Pathophysiology of the Pancreas

Question 1

What opioid should be avoided in treating acute pancreatic pain due to its contractile effects on the sphincter of Oddi?

Answer 1

Morphine

Question 2

What are the ionic laboratory findings in acute pancreatitis?

Answer 2

Hypocalcemia, hypomagnesemia, hyperkalemia, hyperglycemia

Question 3

What is the function of cholecystokinin?

Answer 3

Simulates release of bile from the gallbladder and digestive enzymes from the pancreas into the duodenum

Question 4

The endocrine portion of the pancreas contains Islets of Langerhans. What molecules are secreted from these Islets?

Answer 4

Insulin, glucagon, somatostatin

Question 5

What is the gold-standard imaging for diagnosis of acute pancreatitis?

Answer 5

CT

Question 6

How does excessive alcohol use increase the risk of pancreatitis?

Answer 6

Increases contraction of the sphincter of Oddi, promotes cholecystokinin secretion, causes calcium dysregulation, oxidative stress

Question 7

In chronic pancreatitis, there is fibrosis and permanent destruction of the exocrine and endocrine pancreatic functions. Which functions are lost first?

Answer 7

Exocrine functions lost first, endocrine function lost in late stages

Question 8

How are serum amylase and lipase levels affected during acute pancreatitis?

Answer 8

Increased at least 3x

Question 9

What is the clinical presentation of acute pancreatitis?

Answer 9

Sudden, severe pain that beings in the epigastrium and radiates to the back, anorexia, nausea, vomiting

Question 10

Where are most pancreatic digestive enzymes synthesized and stored?

Answer 10

Acinar cells

Question 11

True/False. Decreased calcium levels promote the activation of trypsinogen and acute pancreatitis.

Answer 11

False - hypercalcemia promotes trypsinogen activation

Question 12

Autoimmune pancreatitis is responsible for chronic pancreatitis. What is the difference between Types 1 & 2?

Answer 12

Type 1 - IgG4 with plasma cells

Type 2 - neutrophils without IgG4

Question 13

True/False. The prognosis of pancreatitis is related to the amount of pancreatic necrosis.

Answer 13

True. Increased necrosis = poorer prognosis

Question 14

What transcription factor plays a primary role in the progression of local inflammation to systemic inflammatory response syndrome?

Answer 14

NF-kB

Question 15

Serum amylase and lipase are elevated in acute pancreatitis. What are their levels in chronic pancreatitis?

Answer 15

Amylase and lipase may be elevated or low due to the destruction of acinar cells.

Question 16

What is the clinical presentation of chronic pancreatitis?

Answer 16

Episodic abdominal pain triggered by alcohol or overeating, weight loss, steatorrhea, diabetes, jaundice

Question 17

How are inactive pancreatic digestive enzymes activated?

Answer 17

Enteropeptidase cleaves trypsinogen to trypsin. Active trypsin cleaves and activates other digestive enzymes

Question 18

What is the most specific and sensitive laboratory marker for acute pancreatitis?

Answer 18

Serum lipase - however, it is difficult to measure

Question 19

What cytokines are persistently produced in chronic pancreatitis?

Answer 19

TGF-b & platelet-derived growth factor (PDGF)

Question 20

What is the recommended treatment for acute pancreatitis?

Answer 20

NPO, IV fluids, opioids for pain management

Question 21

What is the most common cause of chronic pancreatitis?

Answer 21

Chronic alcohol use

Question 22

The exocrine portion is responsible for most of the pancreas’s function. What enzymes does it secrete?

Answer 22

Digestive enzymes

Question 23

What is the mechanism of colocalization of pancreatic enzymes and lysosome hydrolases?

Answer 23

Pancreatic enzymes are trafficked to lysosomes and activated by hydrolases. This causes apoptosis of lysosomes and the release of activated enzymes into acinar cells

Question 24

Acute pancreatitis can have many etiologies. What factors are most responsible for metabolic acute pancreatitis?

Answer 24

Alcohol overuse, hypertriglyceridemia

Question 25

In acute hemorrhagic pancreatitis, these signs may be present.

Answer 25

Ecchymoses of the flank (Grey Turner’s Sign) and periumbilical region (Cullen’s Sign)

Question 26

Vascular fluid is lost during acute pancreatitis due to inflammation. What effect will this have on hematocrit?

Answer 26

Hematocrit is elevated in acute pancreatitis.

Question 27

What is the leading cause of death within the first week for patients with acute pancreatitis?

Answer 27

Multi-organ failure. After the first week, sepsis becomes the leading cause of death

Question 28

What factors increase the risk of systemic inflammatory response syndrome due to acute pancreatitis?

Answer 28

Obesity, chronic alcohol use

Question 29

True/False. Hereditary factors are responsible for a majority of chronic pancreatitis cases.

Answer 29

False - Chronic alcohol use is the leading cause of chronic pancreatitis, but hereditary factors are responsible for 25% of cases

Question 30

What four mechanisms promote premature activation of trypsinogen?

Answer 30

Duct obstruction, acinar cell injury, calcium dysregulation, colocalization of pancreatic enzymes and lysosomal hydrolases

Question 31

What is the etiology of cholelithiasis in causing acute pancreatitis?

Answer 31

Mechanical obstruction

Question 32

What enzyme is responsible for cleaving trypsinogen to trypsin?

Answer 32

Enteropeptidase