Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > W7: Pancreas: Anatomy, Physiology Pancreatitis & Pancreatic Tumours > Flashcards

W7: Pancreas: Anatomy, Physiology Pancreatitis & Pancreatic Tumours Flashcards

1
Q

What are the 5 anatomical segments of the pancreas?

A
  • head
  • neck
  • body
  • tail
  • uncinate process
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 2 vessels that branch from the aorta give the pancreas its arterial blood supply?

A
  • Celiac trunk

- superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the gastroduodenal artery split into to supply the head of the pancreas?

A
  • anterior superior pancreaticoduodenal artery

- posterior superior pancreaticoduodenal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What vessel branches from the splenic artery to supply the neck, body and tail of the pancreas?

A

dorsal pancreatic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What 2 vessels branch fro the superior mesenteric artery to supply the uncinate process of the pancreas?

A
  • anterior inferior pancreaticoduodenal artery

- posterior inferior pancreaticoduodenal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What venous blood vessel passes behind the pancreas and changes name as it drains into the liver?

A

Inferior mesenteric vein to portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What three blood vessels branch from the superior mesenteric vein to supply venous drainage to the head and uncinate process of the pancreas?

A
  • anterior inferior pancreaticoduodenal vein
  • posterior inferior pancreaticoduodenal vein
  • anterior superior pancreaticoduodenal vein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What blood vessel branches from the portal vein to give venous drainage to the head and uncinate process of the pancreas?

A

posterior superior pancreaticoduodenal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What three veins supply venous drainage to the neck, body and tail of the pancreas?

A
  • splenic vein
  • inferior mesenteric vein
  • inferior pancreatic vein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the ampulla of vater?

A

where the bile duct and pancreatic duct meet to drain into the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What two ducts meet to form the common bile duct?

A
  • Cystic duct

- common hepatic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What cells of the pancreas carry out the exocrine function and what do they secrete?

A
  • acinar cells

- secrete pancreatic enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What cells of the pancreas carry out the endocrine function and what do they secrete?

A
  • Islets of Langerhans

- secrete hormones into blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Approximately how much of the exocrine pancreas comprises of the parenchyma?

A

98%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 4 cells in the Islet’s of Langerhan’s and which are there most of?

A
  • alpha cells
  • beta cells (most of these)
  • delta cells
  • F cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do beta cells of the pancreas secrete?

A

insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do alpha cells of the pancreas secrete?

A

glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do delta cells secrete?

A

somatostatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do F cells secrete?

A

pancreatic polypeptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What regulates secretion of pancreatic fluid from the acinar cells?

A
  • vagus nerve

- gastrin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are 3 major types of enzymes secreted in pancreatic fluid?

A
  • protease
  • pancreatic lipase
  • pancreatic amylase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

List two types of proteases secreted in pancreatic fluid?

A
  • Trypsin

- Chymotrypsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are 4 additional enzymes (other than proteases, lipase and amylase) secreted in pancreatic fluid?

A
  • ribonuclease
  • deoxyribonuclease
  • gelatinase
  • elastase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What two substances are secreted by the epithelial cells lining the pancreatic ducts?

A
  • water

- bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Approx. how much pancreatic fluid is secreted a day?

A

1 litre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In terms of the causes of acute pancreatitis, what does the acronym “I GET SMASHED” stand for?

A
  • Idiopathic
  • Gallstones
  • Ethanol
  • Trauma
  • Steroids
  • Mumps (+ coxsackie B + viral Hepatitis, adenovirus, HIV)
  • Autoimmune
  • Scorpion bite
  • Hypercalcaemia, Hyperparathyroidism, Hyperlipidaemia
  • ERCP
  • Drugs (azathoprin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the function of cholecystokinin and from where is it secreted?

A
  • stimulates release of bile

- secreted by epithelial cells in the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the pathophysiological theory of acute pancreatitis?

A
  • blocked CBD or PD causes reflux of bile into pancreas and activation of enzymes
  • release of pancreatic enzymes that then autodigest the pancreas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why is activation of trypsinogen to trypsin in the pancreas particularly detrimental to acinar cells in acute pancreatitis?

A

Active trypsin cleaves and activates all the other pancreatic enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

An increase in what intracellular mineral is thought to activate trypsinogen?

A

Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the 4 main stages of acute pancreatitis?

A
  1. Hypovolaemic shock + hypocalcaemia
  2. retroperitoneal haemorrhage
  3. pancreatic necrosis
  4. abscess formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What leads to hypovolaemic shock in the first stage of acute pancreatitis?

