The Exocrine Pancreas

Question 1

What nerves supply the pancreas?

Answer 1

Coeliac plexus from sympathetic chain of splanchnic nerves T5-T9

Question 2

What does secretin act on?

Answer 2

Duct cells

To do with bicarbonate/water

Question 3

What does cck act on?

Answer 3

Acinar cells

To do with enzymes

Question 4

What lymph node is close to celiac plexus?

Answer 4

Celiac lymph node

Question 5

What lymph node sits by the superior mesenteric artery?

Answer 5

Superior mesenteric lymph node

Question 6

Which lymph node points out towards the spleen?

Answer 6

Splenic lymph node

Question 7

Which pancreatic lymph nodes are next to the duodenum?

Answer 7

Anterior and posterior pancreaticoduodenal lymph nodes

Question 8

Which pancreatic lymph node is next to the stomach/pyloris?

Answer 8

Pyloric lymph node

Question 9

Which pancreatic lymph node goes out by the hepatic artery?

Answer 9

Hepatic lymph node

Question 10

Where are the lymph nodes on the body of the pancreas?

Answer 10

Superior body and inferior body

Question 11

Which artery runs over the top of the pancreas towards the spleen?

Answer 11

Splenic artery

Splenic vein goes back behind the pancreas

Question 12

Which artery goes off the aorta in the direction of the liver?

Answer 12

Hepatic artery

Question 13

Where does the tail on the pancreas head towards?

Answer 13

The spleen

Question 14

What is the hooklike structure at the head of the pancreas next to the duodenum?

Answer 14

Uncinate process

Question 15

How do enzymes get out of the pancreas?

Answer 15

Main pancreatic duct

Question 16

Where do pancreatic enzymes flow?

Answer 16

From main pancreatic duct, into duodenum via the pancreaticoduodenal ampulla

Question 17

What duct do only some people have?

Answer 17

Auxiliary duct

Question 18

What cells are the exocrine pancreas and endocrine pancreas?

Answer 18

Expo-acinar units and ducts

Endocrine- islets of langerhans

Question 19

Where does the pancreas form from?

Answer 19

Ventral and dorsal buds from bud cells

Question 20

What cells make all cells of the pancreas?

Answer 20

Bud cells

Question 21

What do PP cells secrete?

Answer 21

Pancreatic polypeptide

Question 22

What causes increase in PP secretion?

Answer 22

Intestinal phase

Amino acids in blood stream

Question 23

What are pancreatic stem cells called?

Answer 23

Centroacinar cells
(Edge of acinar cells, can turn into a duct cell and repair damage)

Question 24

What do acinar cells produce?

Answer 24

Zymogens (active enzyme+part of protein on end making it inactivated) - of lipase, amylase and protease - cleavage causes active enzyme

Question 25

What proteases are produced by acinar cells?

Answer 25

Elastase, chymotrypsin and trypsin

Question 26

Which enzyme produced by acinar cells is linked to pancreatitis and disease?

Answer 26

Trypsin

Question 27

What regulates the release of enzymes from acinar cells?

Answer 27

CCK

Question 28

What is trypsin released by acinar cells as?

Answer 28

Trypsinogen which is activated by enterokinase in the duodenum to trypsin. Start digesting protein, get amino acids which stimulates pancreatic polypeptide which gives further stimulation of digestion

Question 29

What binds to receptor to allow the secretion of bicarbonate and water from duct cells?

Answer 29

Secretin

Question 30

Why do duct cells need to release water?

Answer 30

To wash enzymes down into duodenum

Question 31

What protein regulates pancreatic ductal cells?

Answer 31

CFTR

Question 32

What occurs when secretin binds to receptor on ductal cells?

Answer 32

cAMP activated, activates pKa which activates CFTR channel, CFTR channel pumps Cl- ions out of the pancreatic ductal cell so water follows HCO3- is swapped for Cl- and HCO3- moves out of ductal cells

Question 33

What is Acute pancreatitis associated with?

Answer 33

Necrosis

Question 34

What is apoptosis?

Answer 34

Non inflammatory programmed cell death

Question 35

What goes wrong in pancreatitis?

Answer 35

Trypsin is activated within the acinar cell causing cell damage, causing cytokine release causing pancreatitis and necrosis

Question 36

What activates trypsinogen release within acinar cells?

Answer 36

Pulse of Ca2+ release within the cell

Question 37

What does I GET SMASHEDD stand for?

Answer 37

``` Idiopathic - hereditary Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion stings Hyper -calcaemia, lipidaemia, thermos ERCP Drugs ```

Question 38

Causes of pancreatitis

Answer 38

Increase in activity of CCK Increase in level and amount of trypsinogen Decrease in amount of SPINK1 or trypsinogen inhibitors Causes acinar damage

Question 39

How do gallstones cause pancreatitis?

Answer 39

Gallstone obstructs pancreatic duct Build up of pressure within pancreatic duct Trypsinogen activated in acinar cells