Pancreatic Function (After exam 2)

Question 1

What is included in the Gi system

Answer 1

mouth esophogus, stomach, small intestine/large

Question 2

describe digestion in the small intestines

Answer 2

process which stomach degrades complex molcules for absorption and uses them in the body

ex starches/proteins/lipids

Question 3

Pancreas function
involved in?
not in?

Answer 3

involved in digestion
not in GI

Question 4

Exocrine tissues

Answer 4

production of enzymes used in digestive processes

Question 5

Endocrine tissues

Answer 5

production of insulin and glucagon

Question 6

Physiology of pancreas weight and size
7….
second in….
behind…
1/2

Answer 6

weight 70-105g

second in size to liver, behind periton cavity/1/2 lumbar vertabrae

Question 7

Ampulla of vater
what combines?what does it create?
tucked into?

Answer 7

liver/pancrease combine bile/enzymes
tucked into duodenum

Question 8

Endocrine
releases?
% of tissues?
key feature?

Answer 8

hormone releasing
2% total tissues
islets of langerhans

Question 9

Exocrine
secretes?
tissues?
secretes how much digestive fluid a day?

Answer 9

enzyme secreting
98% tissues
secretes 1-2L a day of digestive fluids

Question 10

islet cells (endocrine)
well….how many types?
a
b
d
g
e

Answer 10

well deliniated 5 cell types
alpha = glucagon
beta = insulin
delta = stomato
gamma = polypep
epsilon = ghrelin

Question 11

Beta cells secrete?

Answer 11

insulin

Question 12

Exocrine Acinar cells
clusters?
produce?
small….
normal person?

Answer 12

grape like clusters
produce digestive fluids
small ducts - join to large

normal person protein rich fluid

Question 13

Bicarb/chloride concentration

vary?
alk…..

Answer 13

vary reciprocally

alkaline pH 8.3 increases conc of bicarb

Question 14

Pancreatic activity

what control?

vagus nerve?

MOST UNDER? examples?

Answer 14

nervous and endocrine control

vagus nerve: secretes pancrease fluid when food is smelled/seen

MOST UNDER HORMONE CONTROL: secretin/CCK

Question 15

Secretin

what kind of fluid? where?
synth…
few?

Answer 15

alkaline pancreatic fluid protects linning

synth in response to acid stomach contents

few digestive enzymes

Question 16

CKK
produced by what cells
release?

Answer 16

produced by cells of intestinal mucosa

release enzymes from acinar cells

Question 17

3 diseases that cause 95% of pancreatic disease/medical attention
c
pc
p

all result in?
compromise

Answer 17

Cystic fibrosis
pancreatic carcinoma
pancreatitis

all result in deminished pancreatic exocrine function

compromise digestion/absorbtion of nutrients

Question 18

Cystic fibrosis
dysf of…
most in?
what genes?

Answer 18

dysfucntion of mucus exo glands

most in caucasians

CFTR genes - chrom 7

Question 19

Initial presentation of cystic fibrosis

Answer 19

obstruction intestinal - newborns

excessive pulm. infections - childhood

pancreatic malabsorbtion - adults uncommon

Question 20

Describe pathology of cystic fibrosis
s/l/a …..convert into….

prevents

Answer 20

small/large ducts/acini dilate and convert into cysts filled w fluids

prevents pancreatic secretions from reaching duodenum

Question 21

Pancreatic carcinoma
4th….

more in what population

survival rates?

what symtom is earlier?

Answer 21

4th most cause of atal cancer

more in black males than females

5yr survival 6% most die in 1yr

head symptoms earlier

Question 22

most common origin of pancreatic carcinoma
adeno…..
pain?

Answer 22

adenocarcinoma of ductal epithelial - very painful

Question 23

Islet cell tumors
affect?
hyperinsulin?
hyperg…

Answer 23

affect endocrine capability
hyperinsulin - low blood sugar
hyperglycemic shock

Question 24

Pancreatic tumors
what secreting?
zol.
gluc

eval with?

Answer 24

gastrin secreting
zollinger-ell syndrome
glucagon secreting rare

for evals: PP, glucagon/gastic levels

Question 25

Pancreatitis | inflm of by? acutechronic? relaspsing common in pain/associated with?

Answer 25

inflam of pancreas by autodigestion acute no perm damage chronic perm damage relapsing: acute/chronic common in mid life painful assoc w alcoholism/biliar tract disease

Question 26

Sympt of acute pancreatitis severe.....location? inc a/l/t/h

Answer 26

severe abdom pain, generalized, lower back pain inc amylase/lipids/trigly/hypercalcemia

Question 27

All three conditions have what in common abn... bulky weight

Answer 27

abn bloating bulky feces weight loss

Question 28

Steatorrhea

Answer 28

unable to digest ats "greasy" stool appearance

Question 29

Malabsorbtion syndrome abn digestion of? vit B12 ---- can be caused by?

Answer 29

abn digestion of proteins/electrolytes vit b12 - megaloblastic anemia can be caused by biliary obstruction/small intestine diseases

Question 30

Endocrine tests reflect? examples?

Answer 30

reflect endocrine cells of pancreas gastrin/insulin/glucose

Question 31

Exocrine tests increased? can be ?

