9. Exocrine Pancreas

Question 1

What are the names of the two sets of lymph nodes closest to the duodenum?

Answer 1

Anterior and posterior pancreaticoduodenal lymph nodes

Question 2

What are the two embryological buds that the pancreas develops from?

Answer 2

Dorsal and ventral

Question 3

What are the endocrine cells of the pancreas? And what do each of them secrete?

Answer 3

Alpha - glucagon
Beta - insulin
Delta - somatostatin
PP - pancreatic polypeptide

Question 4

What are the exocrine cells of the pancreas? And what do they secrete?

Answer 4

Acinar - produce enzymes
Duct - secrete bicarbonate/water
Centroacinar - stem cell

Question 5

What form are the enzymes that acinar cells secrete?

Answer 5

Inactive zygotes

Question 6

Where are enzymes released from?

Answer 6

Zymogen granules

Question 7

What regulates teh release of enzymes?

Answer 7

Cholecytokinin -> it’s activation triggers release

Question 8

How does tripsinogen become tripsin?

Answer 8

Tripsinogen is digested by enerokinase which cuts off the inhibitory part of the protein allowing active tripsin to be produced

Question 9

What does the binding of secretin on ductal cells cause?

Answer 9

Binding causes release of CAMP - causes release of chloride
Chloride then exchanged for bicarbonate
The release of bicarbonate

Question 10

What happens in chronic pancreatitis?

Answer 10

Build up of fibrosis
Loss of muscle masss
Almost inevitably fatal

Question 11

What happens in pancreatic cancer?

Answer 11

Epithelium of the duct is thickened, inflammation of fibrosis
Patient loses muscle mass
Almost inevitable fatal

Question 12

What is acute pancreatitis caused by?

Answer 12

Necrosis [cell death with inflammation]
Early - Systemic inflammatory response SIRS
Late - multi organ dysfunction syndrome
Death
Endocrine failure
Exocrine failure - malabsorption
Cancer

Question 13

What is the pathogenesis of pancreatitis in acinar cells?

Answer 13

Tripsinogen activated
Active tripsin within acinar cells
Causes cell damage
Causes cytokine release
Leads to necrosis and pancreatitis

Question 14

What activates tripsinogen in acinar cells?

Answer 14

Not too sure
But peaks in Ca2+

Question 15

I GET SMASHED
Eteology of pancreatitis

Answer 15

Idiopathic - dont know cause
Gallstones - main cause
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hyper - calcaemia, lipidaemia ,thermia
Ercp
Drugs

Question 16

What is the supposed relationship between gallstones and pancreatitis?

Answer 16

Gallstones get stuck and block bile release

Question 17

What autosomal recessive disease can lead to pancreatitis?

Answer 17

Cystic fibrosis

Question 18

How does continued alcohol abuse cause chronic pancreatitis?

Answer 18

Continued alcohol abuse - continues acute attacks of pancreatitis - eventually leads to fibrosis and chronic pancreatitis

Question 19

Why does alcohol cause pancreatitis?

Answer 19

Alcohol metabolised 2 ways - oxidative and non oxidative
Oxidative- acetate - no calcium spike - pancreatitis
Non oxidative - fatty acid ethyl esters - calcium spike - pancreatitis

Question 20

How does calcium release cause tripsin to be activated in acinar cells?

Answer 20

Calcium released due to trigger
Fuses lysosomes with zymogen granules
Lysosomes contain proteases which activate tripsinogen