Week 7 - Disorders of the Pancreas

Question 1

list 3 disorders of the pancreas

Answer 1

• acute pancreatitis
• chronic pancreatitis
• pancreatic cancer

Question 2

what are the 2 functions of the pancreas

Answer 2

1. endocrine = produce hormones that regulate BG

2. exocrine = produce enzymes that help digest food into the duodenom

Question 3

what is one of the pancreas’ protective mechanisms

Answer 3

• secretes proteases in an inactive form, which becomes activated once in the duodenom

Question 4

what is protease

Answer 4

• enzyme that breaks down protein

Question 5

what happens once the proteases enter the duodenom?

Answer 5

• trypinsogen is activated into trypsin by the enzyme enterokinase

Question 6

what is the purpose of trypsin

Answer 6

• activates more trypsin & the other proteases

= activation of trypsin initiates a chain rxn resulting in the activation of many proteases

Question 7

what is pancreatitis

Answer 7

• inflammation of the exocrine pancrease

Question 8

what is pancreatitis characterized by

Answer 8

• intrapancreatic activation & release of destructive pancreatic enzymes

Question 9

pancreatitis can be..

Answer 9

• acute or chronic

Question 10

what is acute pancreatitis

Answer 10

• sudden inflammation of the pancreas due to autodigestion & injury to pancreatic cekks

Question 11

what are the 3 most common causes of acute pancreatitis

Answer 11

• alcohol abuse
• cholelithiasis
• severe hyperlipidemia

Question 12

alcohol abuse accounts for __% of all cases of acute pancreatitis & is usually precipitated by…

Answer 12

• 65%

- precipitated by an episode of heavy drinking

Question 13

how does alcohol abuse cause acute pancreatitis (2)

Answer 13

• ethanol has a direct toxic effect on pancreatic cells

- decreased muscle tone in the sphincter of Oddi

Question 14

what does the effect of alcohol on pancreatic cells cause?

Answer 14

• causes lysosomal activation of intracellular trypsin (still in the pancreas)
• this causes the activation of other digestive enzymes = autodigestion of the pancreas

Question 15

what is the sphincter of Oddi

Answer 15

• a muscle in the body that controls the flow of bile & pancreatic juice from the pancrease to the small intestine

Question 16

what does decreased muscle tone of the sphincter of Oddi cause

Answer 16

• reflux of duodenal contents into the pancreatic duct

Question 17

cholelithiasis accounts for __% of cases of acute pancreatitis

Answer 17

18%

Question 18

how do gallstones cause pancreatitis

Answer 18

• if a gallstone gets lodged in the sphincter of oddi, it blocks the pancreatic duct & release of pancreatic juices
  = enzymes stuck in the pancrease
  = inflammation & activation of trypsin

Question 19

list 9 manifestations of pancreatitis

Answer 19

• severe pain
• hemorrhage, shock
• fever
• hyperamylasemia & hyperlipasemia
• hypocalcemia
• hyperglycemia
• pulmonary complication
• hyperkalemia
• peritonitis

Question 20

what kind of pain is present in pancreatitis

Answer 20

• deep epigastric pain and/or LUQ pain that radiates to the back

Question 21

what causes pain in pancreatitis (3)

Answer 21

• inflammation
• enzymatic breakdown of pancreatic tissue
• stimulation of peritoneal nerve endings

Question 22

how does pancreatitis cause hemorrhage & shock

Answer 22

• due to enzymatic destruction of blood vessels

Question 23

what kind of shock does peritonitis cause

Answer 23

• hypovolemia

- neurogenic

Question 24

how can pancreatitis cause fever

Answer 24

• inflammatory cells release pyrogens which cause fever

Question 25

what is hyperamylasemia and hyperlipasemia

Answer 25

excess pancreatic enzymes (amylase & lipase) in the blood

Question 26

what cause hyperamylasemia & hyperlipasemia

Answer 26

- destruction of pancreatic cells = release of amylase & lipase into the interstitial space & is picked up by blood

Question 27

what is the significance of hyperamylasemia & hyperlipasemia

Answer 27

- very imp diagnostic value

Question 28

what causes hypocalcemia

Answer 28

- the release of pancreatic lipase into the interstitial fluid causes breakdown of mesentric adipose tissue & release of free fatty acids

Question 29

what does the release of free fatty acids cause

Answer 29

- bind to free calcium in , the blood , causing hypocalcemia

Question 30

what are 3 manifestations of hypocalcemia

Answer 30

- tetany - prolonged QT interval with risk of VT - convulsions

Question 31

how does pancreatitis cause hyperglycemia

Answer 31

- inflammation of the pancreatic B cells can prevent insulin release = hyperglycemia

Question 32

what can hyperglycemia cause

Answer 32

ketoacidosis

Question 33

how does pancreatitis effect DM

Answer 33

- can cause DM if 70% of B cells are destroyed

Question 34

how does pancreatitis cause pulmonary complication

Answer 34

- pancreatic inflammation & release of proteolytic enzymes = pleural effusion & pulmonary edema - release of pancreatic phospholipase can destroy alveolar surfactant

Question 35

what effect can hypotension have on the lungs

Answer 35

- can lead to "shock lung" or acute respiratory distress syndrome

Question 36

how can pancreatitis cause hyperkalemia (3)

Answer 36

- tissue necrosis causes destruction of cells & their contents to be released (K+) - correction of acidosis (H+ in, K+ out) - after fluid repletion

Question 37

how can pancreatitis cause peritonitis

Answer 37

- activated digestive enzymes can irritate the peritoneum