Flashcards in Pathophysiology of the Exocrine Pancreas Deck (30):
In addition to making the pancreas secrete exocrine hormones, cholecystokinin also ____________.
stimulates the gallbladder to contract
Describe the differences between acute and chronic pancreatitis.
- acute inflammation
- acute pain
- elevated pancreatic enzymes in serum
- chronic inflammation
- chronic pain and malabsorption
- ductal obstruction
- permanent damage to or loss of pancreatic function
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.
In acute pancreatitis, _____________ are prematurely activated in the pancreas.
In order of most-to-least common, what are the presenting signs/symptoms of acute pancreatitis?
- 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
ARDS is associated with _______________.
necrotizing pancreatitis (from severe pancreatitis)
How is acute pancreatitis treated?
- IV fluids
- NPO then slow advancement of diet
- IV narcotics
- consult surgery for stone removal
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.
The most common cause of chronic pancreatitis is ____________.
You need to lose about ______ percent of your pancreas before you have steatorrhea.
Why can hypoglycemia result from chronic pancreatitis?
Because glucagon is also lost in chronic pancreatitis
Haptocorrin is another name for ______________.
Jaundice, dark urine, and pruritus are manifestations of adenocarcinomas in the ___________.
head of the pancreas
True or false: back pain is a symptom of late-development pancreatic cancer.
Neuroendocrine tumors originate from ____________ cells.
islet of Langerhans
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!
Most of the saliva comes from which gland?
With slow salivary flow, the saliva becomes quite _____________.
hypotonic (because the NaCl gets pumped out)
True or false: some pancreatic acinar cells produce trypsinogen and others produce chymotrypsin and the other zymogens.
False. Each cell makes the whole complement.
The zymogens are released by ______________.
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.
At low flow rates of pancreatic secretions, the predominant ion is _________.
At high flow rates of pancreatic secretions, the predominant ion is __________.
bicarb (because the exchanger doesn't have time to work)
Elevated levels of _____________ indicate acute pancreatitis.
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
True or false: ductal strictures are associated with acute pancreatitis.
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
How is chronic pancreatitis treated?
- surgical correction of the blocked duct
- pancreatic enzyme supplementation
- ETOH avoidance