B5-066 Pancreas Flashcards
1
Q
islets of langerhans
endocrine or exocrine?
A
endocrine
2
Q
a-cell
b-cell
d-cell
endocrine or exocrine?
A
endocrine
3
Q
glucagon
endocrine or exocrine?
A
endocrine
4
Q
insulin
endocrine or exocrine?
A
endocrine
5
Q
somatostatin
endocrine or exocrine?
A
endocrine
6
Q
acinar cells
endocrine or exocrine?
A
exocrine
7
Q
a-cells secrete
A
glucagon
8
Q
b-cells secrete
A
insulin
9
Q
produce and transport enzymes to the duodenum
A
acinar cells
10
Q
- extension of intercalated duct cells
- produce bicarbonate
A
centroacinar cells
11
Q
secretion of digestive enzymes, fluid and bicarb
endocrine or exocrine?
A
exocrine
12
Q
the absence of proper pancreatic secretion may eventually cause
A
malnutrition
due to maldigestion/absorption
13
Q
digestive enzymes are produced by […] cells
A
acinar
14
Q
when chyme comes in contact with the intestinal mucosa, it activates
A
pro-entropeptidase –> enteropeptidase
cleaves trysinogen to trypsin
15
Q
zymogens
3
A
chymotrypsinogen
procarboxypeptidases
proelastase
16
Q
premature enzyme activation is prevented by 4 mechanisms..
A
- packaging of zymogens
- intracellular calcium homestasis
- acid-base balance prevents rise in pH
- protease inhibitors secreted by acinar cells
17
Q
produced by centroacinar (ductal) cells
A
bicarb
18
Q
key event in pancreatitis
A
premature trypsinogen activation
caused by elevated Ca+
19
Q
breaks down starch and disaccarides in the cephalic phase
A
pancreatic amylase
20
Q
breaks down triglycerides in the cephalic phase
A
pancreatic lipases
21
Q
breaks down nucleic acids
A
pancreatic ribonuclease and deoxyribonuclease
22
Q
stimulates pancreatic bicarbonates and protein secretion
A
VIP
23
Q
inhibit pancreatic bicarb and protein secretion
A
PP
pancreatic polypeptide
24
Q
stimulates gastic acid secretion
released from G cells
A
gastrin
25
* stimulates secretion of pancreatic enzymes
* contraction of gallbladder
* delivery of bile into small intestine
CCK
26
* stimulates secretion of water and bicarb from the pancreas and bile ducts
* inhibits gastrin secretion
* stimulates bile production
secretin
27
released due to the presence of peptides and amino acids in the gastric lumen
gastrin
28
released in the presence of fatty acids and amino acids in the small intestine
CCK
29
released due to acidic pH in the lumen
secretin
30
individuals with celiac disease have reduced
**CCK**
reduces pancreatic secretions and gallbladder contractions
31
most common cause of exocrine pancreatic insufficiency
chronic pancreatitis
32
abnormal sticky mucus that blocks bile and pancreatic ducts
Cystic fibrosis
| cause of exocrine pancreatic insufficiency
33
9/10 CF patients depend on
PERT
34
in CF, lack of Cl- in lumen leads to
reduced H2O in lumen
35
causes of exocrine pancreatic insufficiency
| 4
* obstruction of biliary or pancreatic duct
* pancreatic cancer
* previous pancreatic surgery
* DM1
36
major characteristics of EPI
| 5
* frequent diarrhea
* gas/bloating
* stomach pain
* steatorrhea
* weight loss
37
20% of patients with chronic pancreatitis develop
EPI
38
EPI is treated with
PERT
39
gold standard for diagnosis of EPI
72 hr fecal fat test
40
* lipid soluble vitamin deficiency
* fecal elastase <200
* MPD dilation on imaging
| high clinical suspicion for
EPI
41
fecal elastase <15
| high clinical suspicion
EPI
42
avoid [...] in the treatment of EPI, they can make steatorrhea worse
calcium containing antacids
43
must be taken with a PPI or H2 blocker
viokace
| non-enteric coated
44
enteric coated/delayed release PERT therapy options
creon
pancreaze
pertyze
| etc
45
what PERT medication should be avoided in the treatment of CF?
non-enteric coated (viokace)
| require PPI or H2 inhibitor
46
associated with a higher number of hospitalizations for PH in CF patients
PPI
47
most common side effect of PERT therapy
hyperglycemia or hypoglycemia due to rate of amylase action
48
two major risk factors for chronic pancreatitis
alcohol
tobacco
49
* hypertrophy/dystrophy of nerves
* lymphocyte infiltration/fibrosis
chronic pancreatitis
50
characterized by **irreversible** damage that alters the organ's normal structure and function
chronic pancreatitis
51
major symptom is **chronic pain** starting in epigastrium and radiating toward back
chronic pancreatitis
52
patchy, focal disease characterized by mononuclear infiltrate and **fibrosis**
chronic pancreatitis
53
involves a large portion of the entire pancreas with a predominantly **neutrophilic** inflammatory response
acute pancreatitis
54
serum amylase and lipase concentrations tend to be [...] in chronic pancreatitis
normal
55
serum amylase and lipase tend to be [....] in acute pancreatitis
elevated
56
* upper abdominal "piercing" pain that travels to back
* aggravated by eating
* pain is **always** present but for variable periods of time
acute pancreatitis
57
* pain is constant, severe, radiates to back
* "gnawing"
* does not always present with pain
chronic pancreatitis
58
* acute inflammation
* acute abdominal pain
* elevated pancreatic serum enzymes (<24 hrs from onset)
* self-limited
acute pancreatitis
59
* pancreatic serum enzymes not elevated
* fibrosis and ductal obstruction
* permanent loss of function
chronic pancreatitis
60
what is considered chronic alcohol use that would lead to chronic pancreatits?
1 bottle of wine or 6-pack per day
for a decade
61
30% of chronic pancreatitis is
| cause
idiopathic
62
autoimmune pancreatitis is associated with
SLE
63
how does chronic alcohol use cause pancreatitis?
* ethanol disturbs the Ca+ homeostasis, causes oxidative stress
* activates trypsin prematurely
64
predominate in males
| large or small duct disease
large
65
* calcium carbonate stones
* diffuse pancreatic calcifications
* dilation visible on diagnostic imaging
| large or small duct disease
large
66
* normal imaging
* non-dilated main pancreatic duct
* no pancreatic calcification
| large or small duct disease
small
67
predominate in females
| large or small duct disease
small
68
fecal elastase will be [...] in chronic pancreatitis
abnormally low
69
hypercalcemia
| acute or chronic pancreatitis?
chronic
70
hypocalcemia
| acute or chronic pancreatitis?
acute
71
monitored to evaluate efficacy of PERT
fecal fat
72
serum amylase/lipase rarely elevated
| acute or chronic pancreatitis?
chronic
73
steatorrhea occurs when lipase production is less than [...]% of normal levels
10
74
chronic pancreatitis patients should be assessed frequently for [...] and [...] due to fat soluble vitamin deficiency
clotting function
bone density
75
management of chronic pancreatitis
* eliminate precipitating factor
* mangement of pain
* PERT
76
effective at reducing symptoms in chronic pancreatitis patients with an autoimmune etiology
steroids
77
chronic pancreatitis is caused by [...] in most cases
alcohol abuse
78
a a-cell tumor would secrete [...] and cause [...]
glucagon
hyperglycemia
79
a b-cell tumor would secrete [...] and cause [...]
insulin
hypoglycemia
80
a d-cell tumor would secrete [...] and cause [...]
somatostatin
diabetes, steatorrhea
81
a g-cell tumor would secrete [...] and cause [...]
gastrin
zollinger-ellison syndrome
82
an acinar cell tumor would secrete [...] and cause [...]
pancreatic enzymes
pancreatitis
83
a deficiency in vitamin A would cause
night blindness
84
a deficiency in vitamin K would cause
easy bruising
85
without exocrine function of the pancreas, [...] and [...] can not be digested/absorbed
dietary lipids
fat soluble vitamins
86
* stimulates pancreatic release of bicarbonate and water
* inhibits gastrin production by stomach
secretin
87
stimulates pancreatic enzyme release
CCK
88
most common causes of EPI
| 2
1. chronic pancreatitis
2. cystic fibrosis
89
how does CF cause EPI?
thick mucus in the pancreas blocks pancreatic enzymes from entering the small intestine
90
most specific test to evaluate chronic pancreatitis
fecal elastase
91
non-enterically coated PERT should be administered with a
PPI
| prevents acid inactivation of enzyme
92
released from duodenum in response to amino acids and fatty acids
CCK
