(F) L5: GITP: Pancreas Flashcards by Kchianna Lauren Coronel

Q

The pancreas is the only digestive accessory gland located where in respect to the GIT?

A

Outside the GIT

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Q

Composition

Composed of the islets of Langerhans that produces insulin, glucagon, and other hormones

A

Endocrine Glandular Cells (1%)

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Q

Composition

Consists of acinar cells (grape-like clusters) responsible for the production of pancreatic juices

A

Exocrine Glandular Cells (99%)

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Q

Composition (Exocrine)

These are rich in digestive enzymes capable of digesting carbohydrates (amylase), proteins (trypsin and elastase), and lipids (lipase)

A

Pancreatic Juices

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Q

Composition (Exocrine)

Pancreatic juices are made up of what 3 components?

A

Water
Sodium bicarbonate
Other enzymes

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Q

Composition (Exocrine)

Sodium bicarbonate functions by:
1. Buffering the (acidic/alkaline) gastric juice
2. (Stopping/Starting) the action of pepsin
3. Producing the optimum (temperature/pH) at neutral levels for pancreatic and brush border enzymes

A

Acidic
Stopping
pH

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Q

Regulation of Pancreatic Secretions

Secretin and Cholecystokinin are secreted by what cells?

A

Enteroendocrine Cells

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Q

Regulation of Pancreatic Secretions

This regulates the production of pancreatic juice by inhibiting gastrin secretion
Is stimulated by the acidic gastric content, wherein if present, the pancreas will be stimulated to release it

A

Secretin

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Q

Regulation of Pancreatic Secretions

Aka pancreozymin
Regulates the release of pancreatic enzymes by inhibiting gastric emptying and secretion
Stimulated by the presence of amino and fatty acids

A

Cholecystokinin (CKK)

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Q

Regulation of Pancreatic Secretions

Stimulated by acidic gastric contents:
A. Secretin
B. Cholecystokinin
C. Both
D. Neither

A

A. Secretin

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Q

Regulation of Pancreatic Secretions

Stimulated by amino acids and fatty acids:
A. Secretin
B. Cholecystokinin
C. Both
D. Neither

A

B. Cholecystokinin

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Q

Regulation of Pancreatic Secretions

Produced by enteroendocrine cells:
A. Secretin
B. Cholecystokinin
C. Both
D. Neither

A

C. Both

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Q

Pancreatic Diseases

If the head of the pancreas is the one affected, what effect does it have on the patient?

A

Mild and often no adverse effects

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Q

Pancreatic Diseases

If the body of pancreas is the one affected, what effect does it have on the patient?

A

Signs and symptoms are present

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Q

Pancreatic Diseases

Aka fibrocystic disease of the pancreas/mucoviscocidosis
The dysfunction of all mucus and exocrine glands throughout the body including sweat and sebaceous glands wherein they turn into small cysts
Affects the pancreas, liver, lungs, sinuses, skin, intestine, and reproductive organs

A

Cystic Fibrosis

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Q

Pancreatic Diseases

A systemic disease wherein all organs are mucus-filled

A

Cystic Fibrosis

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Q

Pancreatic Diseases

Symptoms of Cystic Fibrosis:
1. Pancreatic ducts are (constricted/dilated)
2. Acinar cells convert into (small/large cysts) filled with mucus
3. Maldigestion occurs as a result of a (increased/decreased) secretion of digestive enzymes

A

Dilated
Small
Decreased

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Q

Pancreatic Diseases

A pancreatic alpha cell tumor that increases gastrin secretion
Aka gastrinoma and is associated with Zollinger-Ellison Syndrome

A

Pancreatic Carcinoma

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Q

Pancreatic Diseases

Alpha or Beta Pancreatic Cell Tumor?
A rare complication that often leads to insulinoma or hyperinsulinism which decreases blood glucose levels

A

Beta

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Q

Pancreatic Diseases

Alpha or Beta Pancreatic Cell Tumor?
The tumor increases gastrin secretion

A

Alpha

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Q

Pancreatic Diseases

Increased gastrin secretion
A. Pancreatic alpha cell tumor
B. Pancreatic beta cell tumor
C. Both
D. Neither

A

A. Pancreatic alpha cell tumor

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Q

Pancreatic Diseases

Increased insulin secretion
A. Pancreatic alpha cell tumor
B. Pancreatic beta cell tumor
C. Both
D. Neither

A

B. Pancreatic beta cell tumor

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Q

Pancreatic Diseases

The inflammation of the pancreas which can be acute with no permanent damage to the pancreas, or chronic with irreversible injury

A

Pancreatitis

Q

Pancreatic Diseases

In pancreatitis, autodigestion of the organ occurs with (increased/decreased) production of trypsin for protein digestion

A

Increased (it breaks down pancreatic cells)

# Pancreatic Diseases Increased or Decreased in Pancreatitis? AMS, LPS, TAGs, Calcium, and Parathyroid Hormone

ALL INCREASED (hypercalcemia and hyperparathyroidism)

# Pancreatic Diseases - Is related to pancreatic disease - There is diminished pancreatic exocrine function compromising digestion and absorption of ingested nutrients (abnormal absorption) - Manifests as abdominal bloating and discomfort, bulky and malodorous feces, and weight loss

General Malabsorption Syndrome

# Pancreatic Function Tests - A stimulation test that measures the secretory and exocrine function of the pancreas - It measures pH, secretory rate, enzyme activities, and sodium bicarbonate

Secretin or CKK Tests

# Pancreatic Function Tests A decrease in sodium bicarbonate is an indication of what disorder?

Cystic Fibrosis

# Pancreatic Function Tests (Secretin/CKK Test) How many hours of fasting is required alongside an intubation of the duodenum?

