Pathophysiology of the Exocrine Pancreas Flashcards Preview

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Flashcards in Pathophysiology of the Exocrine Pancreas Deck (30):
1

In addition to making the pancreas secrete exocrine hormones, cholecystokinin also ____________.

stimulates the gallbladder to contract

2

Describe the differences between acute and chronic pancreatitis.

Acute:
- acute inflammation
- acute pain
- elevated pancreatic enzymes in serum
- self-limited

Chronic:
- chronic inflammation
- chronic pain and malabsorption
- ductal obstruction
- permanent damage to or loss of pancreatic function

3

The most common worldwide cause of acute pancreatitis is ___________, while in America it is ___________.

alcohol (which induces release of zymogens); gallstone obstructions

There are rarer causes of pancreatitis, also: hypercalcemia, hypertriglyceridemia, or medications.

4

In acute pancreatitis, _____________ are prematurely activated in the pancreas.

zymogens

5

In order of most-to-least common, what are the presenting signs/symptoms of acute pancreatitis?

Abdominal pain
Nausea/vomiting
Tachycardia
Fever
Jaundice

6

Describe pseudocysts.

- a collection of pancreatic fluid surrounded by granulation tissue – not epithelium
- results from ductal obstruction or necrosis
- most resolve with time
- 10% - 30% of cases of acute pancreatitis

7

ARDS is associated with _______________.

necrotizing pancreatitis (from severe pancreatitis)

8

How is acute pancreatitis treated?

- IV fluids
- NPO then slow advancement of diet
- IV narcotics
- consult surgery for stone removal

9

True or false: diabetes is an early manifestation of chronic pancreatitis.

False. Diabetes can result from chronic pancreatitis, but it is usually a late manifestation of the disease.

10

The most common cause of chronic pancreatitis is ____________.

alcohol

11

You need to lose about ______ percent of your pancreas before you have steatorrhea.

85

12

Why can hypoglycemia result from chronic pancreatitis?

Because glucagon is also lost in chronic pancreatitis

13

Haptocorrin is another name for ______________.

protein R

14

Jaundice, dark urine, and pruritus are manifestations of adenocarcinomas in the ___________.

head of the pancreas

15

True or false: back pain is a symptom of late-development pancreatic cancer.

True

16

Neuroendocrine tumors originate from ____________ cells.

islet of Langerhans

17

Describe autoimmune pancreatitis.

IgG+ lymphocytes infiltrate the parenchyma of the pancreas, causing pancreatitis symptoms similar to pancreatic cancer (weight loss; abdominal pain; jaundice); more common in males 40 - 70 (weirdly, for autoimmune diseases); presents as the "sausage pancreas" on CT

Treatable with steroids!

18

Most of the saliva comes from which gland?

The submandibular

19

With slow salivary flow, the saliva becomes quite _____________.

hypotonic (because the NaCl gets pumped out)

20

True or false: some pancreatic acinar cells produce trypsinogen and others produce chymotrypsin and the other zymogens.

False. Each cell makes the whole complement.

21

The zymogens are released by ______________.

exocytosis

22

How does pancreatic blockage lead to pancreatitis?

A small amount of trypsin can get activated randomly (i.e., without enterokinase) and then activate the protease cascade.

23

At low flow rates of pancreatic secretions, the predominant ion is _________.

chloride

24

At high flow rates of pancreatic secretions, the predominant ion is __________.

bicarb (because the exchanger doesn't have time to work)

25

Elevated levels of _____________ indicate acute pancreatitis.

serum amylase

26

What are clinical clues that indicate gallstone pancreatitis?

- history of gallstones
- gallstone risk factors
- dilated bile duct
- elevated liver enzymes
- absence of alcohol abuse or other risk factors

27

True or false: ductal strictures are associated with acute pancreatitis.

False. Chronic.

28

Describe the secretin test.

- (1) suck out all of the gastric acid
- (2) give secretin intravenously
- (3) measure the increase in bicarb concentration; if the increase is less than 80 mEq, then that indicates pancreatic failure

29

How is chronic pancreatitis treated?

- surgical correction of the blocked duct
- pancreatic enzyme supplementation
- ETOH avoidance

30

___________ is the fourth leading cause of cancer death in the U.S.

Pancreatic adenocarcinoma

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