Answer 31

inc amylase/lipase indirect or direct

Question 32

Indirect testing used for detection of? qual...f/e

Answer 32

used for detection of malabsorption qualitiative fecal fat anayalsis.elastase...etc

Question 33

Direct testing more s.....than .... needed for test endo....after stim w

Answer 33

most sensitive actual pancreatic secretions MRI/ARCP reduced need for tests endoscopy after stim w secretim/cck

Question 34

how do you assess ductal/secretory capacity

Answer 34

combined secretin/cck

Question 35

CCK test what sec by.... stimulate release.....and sec of direct determ of.... panc obsrtuction: low bicarb/enzymes:

Answer 35

hormone sec by cells in stomach stimulate release of bile into enzymes and sec of enzymes by the pancrease direct determ of exocrine sec capacity of pancreas Panc obstruct: dec flow inc enzymes low bicarb,enzmes: CF, chronic pan edema

Question 36

Fecal fat analysis how many souces? unabsorbed lipids... cells... met. intest..

Answer 36

4 sources unabsorbed ingested lipids lipids excreted into intestine cells shed into intestines met. intestineal bacteria

Question 37

fecal fat of lipid free diet vs rich diet? free? rich? increased fecal fat can be from? severe....assoc w....

Answer 37

free 1-4g rich <7g increased fecal fat can be from obstriction severe steatorrhea assoc w exocrine insuff

Question 38

normal fecal lipids composed of 60% 30% 10% small #

Answer 38

60% fatty acids 30% sterols/alc/carot 10% triglyerides small # cholest/phopho

Question 39

Fecal fat testing stains/skills fat soluble stains what do they do to lipid droplets skill?

Answer 39

fat sol stains (sudan III/IV, oil red, nile blue) dissolve/color lipid droplets techincal skill important

Question 40

Sudan staining what stains yellow/orange with sudan III must be? normal range? Steatorrhea range?

Answer 40

neutral fats/lipids stain yellow orange w sudan III must be heated 40-50 normal steatorrhea >100

Question 41

Definitive or steatorrhea quant.... stool collection? diet? results?

Answer 41

quant fecal fat 72hr stool collection lipid diet 2 days 20% lower results

Question 42

Gravimetric method what do you do to the sample? fatty acid soaps..... excretion of m.....

Answer 42

emulsify sample in water fatty acid soaps conv to free fatty acids - excretion of most lipids to organic solvents

Question 43

Fecal enzymes how much exocrine funct is lost before 72 hr fecal fat is pos? non invasive/indirect test? inc.....dec normal range?

Answer 43

90% of exocrine func lost before 72 hr fecal fat is positive Fecal elastase non invasive/indirect inc fecal fat dec enzymes norm >200

Question 44

Fecal chymotrypsin less affected by?

Answer 44

less sensitive/specific affected by suppliments

Question 45

Sweat chloride CF pts reduced.... dysfunct of..... easy? what increase in CF kids? doesnt determin?

Answer 45

CF pts reduced ability to reabsorb cl from sweat dysfunction of cl transporter difficult test 2-5 fold increase in CF kids doesnt determin hetero/homo

Question 46

Lipase tests? more? increases with persists for? not cleared like?

Answer 46

pancreatic test more sens/spec/accurate inc w 24hr acute pancreatitis persists 8-14 days not cleared like amylase

Question 47

Amylase sign increase within? peak? cleared by....normal after? more sensitive test? measured in?

Answer 47

alternate test sign increase in 75% pt within 3-6hr peak at 24hr cleared by kidneys norm after 3-5 days urine amylase more sensitive measured in saliva/pancreatic fluid

Question 48

Renal clearance amylase serum level changes/ RR? significant increase in? both.....increase in?

Answer 48

minor/interm increase in serum levels RR <3.1 sign increase 8-9 in acute pancreatitis/burns/sepsis both amylase/lipase inc in opiat admin/carcinom

Question 49

Amylase renal clearance test diseases Lipase

Answer 49

mumps/cholest/hep lipase: bone fract/fat embolism

Question 50

Gastrin what kind of hormone? enhances? cells of .... typically to diagnose....

Answer 50

peptide hormone, enhances gastric growth/motility cells of gastirc antrum/duodenum typically to diagnose Zollinger-Ell sydrome (inc stomach acid = ulcers)

Question 51

Intestinal function focuses on eval of.... includes?

Answer 51

clin chem focuses on eval of absorb and disease states includes: celliac/whipplpe..etc

Question 52

lactose what type of sugar/examples found where? Lactase: loss of def lactase... Lactose intol

Answer 52

dissach sugar of glucose/galactose in milk Lactase: small intestine digests lactose loss of def lactase in adults normal lactose intol: abn cramps/bloating - breath test

Question 53

D-Xylose exogenous admin of... presence? doesnt require?

Answer 53

exogen admin simple monosacc sugar not norm present in blood doesnt require pancreatic enzymes

Question 54

Carotenoids what kind of chemical? main precursor of? how many most common account for 90% dec in?

Answer 54

phytochemicals main precursor of vit A 6 most common carot account for 90% dec in malabsorb/starvation/fever