Pancreatic Function Flashcards by Jillian Jarrell

What does the GI system contain

mouth, esophagus, stomach, small intestine, large intestine

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What process does is this describing?

The process by which starches, proteins, lipids, nucleic acids, other complex molecules are degraded for absorption and use in the body

Digestion (small intestine mostly)

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This is a description of which organ:

Large gland involved in digestion
Not in the GI tract
Exocrine tissues: production of enzymes used in digestive process
Endocrine tissues: production of insulin and glucagon

Pancreas

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This is the physiology of which organ?

Weights 70-105 g
Second in size to the liver
Behind the peritoneal cavity
About the level of first and second lumbar vertebrae

Pancreas

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What area of the pancreas is this describing:

Liver and pancreas combine enzymes and bile here
Formed by the joining of the pancreatic duct and the common bile duct

Ampulla of Vater

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Name and describe the TWO distinct tissues of the pancreas

Endocrine
Hormone releasing
2% total tissue
Consists of islets of Langerhans

Exocrine
Enzyme secreting
98% tissue
Secretes 1.5-2 L/day of fluid—digestive fluid

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What cell does this describe and which pancreas tissue is this a part of?

Well-delineated, spherical, or ovoid clusters of 5 cell types
Secrete 5 hormones
Alpha—glucagon
Beta—insulin
Delta—somastostatin
Gamma– pancreatic polypeptide hormones
Epsilon–ghrelin
Hormones secreted into surrounding blood vessels and transported to tissues/organs

Islet Cells of the ENDOcrine Tissue

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What cell does this describe and which pancreas tissue is this a part of?

Produce the digestive fluid

Connected by small ducts—join together into larger ducts (grape like structure)
Major pancreatic duct and smaller accessory duct

Normal, protein rich pancreatic fluid
Clear, colorless, watery
Alkaline pH up to 8.3
Caused by high concentration of sodium bicarb used to neutralize gastric fluid (hydrochloric acid)

Bicarbonate and chloride concentrations vary reciprocally
Total about 150 mmol/L
Fluid has same concentrations of K and Na as serum

Acinar cells (grape-like clusters) of the EXOcrine tissue

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Exocrine digestive enzymes work on what 3 major classes of food?

Proteins
Carbohydrates
Fats

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What are the digestive enzymes of the acinar cells in the pancreas exocrine tissue?

Proteolytic enzymes: trypsin, chymotrypsin, elastase, collagenase, leucine aminopeptidase, and some carboxypeptidases
Lipid-digesting enzymes: lipase, lecithinase
Carbohydrate-splitting pancreatic amylase
Several nucleases: ribonucleases—separate nitrogen containing bases from their sugar phosphate strands

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What is under both nervous and endocrine control?

Pancreatic activity

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This can secrete pancreas fluid when food is seen or smelled

Vagus Nerve

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What is:

Responsible for alkaline pancreatic fluid that protects lining of intestine

Synthesized in response to acid stomach contents

Contains few digestive enzymes

Secretin

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What is produced by cells of intestinal mucosa and responsible for release of enzymes from acinar cells

Cholecystokinin (CCK)—formerly called pancreozymin

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What 3 disease states cause 95% of medical attention to the pancreas?

Cystic Fibrosis
Pancreatic Carcinoma
Pancreatitis

All 3 can:
Result in severely diminished pancreatic exocrine function
Significantly compromise digestion and absorption of nutrients

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What pancreatic disease does this describe:

Inherited autosomal recessive disorder
Dysfunction of mucous exocrine glands
Most common Caucasian in U.S.
1 in 6000 live births
High frequency in Brittany, France
10% carry gene
CFTR gene—chromosome 7
Newborn screening standards

Cystic Fibrosis

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What pancreatic disease does this describe:

Initial presentation varies
Intestinal obstruction: newborn
Excessive pulmonary infections: childhood
Pancreatogenous malabsorption: adults–uncommon
Causes small and large ducts and the acini to dilate and convert into cysts filled with mucous
Prevents pancreatic secretions from reaching duodenum
Can cause a plug that may cause bowel obstruction

Cystic Fibrosis

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What pancreatic disease does this describe:

4th most frequent form of fatal cancer
7% of all deaths from malignant neoplasms
More males vs females
More blacks./Af.Am. vs other races
5 yr survival 6%
Most die within 1 yr

Pancreatic Carcinoma

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What pancreatic disease does this describe:

Adenocarcinomas of ductal epithelium—most common origin
Rich supply of nerves—very painful
Delayed diagnosis if tumor is in the neck or body
Head—symptoms earlier—near bile duct
Signs: jaundice, weight loss, anorexia, nausea

Pancreatic Carcinoma

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What effects do islet cell tumors have in a patient with pancreatic carcinoma?

