Pancreas & GI System

Question 1

Pancreas endocrine functions

Answer 1

insulin
glucagon
somatostatin

Question 2

pancreas exocrine functions

Answer 2

enzymes for digestion & bicarb ion to neutralize acids in intestine
amylase (CHO) & lipase (fats)
trypsin, chymotrypsin, elastase, collegenase, leucine aminopeptidase

Question 3

pancreas nerve control

Answer 3

vagus nerve branches

stimulates small amount of secretions responding to food smell /view

Question 4

pancreas endocrine control

Answer 4

CCK & Secretin

Question 5

Secretin

Answer 5

made in response to HCL acid @ duodenum in small intestine

leads to pancreas release of bicarb ion

Question 6

CCK

Answer 6

cholecystokinin from intestinal mucosa

causes pancreas to release digestive enzymes

Question 7

pancreatic diseases

Answer 7

cystic fibrosis
pancreatic cancer
pancreatitis

Question 8

Cystic fibrosis

Answer 8

dysfunction of mucous & exocrine glands throughout the body
see intestinal obstruction, pulmonary infections & pancreatic malabsorption
ch 7 gene CFTR

Question 9

sweat chloride test

Answer 9

> 60 mEg/L is diagnostic

done at least twice

Question 10

sweat chloride test

Answer 10

> 60 mEg/L is diagnostic
done at least twice
apply pilocarpine to skin, collect sweat, measure

Question 11

Pancreatic Carcinoma

Answer 11

death w/in 1 yr for 90% of diagnosed cases

tumors in tail & body of pancreas missed until advanced

Question 12

signs of pancreatic carcinoma

Answer 12

jaundice (post-hepatic), weight loss, anorexia, nausea
islets of pancreas make excess insulin
overproduction of gastrin in Zollinger-Ellison syndrome

Question 13

Acute Pancreatitis

Answer 13

inflammation of pancreas (usually reversible)

autodigestion of gland due to reflux of bile &/or duodenal contents into pancreatic duct

Question 14

causes of acute pancreatitis

Answer 14

alcohol abuse
mumps
obstruction of biliary tract
gallstones
pancreatic tumors
atherosclerotic disease
shock
pregnancy
hypercalecemia
immunologic factors associated w/ transplantation

Question 15

lab tests for acute pancreatitis

Answer 15

amylase 2-3x
lipase elevated but as much as amylase
increased triglycerides, variable calcium levels
decreased 02

Question 16

Chronic pancreatitis most common cause

Answer 16

alcohol abuse

Question 17

chronic pancreatitis signs/symptoms/things associated w/ it

Answer 17

edema & fluid buildup in peritoneal cavity w/ associated decrease in blood volume
acinar cells of pancreas become infiltrated by inflammation
can develop hemorrhage & necrosis

Question 18

chronic pancreatitis labs

Answer 18

increased lipase, triglycerides, & calcium

decreased 02

Question 19

‘give away’ for chronic pancreatitis

Answer 19

elevated lipase & normal amylase

hemorrhage is exclusively chronic

Question 20

relapse/recurrent pancreatitis

Answer 20

causes similar to acute pancreatitis

either acute or chronic w/ similar labs

Question 21

symptom/lab result that is common to all pancreatitis

Answer 21

steatorrhea - greasy feces >5g/24hr fecal fat

& malabsorption

Question 22

pancreatic function testing

Answer 22

amylase & lipase
malabsorption using D-xylose
CCK, secretin, fecal fat, trypsin, chymotrypsin
bilirubin & ALP (biliary obstruction)
assays for gastrin, insulin, glucose
secretin clearance test

Question 23

Secretin clearance testing

Answer 23

give IV secretin, follow w/ CCK
collect secretions for 30, 60, or 80 mins in either 10 min intervals or as a single pool
measure pH, secretion rate, enzyme activities, & bicarb ion

Question 24

Fecal Fat analysis

Answer 24

qualitative testing: lipid stains such as Sudan III, Oil red O, nile blue sulfate
quantitative: collect stool for 3 days & use gravimetric, titrimetric, infrared & nuclear magnetic resonance spectroscopy

Question 25

when is steatorrhea seen?

Answer 25

biliary obstruction pancreatic insufficiency disease of small intestine

Question 26

gravimetric method

Answer 26

``` extract fatty acids into organic solvent aliquot in pre-weighed container evaporate solvent weigh residue take difference in weight 1-7 g/24 hr range ```

Question 27

Titrimetric method

Answer 27

extract saponified lipids, evaporate solven, reconstitute in ethanol, titrate w/ NaOH results are 20% less than gravimetric method

Question 28

cases w/ amylase increases

Answer 28

75% of acute pancreatitis burns sepsis diabetic ketoacidosis

Question 29

parietal cells

Answer 29

produce HCl acid & intrinsic factor (facilitates absorption of vit B12 in ileum)

Question 30

Chief cells

Answer 30

pepsin cells | make pepsinogen - converted by acid to pepsin to break down proteins

Question 31

G cells

Answer 31

produce gastrin in antrum of stomach & duodenum | respond to stimulation from vegas nerve

Question 32

Gastrin stimulation

Answer 32

neurogenic impulses= smell, sight, anticipation distention of stomach w/ food/fluid contact of protein- breakdown called secretagogues

Question 33

Gastrin inhibited by

Answer 33

high gastric acidity gastric inhibitory polypeptide (GIP) secreted in response to food vasoactive intestinal polypeptide (VIP)- inhibits everything about gastrin

Question 34

Gastric analysis

Answer 34

measure basal acid output (BAO) & peak acid output (PAO) | pentagastrin stimulation - synthetic peptide

Question 35

gastric acid & pernicious anemia

Answer 35

no acid present

Question 36

gastric acid & Zollinger-Ellison syndrome

Answer 36

hyperacid present normal range: 50-150 pg/ml Z-E : 1000-400000 pg/ml

Question 37

Gastric ulcer

Answer 37

normal acid output

Question 38

duodenal ulcer

Answer 38

increased output for BAO & PAO

Question 39

Small intestine

Answer 39

20 feet | absorb nutrients & water through passive & active transport

Question 40

Large intestine

Answer 40

5 feet long | water reabsorption & store feces

Question 41

pathology of intestine

Answer 41

MALABSORPTION mostly celiac's disease, whipple's disease, crohns disease, primary intestinal lymphangiectasia, ischema, amyloidosis, giardiasis, lactase deficiency, hartnup syndrome

Question 42

Hartnup syndrome

Answer 42

defect in transport of phenylalanine & leucine

Question 43

Tests for intestinal function

Answer 43

``` lactose tolerance test D-xylose absorption test serum carotenoids fat soluble vit assays albumin folate & vit B12 iron assays calcium & magnesium (decreases seen in vit D deficiency) ```

Question 44

Lactose tolerance test

Answer 44

hydrogen ion breath test acquired deficiency > genetic cramps, diarrhea, abdominal discomfort

Question 45

D- Xylose test

Answer 45

pentose sugar not found in foods absorbed unaltered by the proximal small intestine & filtered out the kidney unchanged heat urine to change D-xylose to furfural react w/ p-bromoaniline spectro

Question 46

Serum Carotenoids

Answer 46

humans express carotenoids of lycopene, xanthophyll, & beta carotene tell about human lipid absorption