?

A

endocrine

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3
Q

glucagon

endocrine or exocrine?

A

endocrine

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4
Q

insulin

endocrine or exocrine?

A

endocrine

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5
Q

somatostatin

endocrine or exocrine?

A

endocrine

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6
Q

acinar cells

endocrine or exocrine?

A

exocrine

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7
Q

a-cells secrete

A

glucagon

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8
Q

b-cells secrete

A

insulin

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9
Q

produce and transport enzymes to the duodenum

A

acinar cells

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10
Q
  • extension of intercalated duct cells
  • produce bicarbonate
A

centroacinar cells

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11
Q

secretion of digestive enzymes, fluid and bicarb

endocrine or exocrine?

A

exocrine

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12
Q

the absence of proper pancreatic secretion may eventually cause

A

malnutrition

due to maldigestion/absorption

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13
Q

digestive enzymes are produced by […] cells

A

acinar

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14
Q

when chyme comes in contact with the intestinal mucosa, it activates

A

pro-entropeptidase –> enteropeptidase

cleaves trysinogen to trypsin

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15
Q

zymogens

3

A

chymotrypsinogen
procarboxypeptidases
proelastase

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16
Q

premature enzyme activation is prevented by 4 mechanisms..

A
  1. packaging of zymogens
  2. intracellular calcium homestasis
  3. acid-base balance prevents rise in pH
  4. protease inhibitors secreted by acinar cells
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17
Q

produced by centroacinar (ductal) cells

A

bicarb

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18
Q

key event in pancreatitis

A

premature trypsinogen activation

caused by elevated Ca+

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19
Q

breaks down starch and disaccarides in the cephalic phase

A

pancreatic amylase

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20
Q

breaks down triglycerides in the cephalic phase

A

pancreatic lipases

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21
Q

breaks down nucleic acids

A

pancreatic ribonuclease and deoxyribonuclease

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22
Q

stimulates pancreatic bicarbonates and protein secretion

A

VIP

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23
Q

inhibit pancreatic bicarb and protein secretion

A

PP

pancreatic polypeptide

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24
Q

stimulates gastic acid secretion
released from G cells

A

gastrin

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25
Q
  • stimulates secretion of pancreatic enzymes
  • contraction of gallbladder
  • delivery of bile into small intestine
A

CCK

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26
Q
  • stimulates secretion of water and bicarb from the pancreas and bile ducts
  • inhibits gastrin secretion
  • stimulates bile production
A

secretin

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27
Q

released due to the presence of peptides and amino acids in the gastric lumen

A

gastrin

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28
Q

released in the presence of fatty acids and amino acids in the small intestine

A

CCK

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29
Q

released due to acidic pH in the lumen

A

secretin

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30
Q

individuals with celiac disease have reduced

A

CCK
reduces pancreatic secretions and gallbladder contractions

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31
Q

most common cause of exocrine pancreatic insufficiency

A

chronic pancreatitis

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32
Q

abnormal sticky mucus that blocks bile and pancreatic ducts

A

Cystic fibrosis

cause of exocrine pancreatic insufficiency

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33
Q

9/10 CF patients depend on

A

PERT

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34
Q

in CF, lack of Cl- in lumen leads to

A

reduced H2O in lumen

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35
Q

causes of exocrine pancreatic insufficiency

4

A
  • obstruction of biliary or pancreatic duct
  • pancreatic cancer
  • previous pancreatic surgery
  • DM1
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36
Q

major characteristics of EPI

5

A
  • frequent diarrhea
  • gas/bloating
  • stomach pain
  • steatorrhea
  • weight loss
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37
Q

20% of patients with chronic pancreatitis develop

A

EPI

38
Q

EPI is treated with

A

PERT

39
Q

gold standard for diagnosis of EPI

A

72 hr fecal fat test

40
Q
  • lipid soluble vitamin deficiency
  • fecal elastase <200
  • MPD dilation on imaging

high clinical suspicion for

A

EPI

41
Q

fecal elastase <15

high clinical suspicion

A

EPI

42
Q

avoid […] in the treatment of EPI, they can make steatorrhea worse

A

calcium containing antacids

43
Q

must be taken with a PPI or H2 blocker

A

viokace

non-enteric coated

44
Q

enteric coated/delayed release PERT therapy options

A

creon
pancreaze
pertyze

etc

45
Q

what PERT medication should be avoided in the treatment of CF?