Affect endocrine capability

Hyperinsulinism—low blood sugar

Hypoglycemic shock

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These are the tests recommended for which pancreatic disease: pancreatic polypeptide (PP), other biochemicals, glucagon and gastric levels for gastrointestinal evaluations

Pancreatic Carcinoma

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What two secretions are pancreatic tumors capable of?

Gastrin secreting
Gastrinomas
Cause Zollinger-Ellison Syndrome
Duodenal in origin
Symptoms: watery diarrhea, recurring peptic ulcer, significant gastric hypersecretion, hyperacidity

Glucagon secreting
Rare

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What pancreatic disease matches this description:

Inflammation of the pancreas caused by autodigestion of the pancreas
Result of bile or duodenal contents into the pancreatic duct

Pancreatitis

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What pancreatic disease causes these pathological changes:

Acute edema, cellular infiltration—leads to necrosis of acinar cells, hemorrhage as possible result of necrotic blood vessels, intra- and extra-hepatic pancreatic fat necrosis

Pancreatitis

What pancreatic disease has the following features: Acute—no permanent damage Chronic—irreversible injury Relapsing/recurring—acute or chronic, common in midlife, painful episodes with nausea/vomiting, often associated with alcohol abuse, biliary tract diseases

Pancreatitis

The below factors are associated with the acute form of what pancreatic disease? Mumps Biliary tract obstruction Pancreatic tumors Tissue injury Atherosclerotic disease Hereditary pancreatitis Immunologic factors: post-renal transplant, hypersensitivity Chronic---similar to acute---alcohol consumption most common predisposing factor

Pancreatitis

These are the symptoms of what pancreatic disease? Severe abdominal pain Generalized or upper quadrant Radiates toward back or down the flank

Acute Pancreatitis

These are the lab findings of the acute version of what disease? Increased: amylase, lipase, triglycerides, hypercalcemia Can see hypocalcemia rarely Due to sudden removal of calcium by calcium fixation by fatty acids liberated by lipase action on triglycerides

Acute Pancreatitis

Pancreatitis, Pancreatic Carcinoma and Cystic Fibrosis are the essence of what syndrome?

Mal-absorption Syndrome

This is a general description of: Abdominal bloating and discomfort Frequent passage of bulky malodorous feces Weight loss Steatorrhea: failure to digest or absorb fats Gives “greasy appearance to feces (>5 g fecal fat/24 hrs)

Mal-absorption Syndrome

These are all characteristics of: Typically involves abnormal digestion or absorption of proteins, carbohydrates, polysaccharides, other complex molecules, and lipids Severely deranged absorption and metabolism of electrolytes, water, vitamins (fat soluble A,D,E,K) and minerals Can involve a single substance: ex. Vit B12—megaloblastic anemia Can also be caused by biliary obstruction or diseases of small intestine

Mal-absorption Syndrome

Gastrin, insulin, and glucose are tests run on which pancreatic tissue?

Endocrine Tests

What is this measuring? Suspected with increased Amylase and Lipase Can be measured indirectly or directly

Exocrine Pancreatic Function

This type of testing has these characteristics: Include those used for detection of malabsorption Qualitative fecal fat analysis, fecal elastase, fecal chymotrypsin, bilirubin

Indirect

These characteristics describe what type of testing? Most sensitive Performed on actual pancreatic secretions Advances in imaging: MRI and MRCP (magnetic resonance cholangiopancreatophraphy) has reduced the need for the tests Endoscopy or the Dreiling tube method after stimulation with secretin and/or cholecystokinin (CCK) Combined secretin/CCK test done at specialized centers to simultaneously assess ductal and secretory capacity

Direct

What test fits this description? Hormone secreted by cells in the stomach Stimulates the release of bile into the intestine Stimulates secretion of enzymes by the pancreas Direct determination of the exocrine secretory capacity of the pancreas Intubation of duodenum with out contaminating with gastric fluid Secretions are collected and measured pH, secretory rate, enzyme activity and bicarb are measured Total volume affects results Pancreatic obstruction: decreased pancreatic flow and increased enzymes Low bicarb and enzymes: CF, chronic pancreatitis, pancreatic cysts, calcification, and edema of pancreas

Cholecystokinin Test (CCK)

What are these? Unabsorbed ingested lipids Lipids excreted into the intestine Cells shed into the intestine Metabolism on intestinal bacteria

