Pancreas/Gall Bladder Physiology

Question 1

What cells in the pancreas secrete digestive enzymes?

Answer 1

Acinar cells

Question 2

What cells in the pancreas secrete bicarbonate?

Answer 2

Centroacinar and duct cells

Question 3

What proteases are secreted by the pancreas?

Answer 3

Trypsinogen
Chymotrypsinogen
Proelastase
Procarboxypeptidase A and B

Question 4

What amylolytic enzymes are secreted by the pancreas?

Answer 4

Amylase (pancreatic amylase)

Question 5

What lipase are secreted by the pancreas?

Answer 5

lipase
Nonspecific esterase
Prophospholipase A2

Question 6

What nucleases are secreted by the pancreas?

Answer 6

Deoxyribonuclease

Ribonuclease

Question 7

What is the role of colipase?

Answer 7

Works with lipase to activate it.

Question 8

What are the granules called that hold enzymes in the pancreas?

Answer 8

Zymogen granules

Question 9

What two ions are exchanged as a part of the duct function?

Answer 9

Bicarbonate pushed out for chloride being brought in

Question 10

What transporter is important for Cl homeostasis in the centroacinar cells?

Answer 10

CFTR

Question 11

During the cephalic/gastric phase, what stimulates acinar cells?

Answer 11

ACh, GRP from vagal centers

Question 12

In the intestinal phase, what changes in enzyme output is seen?

Answer 12

30% enzyme output increased to 70%

Question 13

What cells secrete CCK? What activates them?

Answer 13

I cells activated by CCK-RP and monitor peptide

Question 14

What cells secrete secretin? What activates them?

Answer 14

S cells activated by H+

Question 15

What is the intracellular pathway by which acinar cells increase content discharge?

Answer 15

Ca mostly

Then cAMP

Question 16

What activates CCK-RP release?

Answer 16

Amino acids and fatty acids in lumen

Question 17

What are four things that CCK does?

Answer 17

Gall bladder contraction
Pancreas acinar secretion
Stomach reduced emptying
Sphincter of Oddi relaxation

Question 18

What activates trypsinogen?

Answer 18

Enteropeptidase

Question 19

What enzyme is mutated in hereditary pancreatitis? What is its role?

Answer 19

PRSS1 gene

Trypsinogen gene mutation that prevents trypsin elimination

Question 20

What are some effects of pancreatitis?

Answer 20

Abdominal pain from pancreatic autodigestion
Increased serum lipase and amylase
Steatorrhea and fat-soluble vitamin insufficiency
Malignancy, diabetes, infx

Question 21

Why does oral glucose lead to higher insulin levels than IV glucose?

Answer 21

GLP1 is released from L cells in the intestine and GIP from K cells

Question 22

What happens to satiety when someone lacks sleep?

Answer 22

Leptin levels lower, decreasing satiety and inducing hyperphagia and overeating

Question 23

What four hormones stimulate insulin secretion of beta cells in the islets of langerhans? Which are negative regulators?

Answer 23

GLP-1, gastrin, cholecystokinin, and acetylcholine

Negative regulators: somatostatin, norepinephrine

Question 24

What molecules are satiety signals at the hypothalamus?

Answer 24

GLP1, CCK, Insulin, Leptin

Question 25

What molecule stimulates appetite and decreases energy expenditure?

Answer 25

Ghrelin

Question 26

What produces ghrelin?

Answer 26

Fundus of stomach

Question 27

What are the major functions of the liver?

Answer 27

Processing all ingested nutrients, detoxification Metabolism of carbs, fats, proteins Buffers glucose Synth of factors important for circulatory system Bile formation for uptake and excretion of lipophilic molecules

Question 28

What cells synthesize bile?

Answer 28

Hepatocytes

Question 29

What is the hepatic triad?

Answer 29

Portal vein, hepatic artery, bile duct

Question 30

What is a Kupffer cell?

Answer 30

Macrophage of the liver

Question 31

Where are chylomicron remnants sieved into?

Answer 31

Space of Disse

Question 32

What is the role of stellate cells?

Answer 32

Produce collagen | Store lipids like Vitamin A

Question 33

What synthetic cells are hyperactive in cirrhosis? | What does that cause?

Answer 33

Stellate cells | Irreversible deposition of excess collagen

Question 34

What causes stellate cells to be hyperactive in cirrhosis?

Answer 34

Oxidative stress causes Kupffer cells to release cytokines inducing collagen production

Question 35

What is hepatic encephalopathy?

Answer 35

When toxins enter blood stream because of too much shunting

Question 36

What facilitates excretion of hydrophobic molecules?

Answer 36

Bile salts

Question 37

Describe the pathway of bile salts

Answer 37

``` Secreted into bile duct Concentrated in gall bladder Passes to duodenum Reabsorbed from ileum into portal vein Goes back to liver ```

Question 38

How much of the bile salts are lost in feces?

Answer 38

5%

Question 39

What enzyme is critical for cholesterol conversion into bile acid?

Answer 39

7-a-hydroxylase

Question 40

What must be added to a bile acid to become a bile salt?

Answer 40

Glycine or taurine

Question 41

What bacterial product of bile salts must be sulfated and excreted?

Answer 41

Lithocholic acid

Question 42

After leaving the canaliculi, where does bile go? What lines these ducts?

Answer 42

Canals of Hering | Lined with cholangiocytes

Question 43

What is taken out and added in the canals of Hering

Answer 43

Glucose and amino acids removed | IgA and mucus added

Question 44

What causes bile to be concentrated in the gall bladder?

Answer 44

Na and Cl pumped out of bile, water follows osmotic gradient

Question 45

What transporter is responsible for conjugated bile salt uptake from the GI lumen? Where is it found?

Answer 45

Apical sodium-dependent bile salt transporter | Foundin Ileum

Question 46

What transporter is responsible for taking up conjugated bile salts from the sinusoids?

Answer 46

Na dependent taurocholate transporter

Question 47

What are causes of cholestasis (impaired bile secretion)?

Answer 47

Primary Biliary Cirrhosis (destruction of cholangiocytes) Primary Sclerosing Cholangitis (inflammation of bile ducts) Pregnancy (progesterone reduces GB smooth muscle tone)

Question 48

What are some effects of cholestasis?

Answer 48

Metabolic dysfunction (bile accumulation in liver) Itching (bile in plasma) Hypercholesterolemia Deficiency of ADEK