Clinical Chemistry > Pancreatic function > Flashcards

Pancreatic function Flashcards

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1
Q

List endocrine tests

A
  • Gastrin
  • Insulin
  • Glucose
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2
Q

List exocrine pancreatic function tests

A

Amylase and lipase

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3
Q

List indirect tests

A
  • Qualitative fecal fat analysis
  • Fecal elastase
  • Fecal chymotrypsin
  • Bilirubin
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4
Q

Which pancreatic function test is the most sensitive, uses actual pancreatic secretions, endoscopy/Dreiling tube method after stimulation with secretin and/or cholecystokinin (CCK)?

A

Direct

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5
Q

CCK

A
  • Hormone secreted by intestinal mucosal cells
  • Causes acinar cells to secrete enzymes and bile
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6
Q

CCK test measures

A
  • pH
  • Secretory rate
  • Enzyme activity
  • Bicarb
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7
Q

How does pancreatic obstruction affect pancreatic flow and enzymes?

A
  • Decreased pancreatic flow
  • Increased enzymes
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8
Q

Which diseases show reduced bicarb and enzymes

A
  • CF
  • Chronic pancreatitis
  • Pancreatic cysts
  • Calcification
  • Edema of pancreas
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9
Q

4 sources of fecal lipids

A
  1. Unabsorbed ingested lipids
  2. Lipids excrete into intestine
  3. Cells shed into the intestine
  4. Metabolism of intestinal bacteria
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10
Q

Normal fecal lipid composition

A
  • 60% fatty acids
  • 30% sterols, higher alcohols, and carotenoids
  • 10% triglycerides
  • small amounts of cholesterol and phospholipids
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11
Q

Increased fecal fat can be caused by

A

Biliary obstruction

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12
Q

Severe steatorrhea associated with

A

Exocrine pancreatic insufficiency or disease of small intestine

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13
Q

Fecal fat qualitative screening test uses which fat soluble stains?

A
  • Sudan III
  • Sudan IV
  • Oil Red O
  • Nile blue sulfate
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14
Q

Is technical skill important in Fecal fat qualitative screening test?

A

Yes

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15
Q

How do fat soluble stains work?

A

Dissolve in and color lipid droplets

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16
Q

Sudan staining colors which fats? Which colors?

A
  • Neutral fats (triglycerides) and other lipids
  • Yellow-orange to red with Sudan III
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17
Q

Which type of fat stain requires heating?

A

Sudan

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18
Q

Steatorrhea features how many lipid droplets?

A

> 100 small/large may be present

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19
Q

Definitive test for steatorrhea

A

Quantitative fecal fat analysis

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20
Q

How many hr stool specimen for Quantitative fecal fat analysis?

A

72 hr

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21
Q

Diet for Quantitative fecal fat analysis

A

Lipid-rich diet for at least 2 days

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22
Q

Quantitative fecal fat analysis measures which fats?

A

Only saponifiable fatty acids

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23
Q

Gravimetric method for fecal fat determination

A
  • Emulsify entire fecal sample in water
  • Fatty acid soaps (Ca and Mg salts of fatty acids) are converted to free fatty acids
  • Extract lipids into organic solvent
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24
Q

How much exocrine pancreatic function is lost before a 72 hr fecal fat test becomes positive?