6 hours

# Pancreatic Function Tests (Secretin/CKK Test) Secretin and CKK are administered via what? | Note: The patient can be stimulated with either or both

IV

# Pancreatic Function Tests (Secretin/CKK Test) Duodenal aspirate is collected and analyzed at what time intervals?

30, 60, and 80 minutes

# Pancreatic Function Tests (Secretin/CKK Test) Male or Female Value? 15 mM per hour

Male

# Pancreatic Function Tests (Secretin/CKK Test) Male or Female Value? 12 mM per hour

Female

# Pancreatic Function Tests - Used for diagnosis of lipid malabsorption - Can be qualitative or quantitative

Fecal Fat Analysis

# Pancreatic Function Tests (Fecal Fat Analysis) Interpret the results: 1 to 4 grams per day

Lipid-free diet

# Pancreatic Function Tests (Fecal Fat Analysis) Interpret the results: Less than 7 grams per day

Lipid-rich diet

# Pancreatic Function Tests (Fecal Fat Analysis) This screening test uses Sudan II and IV, Oil Red O, and Nile Blue Sulfate

Qualitative Screening

# Pancreatic Function Tests (Fecal Fat Analysis) Sudan III and IV stains TAGs (neutral fats) what color? | Note: For qualitative screening

Yellow-orange to red

# Pancreatic Function Tests (Fecal Fat Analysis) What is the normal value for the qualitative screening test?

40 to 50 small lipid droplets in a HPF (diameters of 1 to 5mm)

# Pancreatic Function Tests (Fecal Fat Analysis) - Refers to the the failure to absorb fats - Indicated by more than (>) 50 small lipid droplets per HPF with a diameter of 50 to 100mm fat globules

Steatorrhea | Note: For qualitative screening

# Pancreatic Function Tests (Fecal Fat Analysis) This requires a 72-hour stool sample

Quantitative Screening

# Pancreatic Function Tests (Fecal Fat Analysis) In Quantitative Screening, this method uses fatty acid soap converted to free fatty acids

Gravimetric Method

# Pancreatic Function Tests (Fecal Fat Analysis) In Quantitative Screening, this method incorporates saponification of lipids by hydroxide

Titration Method

# Pancreatic Function Tests - The measurement of sodium and chloride concentration in sweat to diagnose cystic fibrosis in children - A traditional method of sweat collection is done by using plastic bags or wrapping the patient in blankets

Sweat Electrolyte Determination

# Pancreatic Function Tests (Sweat Electrolyte Determination) This is the method of choice for sweat collection wherein an electric current is used causing a migration of pilocarpine to skin in the forearm

Pilocarpine Iontophoresis Technique

# Pancreatic Function Tests (Sweat Electrolyte Determination) A result of more than how many mmol/L is indicative of cystic fibrosis?

60 mmol/L

# Pancreatic Enzymes - A measurement for acute pancreatitis - Not a specific measure of pancreatic function because these are also produced by the salivary glands - It detects pancreatic disease, such as acute pancreatitis in adults - Is freely filtered by the glomerular capillaries

Serum Amylase of > 600 SU/dL (Somogyi Units)

# Pancreatic Enzymes - A sensitive marker of acute pancreatitis wherein values of 1000 SU/dL indicates it - There is intermittent or minor increase in serum concentration

Amylase Clearance

# Pancreatic Enzymes - This is an enzyme that hydrolyzes glycerol esters of TAG - This is normally absent in the urine because it is freely filtered but reabsorbed - A more sensitive indicator of acute pancreatitis compared to the other technique since this is only produced in the pancreas

Serum Lipase

# Diseases Associated with AMS and LPS Increased AMS, LPS, or BOTH? - Opiate administration - Pancreatic carcinoma - Intestinal infarction - Intestinal obstruction - Intestinal perforation - Pancreatic trauma - Mumps

Both increased

# Diseases Associated with AMS and LPS Increased AMS, LPS, or BOTH? - Cholecystitis - Hepatitis - Cirrhosis - Ruptured ectopic pregnancy - Macroamelysia

AMS

# Diseases Associated with AMS and LPS Increased AMS, LPS, or BOTH? - Fractured bones - Fat embolism

LPS

# Pancreatic Enzymes - A chymotrypsin-like enzyme secreted by the pancreas - Sensitive marker of pancreatic function - A non-invasive method performed using a random stool sample

Fecal Elastase

# Pancreatic Enzymes (Fecal Elastase) Interpret results: Greater than 200 µg/g

Normal

# Pancreatic Enzymes (Fecal Elastase) Interpret results: 100-200 µg/g

Pancreatic insufficiency

# Pancreatic Enzymes (Fecal Elastase) Interpret results: < 100 µg/g

Severe pancreatic insufficiency