The 4 sources of fecal lipids

A lipid rich diet doesn't usually exceed excreting how many grams per day

7 g/day

The below description is the composition of what: 60% fatty acids 30% sterols, higher alcohols and carotenoids 10% triglycerides Small amounts of cholesterol and phospholipids

Normal fecal lipids

Increased fecal fat can be caused by what issue?

biliary obstruction

What issue is associated with exocrine pancreatic insufficiency or disease of small intestine

Severe steatorrhea

This is a description of what test: Neutral fats (trig) and other lipids: stain yellow-orange to red with Sudan III Must be heated Normal has 40-50 small lipid drops/hpf Steatorrhea: >100 small drops and large drops may be present

Sudan Staining

This is a description of what test: Definitive test for steatorrhea 72-hr stool collection (up to 5 d) Gravimetric and titrimetric methods Lipid rich diet for at least 2 days Measure only saponifiable fatty acids 20% lower results

Quantitative Fecal Fat Analysis

This is a description of what test: Emulsify entire fecal sample in water Fatty acid soaps (Ca and Mg salts of fatty acids) are converted to free fatty acid—followed by extraction of most of the lipids into an organic solvent

Gravimetric Method for Fecal Fat Determination

What fecal enzyme fits this description: Non-invasive indirect indicator of moderate and severe exocrine pancreatic dysfunction Chymotrypsin-like enzyme secreted by pancreas In exocrine pancreatic insufficiency, fecal fat increased, fecal enzymes decreased RR for normal: >200 ug/g Moderate insufficiency 100-200 ug/g Severe insufficiency <100 ug/g

Fecal elastase-1

These are the defining characteristics of what enzyme? Less sensitive and specific Can be affected by supplements

Fecal chymotrypsin

These are the defining characteristics of what test: CF patients have reduced ability to resorb Cl from sweat Due to dysfunction of the chloride transporter (CFTR gene product) Difficult test to perform 2-5 fold increase in sweat Na and Cl are diagnostic of CF in kids Nothing else causes sweat Cl over 80 mmol/L Doesn’t distinguish hetero- from homozygous carriers

Sweat Chloride Testing

These are defining characteristics of what serum enzyme: Almost exclusively pancreatic test More sensitive, specific, accurate Increases within 24 hrs acute pancreatitis Persists for 8-14 days from reabsorption Not cleared like amylase

Lipase

These are defining characteristics of what serum enzyme: Alternate Significant increases in 75% of patients increases within 3-6 hours Peak at 24 hrs Clearance by the kidneys—returns to normal 3-5 days Urine amylase more sensitive indicator Magnitude doesn’t correlate with severity Also measured in saliva and pancreatic fluid

Amylase

This is a description of what process? Useful in detecting minor or intermittent increases in serum levels RR <3.1% Significantly increased 8-9% seen in acute pancreatitis, burns, sepsis, diabetic ketoacidosis

Renal clearance of Amylase

These situations cause an increase in what? Opiate administration, pancreatic carcinoma, intestinal infarction, obstruction or perforation, pancreatic trauma

Both Amylase and Lipase

These disorders cause an increase in what? Mumps, cholecystitis, hepatitis, cirrhosis, ruptured ectopic pregnancy, macroamylasemia

Amylase

Bone fractures and fat embolisms cause an increase in what?

Lipase

This is a description of what test: Peptide hormone, enhances gastric growth, gastric motility, secretion of hydrochloric acid Present in G cells of gastric antrum and duodenum Basal level and stimulation done Typically done to diagnose Zollinger-Ellison syndrome (gastrinoma—increased stomach acid leading to ulcers)

Gastric Secretion

Characteristics of what test: Clinical chem focuses on evaluation of absorption and its various disease states Include: tropical sprue, celiac disease, Whipple’s disease Crohn’s disease, primary intestinal lymphoma, small intestinal resection, intestinal lymphangiectasia, ischemia, amyloidosis, giardiasis, and lactose intolerance

Intestinal Function

Description of what test: Disaccharide sugar composed of glucose and galactose present in mammalian milk Lactase: enzyme produced in small intestine that digests lactose Loss or deficient lactase in adults is normal Lactose intolerance: abdominal cramps, bloating, diarrhea Lactose tolerance test Largely replaced by a breath test

Lactose

Description of what test? Exogenously administered simple monosaccharide sugar Not normally present in blood Doesn’t require pancreatic lytic enzymes

D-xylose

Description of what test? Phytochemicals Main precursors of Vit A 6 most common carotenoids account for 90% Decreases seen: malabsorption, starvation, diet, fever

Carotenoids