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Gastrointestinal (LECTURE NOTES) > Pancreatic Diseases > Flashcards

Flashcards in Pancreatic Diseases Deck (43):
1

What is the role of the pancreas

Serves vital exocrine digestive functions and acts as the site of production of the endocrine hormones, insulin and glucagon, controlling glucose homeostasis

2

How is self-digestion prevented

By a carefully balanced suppressor system: disruption of that system by a variety of causes can result in pancreatic inflammation called pancreatitis

3

What can pancreatitis cause

scarring and destruction of pancreatic tissue with resultant loss of exocrine / endocrine function

4

What do pancreatic lobules consist of

connective tissue surrounding alveoli or pouches that are filled with secretory cells

5

What are the names of the islands of connective tissue between the alveoli

The islets of Langerhan

6

What types of cells are contained within the Islets of Langerhan

A and B cells

7

What are the role of the A and B cells in the islets of Langerhan

they produce the endocrine secretios of the pancreas involved in flucose homeostasis

8

What are the 3 parts of the pancreas

Head, body and tail

9

Where does the pancreatic duct commence

In the tail of the pancreas where the small duct from the pancreatic lobules join

10

What does the dorsal part of the pancreas form

Part of the head, the body and tail

11

What does the ventral part of the pancreas form

The rest of the head and uncinate process

12

Where does the pancreas lie initially in embryology

Intraperitoneally between the two layers of the dorsal mesogastrium

13

Where does the pancreas lie initially in embryology

Intraperitoneally between the two layers of the dorsal mesogastrium

14

What is released in response to a meal

Release of of cholecystokinin

15

Name 4 digestive enzymes produced in the pancreas

Amylase (carbs)
Lipase (fats)
Proteases (proteins)
Nucleases (DNA and RNA)

16

how does amylase work

It hydrolyses polysaccharides in starch and glycogen to maltose and other small oligosaccharides which can then be celaved to glucose by brush border enzymes in the small intestinal mucosa

17

Where else in the body is amylase produced

Salivary glands

18

What is the function of Co-lipase

T prevent bile salts from inhibiting the liplysis of triglycerides

19

Where is trypsin secreted from and as what

The acinar cells as trypsinogen

20

What is activated trypsin important in

As the common activator of other pancreatic enzymes such as more trypsinogen, chymotrypsinogen, proelastase, procarbosypeptidases and prophospholipase

21

How does trypsin act

To hydrolyse peptide bonds within the polypeptide chain of proteins

22

Pancreatic enzymes require a neutral pH to function. How is this environment promoted?

By the secretion of Sodium bicarbonate by pancreatic duct cells to neutralise the gastric acid which enters the duodenum

23

What is the main association with in chronic pancreatitis

Alcohol abuse

24

What are the 3 main features of chornic pancreatitis

Pain - epigastric (radiates to back)
Maldigestion - due to glandular destruction - daily exocrine and endocrine requirements cannot be met
Diabetes - pancreatic endocrine insufficiency results in flucose introlerance as insulin production drop below requirements

25

Why is the diagnosis of chronic pancreatitis often difficult

amylase and lipase levels are frequently normal

26

How is endocrine dysfunction tested for

Fasting glucose and glucose tolerance testing if indicated

27

How is exocrine function tested

using faecal elastase
reduced levels indicating reduced exocrine function

28

What provides the best means of assessing the degree of calcification of the pancreas

CT scan

29

What is the management for chronic pancreatitis

Largely symptomatic and aimed at managing pain and exocrine and endocrine insufficiency as well as nutritional support
Avoidance of alcohol and smoking

30

Aggressive glucose management should be reserved for who

Patients with good compliance and cessation of alcohol

31

What are the majority of pancreatic cancer

Adenocarcinomas

32

Pancreatic carcinoma is twice as common in men compared to women. True or false

True

33

At what age do pancreatic carcinomas appear

55

34

What are some of the clinical features of pancreatic carcinoma

Severe abdominal pain (radiating to back)
weight loss
obstructive jaundice
potentially splenomegaly
diabetes (due to glandular destruction by the tumour)

35

What is found in the investigations for Pancreatic carcinoma

Elevated ALP
elevated bilirubin

36

What are the 2 preferred imaging tests

CT or MRCP

37

What is the overall survival rate for pancreatic cancer

38

What is the only chance of curing pancreatic cancer

Total resection of the tumour

39

What is cystadenocarcinoma

A rare adenomatous tumour that results from malignant degeneration of a mucous cystadenoma

40

Is the tumour in cystadnocarcinoma fast or slow growing

Slow

41

Who is most likely to get an intraductal papillary mucinous tumour

Females

42

What does the tumour do in intraductal papillary mucinous

It over-secretes mucin, causing pain and recurrent bouts of pancreatitis

43

What is the typical appearance seen on ERCP

Fish eye