A

non-enteric coated (viokace)

require PPI or H2 inhibitor

46
Q

associated with a higher number of hospitalizations for PH in CF patients

A

PPI

47
Q

most common side effect of PERT therapy

A

hyperglycemia or hypoglycemia due to rate of amylase action

48
Q

two major risk factors for chronic pancreatitis

A

alcohol
tobacco

49
Q
  • hypertrophy/dystrophy of nerves
  • lymphocyte infiltration/fibrosis
A

chronic pancreatitis

50
Q

characterized by irreversible damage that alters the organ’s normal structure and function

A

chronic pancreatitis

51
Q

major symptom is chronic pain starting in epigastrium and radiating toward back

A

chronic pancreatitis

52
Q

patchy, focal disease characterized by mononuclear infiltrate and fibrosis

A

chronic pancreatitis

53
Q

involves a large portion of the entire pancreas with a predominantly neutrophilic inflammatory response

A

acute pancreatitis

54
Q

serum amylase and lipase concentrations tend to be […] in chronic pancreatitis

A

normal

55
Q

serum amylase and lipase tend to be [….] in acute pancreatitis

A

elevated

56
Q
  • upper abdominal “piercing” pain that travels to back
  • aggravated by eating
  • pain is always present but for variable periods of time
A

acute pancreatitis

57
Q
  • pain is constant, severe, radiates to back
  • “gnawing”
  • does not always present with pain
A

chronic pancreatitis

58
Q
  • acute inflammation
  • acute abdominal pain
  • elevated pancreatic serum enzymes (<24 hrs from onset)
  • self-limited
A

acute pancreatitis

59
Q
  • pancreatic serum enzymes not elevated
  • fibrosis and ductal obstruction
  • permanent loss of function
A

chronic pancreatitis

60
Q

what is considered chronic alcohol use that would lead to chronic pancreatits?

A

1 bottle of wine or 6-pack per day
for a decade

61
Q

30% of chronic pancreatitis is

cause

A

idiopathic

62
Q

autoimmune pancreatitis is associated with

A

SLE

63
Q

how does chronic alcohol use cause pancreatitis?

A
  • ethanol disturbs the Ca+ homeostasis, causes oxidative stress
  • activates trypsin prematurely
64
Q

predominate in males

large or small duct disease

A

large

65
Q
  • calcium carbonate stones
  • diffuse pancreatic calcifications
  • dilation visible on diagnostic imaging

large or small duct disease

A

large

66
Q
  • normal imaging
  • non-dilated main pancreatic duct
  • no pancreatic calcification

large or small duct disease

A

small

67
Q

predominate in females

large or small duct disease

A

small

68
Q

fecal elastase will be […] in chronic pancreatitis

A

abnormally low

69
Q

hypercalcemia

acute or chronic pancreatitis?

A

chronic

70
Q

hypocalcemia

acute or chronic pancreatitis?

A

acute

71
Q

monitored to evaluate efficacy of PERT

A

fecal fat

72
Q

serum amylase/lipase rarely elevated

acute or chronic pancreatitis?

A

chronic

73
Q

steatorrhea occurs when lipase production is less than […]% of normal levels

A

10

74
Q

chronic pancreatitis patients should be assessed frequently for […] and […] due to fat soluble vitamin deficiency

A

clotting function
bone density

75
Q

management of chronic pancreatitis

A
  • eliminate precipitating factor
  • mangement of pain
  • PERT
76
Q

effective at reducing symptoms in chronic pancreatitis patients with an autoimmune etiology

A

steroids

77
Q

chronic pancreatitis is caused by […] in most cases

A

alcohol abuse

78
Q

a a-cell tumor would secrete […] and cause […]

A

glucagon
hyperglycemia

79
Q

a b-cell tumor would secrete […] and cause […]

A

insulin
hypoglycemia

80
Q

a d-cell tumor would secrete […] and cause […]

A

somatostatin
diabetes, steatorrhea

81
Q

a g-cell tumor would secrete […] and cause […]

A

gastrin
zollinger-ellison syndrome

82
Q

an acinar cell tumor would secrete […] and cause […]

A

pancreatic enzymes
pancreatitis

83
Q

a deficiency in vitamin A would cause

A

night blindness

84
Q

a deficiency in vitamin K would cause

A

easy bruising

85
Q

without exocrine function of the pancreas, […] and […] can not be digested/absorbed

A

dietary lipids
fat soluble vitamins

86
Q
  • stimulates pancreatic release of bicarbonate and water
  • inhibits gastrin production by stomach
A

secretin

87
Q

stimulates pancreatic enzyme release

A

CCK

88
Q

most common causes of EPI

2

A
  1. chronic pancreatitis
  2. cystic fibrosis
89
Q

how does CF cause EPI?

A

thick mucus in the pancreas blocks pancreatic enzymes from entering the small intestine

90
Q

most specific test to evaluate chronic pancreatitis

A

fecal elastase

91
Q

non-enterically coated PERT should be administered with a

A

PPI

prevents acid inactivation of enzyme

92
Q

released from duodenum in response to amino acids and fatty acids

A

CCK

GIR Test 3 (16 decks)

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