Pancreatitis

Question 1

Pancreas as an endocrine and exocrine gland

Answer 1

Endocrine = releases hormones from the islets of Langerhans (alpha - glucagon, beta - insulin)

Exocrine = secretes digestive enzymes into the duodenum via the pancreatic duct

Question 2

Examples of proteases, amylase and lipase that the pancreas secretes

Answer 2

Protease = trypsin (active form of trypsinogen) and chymotrypsin

Amylase = P-type amylase

Lipase = triglyceride lipase

Question 3

Function and location of Acini cells

Answer 3

secrete enzymes and branch off interlobular cells

Question 4

Function and location of ductal cells

Answer 4

secrete bicarbonate and branch from pancreatic duct

Question 5

What is the ampulla of Vater?

Answer 5

where the pancreatic and bile duct meet

Question 6

Function of secretin

Answer 6

stimulates ductal cells to release bicarbonate to neutralise acid

Question 7

Function of Cholecystokinin

Answer 7

stimulates acini cells to release digestive enzymes

Question 8

Function of enterokinase

Answer 8

activates trypsinogen to form trypsin in duodenum

Question 9

Function of acetylcholine in the GI tract

Answer 9

stimulates enzyme secretion

Question 10

3 main causes of pancreatitis

Answer 10

Acinar cell damage
Ductal obstruction
Medications/toxic agents

Question 11

How can acinar cell damage lead to pancreatitis

Answer 11

enzyme activation = autodigestion

commonly due to alcohol (increased enzyme secretion, increased viscosity = plug/stone formation and necrosis)

Question 12

How can a ductal obstruction lead to pancreatitis

Answer 12

galls stones or ampullary/sphincter blockage = enzyme accumulation and activation

Question 13

How can medications/toxic agents lead to pancreatitis?

Answer 13

alter secretion or reflux activated enzymes

Question 14

How does pancreatitis progress?

Answer 14

enzyme leakage = autodigestion = inflammation = necrosis

enzymes enter bloodstream = multi-organ inflammation

Question 15

Clinical signs and symptoms of pancreatitis

Answer 15

Pain: severe, radiating and worse after eating
N/V, distention and hypotension
Bruising: Cullen’s sign and Grey Turner’s sign

Question 16

What are Cullen’s and Grey Turner’s signs

Answer 16

Cullen’s: umbilical bruising
Grey Turner’s: flank bruising

Question 17

Reasons for chronic pancreatitis (7)

Answer 17

Chronic alcohol use
Smoking
Genetics
Autoimmune
Duct narrowing
Malnutrition
Idiopathic

Question 18

Progression of chronic pancreatitis

Answer 18

inflammation = fibrosis = loss of exocrine/endocrine function = malabsorption and diabetes

Question 19

Complications of chronic pancreatitis

Answer 19

Calcium stone formation
Duct scarring
electrolyte imbalances - cardiac conduction issues

Question 20

Why does the breakdown of dietary fats not begin until the food reaches the duodenum, and what role do bile and pancreatic enzymes (juices) play in this process?

Answer 20

Requires presence of bile (emulsification) and pancreatic enzymes (chemical digestion) - not available in the stomach

fats unaffected in the stomach because of the pH. digestive enzymes like pepsin target proteins

chyme enters duodenum = bile released from gall bladder = emulisifcation = larger surface area

Pancreatic lipase secreted into duodenum = breakdown of triglycerides into fatty acids and monoglycerides, which are absorbed by intestinal cells

Question 21

What is the pathophysiology of acute pancreatitis, and how does it lead to inflammation and tissue damage in the pancreas?

Answer 21

Premature activation of trypsinogen = trypsin
triggers enzyme cascade reaction = autodigestion and inflammation = cytokines and inflammatory mediators released = further damage and oedema and potentially necrosis

inflammation can extend from the pancreas = systemic inflammatory response = sepsis

disruption of the pancreatic ducts can lead to a backup of pancreatic secretions = exacerbation of inflammation