Denning- Pancreas X 2- Leah Flashcards
(44 cards)
Where does the main pancreatic duct empty and what does it join?
Where does the accessory pancreatic duct drain?
Main: joins common bile duct; empties to duodenum at ampulla of vater
Accessory: small papillae slightly proximal to ampulla of vater
Common Requirement for activation for all pancreatic digestive enzymes? Inhibitory enzyme released with acinar and ductal secretion?
- Duodenal enteropeptidase must cleave trypsinogen to trypsin
- Inhibitory Eynzme: serine protease inhibitor Kalazal Type 1
Acinar epithelial cells:
Shape
Location
Function
- Pyramidal shaped; radial orientation
- outside of islets in ductal system
- Secrete inert digestive enzymes; must be activated by proteases
How is the pancreas protected from enzymatic enzymes?
-enzymes inactive when released
AND
-acinar cells resistant to trypsin/chymotrypsin/PLase
Most severe congenital pancreatic condition?
Most common?
Agenesis- worst; incompatible with life
Pancreatic divisum- most common
Gene assc with pancreatic Agenesis?
PDX1; chromosome 13
What causes pancreatic divisum?
Where do pancreatic secretions drain?
Result?
- Failure of dorsal and ventral buds to fuse
- Secretions through small/ minor papillae
- Small papillae overwhelmed –> stenosis –> chronic pancreatitis
Name for a pancreas encircling the duodenum?
How does it present?
Annular pancreas; duodenal obstruction
Ectopic pancreas:
Typical location?
Possible sequelae?
Stomach + duodenum
2% islet cell neoplasms are from ectopic tissue
Acute pancreatitis is a ________ process.
Chronic causes __________.
Acute: reversible
Chronic: irreversible loss exocrine + endocrine function
Top two causes of acute pancreatitis?
Which is seen mostly in males?
Mostly in females?
Alcoholism/ biliary tract disease (male) + gall stones (female)
GET SMASHED mnemonic for causes of acute pancreatitis?
- Gall Stones
- Ethanol
- Trauma
- Steroids
- Mumps
- AI disease
- Scorpion Sting
- Hyperlipidemia
- Drugs
Pain described in acute pancreatitis?
What makes it worse or better?
Key lab findings? ***
Epigastric pain radiating to back
Relieve with doubling up
Worse with food
High amylase and lipase (not necessarily as pronounced in chronic)
Two genes assc with hereditary attacks of acute pancreatitis starting in childhood?
AD: cationic trypsinogen gene (PRSS1)
Trypsin resistant to cleavage
AR: serine protease inhibitor Kazal 1 (SPINK1)
Trypsin not inhibited
Appearance of a pancreas in acute pancreatitis?
5
- Fat Necrosis
- Calcium deposits
- Hemorrhage (destroyed vasculature)
- Edema
- Proteolytic Parenchymal destruction
What is the final common cause of acute pancreatitis in all types?
Activation of pancreatic ENZYMES!
Can be induced by obstruction in stones/alcoholism, defective transport in alcoholism, or cell injury in all types
3 ways alcohol causes acute pancreatitis?
- chronic ingestion = protein plugs –> obstruction
- directly toxic
- increased exocrine secretion
How is trypsin a bad actor in acute pancreatitis?
2 bad actions
- Activates OTHER enzymes
- -> fat and blood cells killed
- Activates kinin system
- -> clotting/complement
How can fat necrosis effect lab values in acute pancreatitis?
Fatty acids combine with calcium –> LOW CALCIUM = BAD PROGNOSTIC SIGN *****
**Test Question ***
How is disease severity predicted in acute pancreatitis?
Ransons criteria 48 HOURS AFTER ADMISSION
List that accounts for age/several labs etc
Worst sequelae of acute pancreatitis?
ARDS –> vascular collapse –> shock and death
4 other conditions to rule out when Dx’ing acute pancreatitis:
- Ruptured appendix
- perforated ulcer
- ruptured gallbladder
- bowel infarction
Four poor prognostic factors in acute pancreatitis?
- age
- high white count
- high glucose
- low ca
Class chronic pancreatitis patient?
Middle aged (AA?) alcoholic male
