122 - Pancreas and Gall Bladder

Question 1

What types of Pancreatitis are there?

Answer 1

Acute
Chronic
Autoimmune
Hereditary
Inflammatory
\+ pancreatic cancer

Question 2

How does acute pancreatitis present?

Answer 2

Acute upper abdo pain
Vomiting
prostration
Few days - few weeks

Question 3

What can cause acture pancreatitis?

Answer 3

Mainly gallstones
Alcohol
Drugs (aspirin, paracetamol, Erthyromycin)
Toxins (insecticide)
Metabolic (hypercalcaemia, Hypertrigliceridemia)
Traumatic
Vascular
Infectious
Ideopathic

Question 4

What investigations can help you diagnose actule pancreatitis?

Answer 4

• Blood enzyme levels (Low Lipase, High serum amylase)
• Asses endocrine function (direct enzyme secretion, in feces - enzyme / what is digested)
• Imaging

Question 5

What imaging can be used for the pancreas?

Answer 5

AXR
USS
CT
MR
MRCP
EUS
ERCP

Question 6

Why isn’t ERCP used all the time?

Answer 6

It is invasive - requires an endoscopy, and can cause acute pancreatitis itself!

Question 7

What is the main cause of chronic pancreatitis?

Answer 7

Alcohol - in young/middle ages men

Developing world - nutitional

Question 8

What is autoimmune pancreatitis associated with?

Answer 8

Increased IgG4 levels

Question 9

What is mutated in a hereditary Pancreatitis?

Answer 9

Catonic trypsinogen gene - so mutant trypsin resists inactivation in the pancreas.

Question 10

What does pancreatic cancer have such a poor prognosis?

Answer 10

• It is retroperitoneal - so not constrained by peritoneum
• It is It has a direct link into the duodenum
• Has a good blood supply - due to its endocrine function

Question 11

What is the cancer marker for Pancreatic cancer?

Answer 11

CA19-9

Question 12

How can pancreatic cancer present?

Answer 12

Relentless pain in upper abdomen/back
Weight loss
Diarrhoea
Jaundice
Diabetes

Question 13

Describe endocrine

Answer 13

Substance secreted directly into the blood stream, where it travels to its place of action

Question 14

Describe exocrine

Answer 14

Substance secreted into ducts where it travels to the place of action

Question 15

What is the endocrine function of the pancreas?

Answer 15

Islet cells - produce Insulin, glucagon, somatostatin and pancreatic polypeptide.

Question 16

What is the exocrine function of the pancreas?

Answer 16

Duct cells secrete bicarbonate - when stimulated by secretin

Acinar cells secrete digestive enxymes (lipase, amylase, proteases) - when stimulated by CCK.

Question 17

What is the distribution of cell types in the pancreas?

Answer 17

10% islet cells
10% Duct cells
80% acinar cells

Question 18

What does pancreatic insufficiency cause?

Answer 18

Diabetes
Maldigestion - malabsorption
Diarrhoea + Steatorrea
Weight loss + malnutition
Deficiency is lipid soluble nutrients - Vit A, D, E and K

Question 19

What is bile?

Answer 19

A watery mixture of organic and inorganic compounds

- Mainly phosphatidylcholine / Lechthin

Question 20

What are bile salts needed for?

Answer 20

Lipid digestion/absorption

Question 21

What do bile salts form to aid FA + MG absorption?

Answer 21

Micelles

Question 22

What do bile salts need to be transported in the enterohepatic circulation?

Answer 22

To be bound to albumin

Question 23

How is cholesterol converted to a bile acid?

Answer 23

Cholesterol -> cholic acid in liver, catalysed by 7 alpha hydroylase
Cholic acid -> deocycholic acid (secondary bile acid) by gut flora.

Question 24

What is the sensory duodenum?

Answer 24

The duodenum has endocrine cells that detect what is passing though it, and respond by secreting CCK or secretin.

• Acid -> secretin -> bicarb released by pancreas
• Protein + fat -> CCK -> Bile released and digestive enzymes

Question 25

How is the haemoglobin in RBC’s degraded?

Answer 25

Haemoglobin - Haem + globin
In macrophage :
Haem - biliverdin - bilirubin
blood - with albumin - to liver
Biliribin - bilirubin anhydrase