Pancreatic Diseases Flashcards

(43 cards)

1
Q

What is the role of the pancreas

A

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

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2
Q

How is self-digestion prevented

A

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

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3
Q

What can pancreatitis cause

A

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

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4
Q

What do pancreatic lobules consist of

A

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

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5
Q

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

A

The islets of Langerhan

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6
Q

What types of cells are contained within the Islets of Langerhan

A

A and B cells

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7
Q

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

A

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

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8
Q

What are the 3 parts of the pancreas

A

Head, body and tail

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9
Q

Where does the pancreatic duct commence

A

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

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10
Q

What does the dorsal part of the pancreas form

A

Part of the head, the body and tail

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11
Q

What does the ventral part of the pancreas form

A

The rest of the head and uncinate process

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12
Q

Where does the pancreas lie initially in embryology

A

Intraperitoneally between the two layers of the dorsal mesogastrium

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13
Q

Where does the pancreas lie initially in embryology

A

Intraperitoneally between the two layers of the dorsal mesogastrium

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14
Q

What is released in response to a meal

A

Release of of cholecystokinin

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15
Q

Name 4 digestive enzymes produced in the pancreas

A

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

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16
Q

how does amylase work

A

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

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17
Q

Where else in the body is amylase produced

A

Salivary glands

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18
Q

What is the function of Co-lipase

A

T prevent bile salts from inhibiting the liplysis of triglycerides

19
Q

Where is trypsin secreted from and as what

A

The acinar cells as trypsinogen

20
Q

What is activated trypsin important in

A

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

21
Q

How does trypsin act

A

To hydrolyse peptide bonds within the polypeptide chain of proteins

22
Q

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

A

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

23
Q

What is the main association with in chronic pancreatitis

A

Alcohol abuse

24
Q

What are the 3 main features of chornic pancreatitis

A

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