A

oedema and fluid shifts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What leads to hypocalcaemia in the first stage of acute pancreatitis?

A

fats are autodigested in the peritoneal cavity meaning Ca++ binding is affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What leads to retroperitoneal haemorrhage in acute pancreatitis?

A

autodigestion of blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What leads to abscess formation in acute pancreatitis?

A

Necrotic pancreatic tissue becoming infected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is DIC?

A

Disseminated Intravascular Coagulation -> overactive blood clotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What can cause shock, pulmonary compromise, acute renal failure and DIC following necrosis in acute pancreatitis?

A

Release of toxic metabolites into blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How does a pseudocyst form in acute pancreatitis?

A

Inflammation can lead to peripancreatic exudation or pancreatic duct leakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the clinical symptoms of acute pancreatitis?

A
  • acute onset epigastric pain/upper abdo
  • pain radiating to back
  • getting progressively severe
  • nausea and vomiting
  • jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What can be found upon examination of a patient with acute pancreatitis and when severe?

A
  • diffuse upper abdominal tenderness
  • maybe fullness in epigastrium due to pseudocyst
  • if severe: widespread guarding and absent bowel sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are three classic signs on the abdomen of a patient with acute pancreatitis and describe these?

A
  • Grey Turner’s sign (flank bruising)
  • Cullen’s signs (periumbilical bruising)
  • Erythema Abigne (hyperpigmentation, fish-net like erythema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the main investigations carried out in acute pancreatitis?

A
  • Bloods
  • arterial blood gas
  • xray
  • ultrasound
  • CT
  • ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the specific blood tests in investigating acute pancreatitis? (10)

A
  • FBC
  • coagulation
  • U&Es
  • LFTs
  • amylase serum
  • lipase serum
  • blood glucose
  • plasma calcium
  • crp
  • lactate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How can acute pancreatitis lead to hypoxia/ARDS?

A

Due to the increased levels of activated trypsinogen in the blood causing damage to the pulmonary vasculature

45
Q

What are two possible signs of acute pancreatitis in xray and explain why these signs can occur?

A
  • pleural effusion -> due to disrupted pancreatic duct leading to fistula or pseudocyst rupture
  • sentinel loop -> dilatation of part of small intestine due to localised inflammation
46
Q

What is the purpose of ultrasound scanning used in the investigation of acute pancreatitis?

A

To find:

  • gallstones
  • common bilde duct size
  • cholecystitis
  • peripancreatic fluid (free fluid)
47
Q

What is the purpose of carrying out a CT scan and when should it be done?

A
  • To assess the degree of pancreatic damage

- should be done after 72hr of pancreatitis

48
Q

List 5 complications that can be picked up in follow up CT scan after acute pancreatitis?

A
  • abscess
  • ascites
  • bleeding
  • fluid collections
  • pancreatic necrosis
49
Q

When is ERCP used in acute pancreatitis?

A

As treatment for CBD stones obstructing bile duct

50
Q

What is the treatment to prevent a recurrent pancreatitis when its caused by gallstone obstruction?

A

Cholecystectomy

51
Q

What is treatment following pancreatitis with more than 50% necrosis?

A
  • antibiotics
  • percutaneous draining
  • endoscopic necrosectomy - debridement and lavage
  • fine needle aspiration for micro
52
Q

What are the two the Prognostic scoring systems used to assess acute pancreatitis?

A
  • Glasgow Criteria

- Ranson’s Criteria

53
Q

What does the PANCREAS acronym stand for in the Glasgow Criteria?

A 
P -PaO2
A - Age >55 
N - Neutrophils
C - Calcium 
R - Renal function
E - Enzymes
A - Albumin 
S - Sugar
54
Q

A score above what is considered severe pancreatitis in both Ranson’s and Glasgow Criterias?

A

3

55
Q

What are the 5 factors of Ranson’s Criteria at admission?

A
  • age
  • blood glucose
  • serum LDH
  • AST
  • WCC
56
Q

What is the serum LDH test a measure of?

A

Lactate dehydrogenase -> an enzyme that when in high accounts is a sign of tissue damage as it has been released from damaged cells

57
Q

What are the 5 factors of Ranson’s Criteria after 48hr from admission?

A
  • HCT fall
  • Blood urea
  • serum calcium
  • arterial PO2
  • base deficit
58
Q

What is HCT test?

