Chapter 18 - Pancreas

Question 1

The pancreas has how many segments:

a. 4
b. 3
c. 12
d. 100

Answer 1

b. 3 (Head, body and tail)

Question 2

Can you name the two basic cell types in the pancreas?

Answer 2

exocrine and endocrine

Question 3

The ___ cells are exocrine cells that form grape-like lobules to form an entire gland in the pancreas.

Answer 3

acinar cells 🍇

Question 4

What does the acinar cells secrete?

Answer 4

Digestive enzymes (eg. amylase, lipase & proteases)

Question 5

What is the name of the main pancreatic duct?

Answer 5

duct of Wirsung (runs the whole length of the pancreas joining the CBD)

Question 6

The minor papilla connects to the accessory duct in the pancreas is called what?

Answer 6

duct of Santorini

Question 7

The remaining 1% of the pancreatic cells are endocrine cells. They are located in the ____ __ _______, mainly in the tail.

Answer 7

islets of Langerhans

Question 8

What are the 2 main functions of the pancreas?

1.
2.

Answer 8

1. Produce enzymes for digestion (exocrine)

2. Produce hormones that regulate BSL (endocrine)

Question 9

What 3 types of endocrine cells does the pancreas produce?

Answer 9

a. alpha - glucagon
b. beta - insulin

d. delta - somatostatin

Question 10

When BSL falls below normal the ___ cells are stimulated to secrete glucagon to increase BSL.

Answer 10

alpha

Question 11

What cell is stimulated to lower the BSL when it is higher than normal?

Answer 11

beta cells secrete insulin to reduce BSL

Question 12

The hormone somatostatin is secreted by the ___ cells and inhibits insulin and glucagon secretions as needed.

Answer 12

delta

Question 13

What are the 4 stages of pancreatic secretions?

Answer 13

1. Rest - slow rate of secretion
2. Cephalic phase - secretion occurs from smell and sight of food
3. Gastric phase - moderate secretions from distention of the stomach
4. Intestinal phase - food in stomach evoke 70% of the maximal rate of secretions

Question 14

Pancreatitis can be categorized into ___ or ___ pancreatitis.

Answer 14

acute or chronic

Question 15

Acute pancretitis is defined when two out of the three criteria is met. What are the three criterias?

Answer 15

1. Abdominal pain
2. Amylase or lipase level 3x greater than normal
   (exocrine acinar cells overstimulates)
3. Radiologic imaging consistent with diagnosis (CT scan or MRI)

Question 16

Common causes of acute pancreatitis includes alcohol, Gallstones, abdominal trauma, infections, drugs and which endoscopic procedure?

Answer 16

ERCP (accounts for 15% of all cases)

Question 17

What is the most severe form of acute pancreatitis?

Answer 17

Necrotizing pancretitis

Question 18

Treatment of acute pancreatitis is aimed at which objectives?

Answer 18

1. Hemodynamic stabilization
2. Correction of metabolic abnormalities
3. Reducing the risk of organ failure

Question 19

Medical treatment of acute pancretitis includes:

Answer 19

1. Pain relief
2. NBM
3. NG sectioning if significant vomiting
4. Electrolyte and fluid replacement
5. Blood transfusion as required
6. Insulin to control hyperglycemia
7. Antibiotics as needed

Question 20

In chronic pancretitis, 70% of cases in Western world is associated with long term ___ use.

Answer 20

alcohol

Question 21

Can you name a few symptoms and signs of chronic pancretitis?

Answer 21

1. Abdominal pain radiating to back
2. Weight loss and debilitation
3. Steatorrhea (oily stool)
4. Diabetes
5. Obstructive jaundice from bile duct stricture
6. Epigastric mass

Question 22

Treatment of chronic pancretitis includes:

Answer 22

1. Abstinence from alcohol
2. Pain relief
3. Nutritional support
4. Oral replacement of pancretatic enzymes when steatorrhea detected
5. Endoscopic intervention (eg. pancreatic stent placement, stone extraction)

Question 23

What is a pseudocyst?

Answer 23

An encapsulated fluid filled sac lined by granulation tissue (no epithlium thus not a true cyst)

Question 24

Diagnosis of pancreatic cystic tumors (most common at the head segment) is obtained by FNA. What is the treatment recommendation?

Answer 24

Whipple procedure (head of pancreas, gallbladder, bile duct and first part of duodenum removed)

Question 25

What is Zollinger-Ellison syndrome (ZES)?

Answer 25

A gastrinoma that releases gastrin to stimulate gastric acid hypersecretion. This leads to severe ulcers in the upper GI tract and often severe diarrhea.

Question 26

What is the medical treatment of Zollinger-Ellison syndrome (ZES)?

Answer 26

Long term PPI use ZES can also be malignant and is treated with chemotherapy and surgery after if not successful.

Question 27

Can you name the tumours associated with the alpha, beta and delta endocrine islet cells?

Answer 27

a. alpha - glucagonomas b. beta - insulinoma (most common) d. delta - somatostatinomas Treatment includes surgical excision.

Question 28

Pancreatic exocrine insufficiency generally results from chronic pancretitis leading to acinar loss. What is the treatment?

Answer 28

Oral enzyme preparations and acid suppression to improve delivery of enzymes into small bowel.

Question 29

Cystic fibrosis is an autosomal-recessive disease that affects the exocrine glands, respiratory system, sweat glands and reproductive system. The definitive diagnostic test for CF is ___. Treatment includes: - managing respiratory complications - Dietary regulation - Vitamin supplements - Pancreatic enzyme replacements

Answer 29

sweat electrolyte test

Question 30

Can you name a few congenital abnormality of the pancreas?

Answer 30

1. Pancreatic Rest (presence of pancreatic tissue usually in the gastric antrum) 2. Pancreas divisum (separate dorsal and ventral pancreatic ducts) 3. Annular pancreas (like pancreas divisum but ventral pancreas encircles duodenum leading to duodenum obstruction)

Question 31

What are the features of Shwachman-Diamond syndrome?

Answer 31

1. pancreatic insufficiency 2. growth retardation (prevalent clinical sign) 3. cyclic Neutropenia 4. metaphyseal dysostosis