A

90%

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25
Fecal elastase-1 is what type of indicator?
Non-invasive indirect indicator of moderate and severe exocrine pancreatic dysfunction (secreted by pancreas)
26
Fecal elastase-1 is similar to which proteolytic enzyme?
Chymotrypsin
27
Fecal fat and fecal enzyme levels in exocrine pancreatic insufficiency
- Fecal fat increased - Fecal enzymes decreased
28
Fecal chymotrypsin sensitivity/specificity and what affects it
- Less sensitive and less specific - Can be affected by supplements
29
Patients with which disease have reduced ability to reabsorb Cl- from sweat and why?
Cystic fibrosis because chloride transporter (CFTR gene product) not functioning
30
Sweat chloride testing level of difficulty to perform
High difficulty
31
How to diagnose CF in kids
2-5x increase in sweat Na and Cl
32
Can sweat chloride testing differ btwn heterozygous and homozygous carriers?
NO
33
Almost exclusively pancreatic test that is more sensitive, specific, and accurate
Lipase
34
Lipase increases within 24 hr of ___ and persists for how many days from reabsorption
- Acute pancreatitis - 8-14 days
35
Is lipase cleared?
NO
36
Pancreatic test cleared by kidneys
Amylase
37
Which amylase test is more sensitive indicator?
Urine amylase
38
Amylase measured in
- Urine - Saliva - Pancreatic fluid
39
Does amylase magntitude correlate with severity?
NO
40
Test useful in detecting minor or intermittent increases in serum amylase levels
Renal clearance of amylase
41
Amylase renal clearance signif increased in
- Acute pancreatitis - Burns - Sepsis - Diabetic ketoacidosis
42
Both amylase and lipase increased in
- Opiate administration - Pancreatic carcinoma - Intestinal infarction - Obstruction or perforation - Pancreatic trauma
43
Only amylase increased in
- Mumps - Cholecystitis - Hepatitis - Cirrhosis - Ruptured ectopic pregnancy - Macroamylasemia
44
Only lipase increased in
- Bone fractures - Fat embolism
45
Gastrin
- Peptide hormone - Enhances gastric growth/motility - Secretion of HCl
46
Gastrin present in which cell type?
G cells of gastric antrum and duodenum
47
Gastrin tested to diagnose
Zollinger-Ellison syndrome
48
Zollinger-Ellison syndrome
Gastrinoma- increased stomach acid leading to ulcers
49
List tests for gastric secretion and intestinal function
- Gastrin - Intestinal function - Lactose - D-xylose - Carotenoids
50
Lactose
Disaccharide sugar composed of glucose and galactose present in mammalian milk
51
Lactase
Produced in small intestine to digest lactose
52
Loss or deficiency of this enzyme in adults is **normal**
Lactase
53
Lactose intolerance symptoms
Cramps, bloating, diarrhea
54
Lactose measurement methods
- Lactose intolerance test - Breath test
55
D-xylose test
- Exogenously given simple monosaccharide sugar - Not normally present in blood - Doesn't require pancreatic lytic enzymes
56
Carotenoid
Phytochemicals that are main Vit A precursors
57
Decrease in carotenoids seen
- Malabsorption - Starvation - Diet - Fever
58
Which organ involved in digestion is not in the GIT?
Pancreas
59
Ampulla of Vater
Liver and pancreas combine enzymes and bile here
60
Pancreas what percent endocrine and exocrine tissue?
2% endocrine 98% exocrine
61
Alpha, beta, gamma, delta, and epsilon cells of Islets of Langerhans secrete what
Alpha = glucagon Beta = insulin Gamma = pancreatic polypeptide hormone Delta = somatostatin Epsilon = ghrelin
62
Bicarb and chloride vary ____
Reciprocally
63
Vagus nerve
Secretes pancreatic fluid when food seen or smelled
64
Secretin
Functions to make alkaline pancreatic fluid in response to acid stomach contents -> protects intestinal lining
65
3 big pancreatic diseases (account for 95% of them)
- Pancreatitis - Pancreatic carcinoma - Cystic fibrosis
66
Cystic fibrosis
- Autosomal recessive - Mucous exocrine gland dysfunction - High freq Brittany, France - CFTR gene
67
Newborn screening standards for which pancreatic disease?
CF
68
Initial CF presentation in newborns
Intestinal obstruction
69
CF initial presentation in childhood
Excessive pulmonary infections
70
CF initial presentation in adults (uncommon)
Pancreatogenous malabsorption
71
CF mechanism
Small and large ducts of acini dilate and convert into mucous-filled cysts, which can cause a plug/bowel obstruction
72
4th most fatal form of cancer
Pancreatic carcinoma
73
Pancreatic carcinoma more common in which sex/race?
Males and blacks
74
Most common pancreatic carcinoma origin
Adenocarcinoma of ductal epithelium
75
Pancreatic cell islet cell tumor effects
Hyperinsulinism and hypoglycemic shock
76
Two types of pancreatic tumors
- Gastrin-secreting - Glucagon-secreting (rare)
77
Pancreatitis
- Inflammation of pancreas due to **autodigestion** - Bile or duodenal contents spill into pancreatic duct
78
Pancreatitis extent of damage in acute and chronic
Acute = no permanent damage Chronic = irreversible injury
79
Pancreatitis lab findings
Elevated amylase, lipase, triglycerides, hypercalcemia
80
3 conditions essence of malabsorption syndrome
1. Abdominal bloating/discomfort 2. Freq bulky smelly poo 3. Weight loss
81
Steatorrhea
Failure to digest or absorb fats (gives greasy appearance)
82
Malabsorption syndrome involves
- Abnormal digestion/absorption of carbs, lipids, proteins - Can't absorb/metabolize electrolytes, water, fat soluble vit (ADEK), and minerals - Can involve single substance (B12)
83
Malabsorption syndrome can be caused by
biliary obstruction or diseases of small intestine
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