A

Haematocrit -> expression of total percentage of blood volume that contains red blood cells

59
Q

List 6 local complications of pancreatitis.

A
  • fluid collection
  • pseudocysts
  • ascites
  • abscess
  • necrosis +/- infection
  • pleural effusion
60
Q

List 8 systemic complications of pancreatitis.

A
  • pulmonary failure
  • renal failure
  • sepsis
  • shock
  • metabolic acidosis
  • hyperglycaemia
  • hypocalcaemia
  • MODS
61
Q

What 3 factors are thought to lead to metabolic acidosis in pancreatitis?

A
  • loss of bicarbonate from pancreas
  • tissue damage leading to acidification of local tissues
  • due to lactic acidosis due to shock, pulmonary failure or sepsis
62
Q

What is general prognosis of acute pancreatitis?

A
  • Mild to moderate tend to recover, may develop acute pancreatitis.
  • severe tend to develop infection/necrosis and mortality is higher
63
Q

What are the main principles of management in acute pancreatitis?

A

Conservative

  • fluid resus
  • electrolyte correction
  • oxygen
  • antibiotics
  • nutrition maybe
  • analgesia (opiates e.g. tramadol, fentanyl)
64
Q

What are some symptoms of pancreatic pseudocysts?

A
  • pain
  • nausea
  • vomiting
  • jaundice
  • weight loss
65
Q

What is treatment for pancreatic pseudocyst?

A
  • endoscopic drainage
  • radiological drainage
  • surgical drainage
66
Q

What is treatment for pancreatic abscess?

A

-CT/US guided retroperitoneal or transperitoneal drainage

67
Q

How does chronic pancreatitis present?

A
  • epigastric pain
  • pain can radiate to back
  • pain may be episodic/chronic
  • anorexia
  • weight loss
68
Q

What substances can exacerbate chronic pancreatitis?

A
  • meal with high fat content

- alcohol excess

69
Q

What are some causes of chronic pancreatitis? (AIPATH)

A
  • alcohol
  • idiopathic
  • PD obstruction
  • autoimmune
  • tropical countries
  • hereditary
70
Q

What is an acquired anomaly that can cause PD obstruction and then chronic pancreatitis?

A

Pancreas Divisum

71
Q

What is pancreas divisum?

A

Congenital anomaly where a single pancreatic duct does not form but remains as two separate ducts

72
Q

What is raised in serum and tissue of type 1 autoimmune chronic pancreatitis?

A

IgG4 levels

73
Q

What are two differences between most common variant type 1 and second variant type 2 autoimmune chronic pancreatitis?

A
  • Raised IgG4 and autoantibodies found in type 1 and not in type 2
  • type 1 can involve extrapancreatic tissue whereas type 2 is usually limited just to pancreas
74
Q

What extrapancreatic tissues can be involved in type 1 autoimmune chronic pancreatitis?

A
  • biliary tree
  • salivary glands
  • renal tissue
  • thyroid tissue
75
Q

What deficiencies can lead to chronic pancreatitis in tropical countries?

A
  • zinc
  • methionine
  • selenium
76
Q

What hereditary disease can lead to chronic pancreatitis and why?

A

Cystic fibrosis due to mucous blocking pancreatic secretions

77
Q

Which type of chronic pancreatitis is not linked to activated trypsin pathways?

A

Autoimmune pancreatitis

78
Q

What can increased calcium in pancreas lead to?

A

Early activation of trypsinogen to trypsin

79
Q

What 3 factors can cause early trypsinogen activation to trypsin?

A
  • low pH
  • active trypsin
  • high calcium levels
80
Q

What are the two main pathophysiological pathways that may be dysfunctional causing chronic pancreatitis due to active trypsin?

A
  • increased/premature activation of trypsin from trypsinogen

- impaired inactivation/clearance of trypsin from pancreas

81
Q

What are two findings in x-ray/CT scan that confirm diagnosis of chronic pancreatitis?

A
  • pancreatic calcifications

- pancreatic duct dilatation

82
Q

What investigations are carried out in chronic pancreatitis?

A
  • serum amylase and lipase
  • serum IgG4 levels
  • faecal elastase
  • gene mutation analysis
  • US
  • CT
  • MRI with MRCP
83
Q

What analgesics are used for pain management in chronic pancreatitis?

A
  • NSAID + opiate
  • coeliac axis nerve block
  • tricyclic antidepressents
84
Q

What are 5 signs of pancreatic insufficiency and what is treatment?

A
  • bloating
  • pain
  • loose, fatty pale stools
  • weight loss
  • increased stool frequency
  • treatment is creon (enzyme replacement therapy)
85
Q

What surgical treatments can be used in patients with chronic pain in chronic pancreatitis?

A

endoscopic or surgical:

  • removal of intraductal stones
  • stenting
  • surgical duct drainage procedure and/or partial resection of head of pancreas
86
Q

What is treatment for malapsorption and steatorrhea in chronic pancreatitis and what might be prescribed in addition?

A

enzyme supplements sometimes prescribed with acid suppressors (PPI’s/H2 receptor antagonist) to prevent acid denaturation of the enzymes

87
Q

What is the Pustow Procedure and what is it used to treat?

A
  • Pustow Procedure is a surgery in which the pancreatic duct is cut open and anastomosed to a section of jejunum that has been divided and other end reattached to end of jejunum
  • chronic pancreatitis
88
Q

What is initial treatment for autoimmune pancreatitis and relapse treatment?

A
  • initial: prednisolone

- relapse: azathioprine

89
Q

What are 8 complications of chronic pancreatitis?

A
  • splenic vein thrombosis
  • pseudoaneurysm on splenic artery
  • pancreatic cancer
  • ascites
  • pleural effusion
  • pseudocysts
  • biliary obstruction
  • duodenal obstruction
90
Q

What can pseudocyst affect?

A
  • occlude bile duct
  • occlude gastric outlet
  • occlude duodenum
91
Q

What is management for duodenal obstruction in chronic pancreatitis?

A
  • stent
  • bypass
  • resection
92
Q

What is the exocrine type of pancreatic tumour?

A

adenocarcinoma

93
Q

List 5 types of endocrine pancreatic tumours.

A
  • gastrinoma
  • insulinoma
  • glucagonoma
  • somatostatinoma
  • vipoma (vaso active intestinal polypeptide)
94
Q

What does a gastrinoma produce and what effect can this have?

A
  • gastrin
  • increases stomach acid
  • > can lead to PUD
95
Q

What does insulinoma produce and what effect can this have?

A
  • insulin

- encourages sugar uptake and storage -> can lead to hypoglycaemia

96
Q

What does glucagonoma produces and what effect can this have?

A
  • glucagon
  • increases serum blood sugars
  • > can lead to hyperglycaemia
97
Q

What is the most common form of pancreatic cancer?

A

Adenocarcinoma (exocrine)

98
Q

Within which part of the pancreas do most tumours form?

A

head of pancreas

99
Q

What does vipoma induce and what are 3 signs of vipoma?

A
  • induces glucogenolysis and hyperglycaemia
  • watery diarrhoea
  • hypokalaemia
  • achlorydia
100
Q

What are 6 symptoms & signs of pancreatic cancer?

A
  • abdo and back pain
  • weight loss
  • anorexia
  • jaundice
  • loose, pale stools
  • dark urine
  • pruritus
101
Q

What are risk factors of pancreatic cancer?

A
  • smoking
  • diabetes
  • chronic pancreatitis
  • obesity
102
Q

What diagnostic tests are used when investigating pancreatic cancer and what can each identify?

A
  • ultrasound -> can identify dilated intrahepatic bile ducts and mass in head of pancreas (not tail or body)
  • contrast CT scan (triple phase) -> mass, lymph node involvement, metastasis
  • endoscopic ultrasound -> used for investigating small lesions CT might miss
  • MRCP/MRI
103
Q

What is prognosis with pancreatic tumour?

A
  • Mostly in-operable, only approx. 20% operable

- survival rate poor

104
Q

What 4 aspects are managed and how in in-operable pancreatic cancer?

A
  • pain -> with opiates
  • malabsorption -> with enzyme supplementation
  • obstructive jaundice -> stents
  • duodenal osbtruction -> stents
105
Q

What are 3 procedures used as treatment in patients with resectable pancreatic tumours?

A
  • Whipple’s procedure
  • distal pancreatectomy
  • total pancreatectomy
106
Q

What are 3 procedures used as treatment in patients with non-resectable pancreatic tumours?

A
  • biliary bypass
  • double bypass
  • gastric bypass
107
Q

What is the Whipple’s Procedure?

A

Surgery where duodenum and head of pancreas are cut out, stomach is joined onto the jejenum and end of pancreas is attached onto the jejenum

108
Q

In which cells does pancreatic adenocarcinoma originate?

A

ductal epithelium

GI (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions