VPHY 4200 Case 2

What does a left shift mean with neutrophils?

They are immature/young

Why does tachycardia occur with acute pancreatitis?

Blood sat is low, so heart has to compensate by pumping faster

How much of total blood volume is plasma?

55%

What are the two primary plasma protein types?

Globulins - transport

Albumins - pH and Colloid Osmotic Pressure (~60%)

What is found in the formed elements of blood?

Erythrocytes (RBCs)

What is found in the buffy coat?

Leukocytes (WBCs) and Platelets

What is the term for a left shift in WBCs?

Leukocytosis

True/False: Po2 is a sum of dissolved and bound O2 in the blood

False:

Only dissolved O2 contributes to partial pressure

What is the solubility of O2 in blood (with units)?

0.003 ml/dl blood/mmHg

What is the approximate Po2 in arteries?

100 mmHg

What is the approximate Po2 in veins?

40 mmHg

What is O2 Capacity?

the maximal amount of O2 that can bind with Hb

Each gram of Hb can transport _____ mL O2

1.34 mL

In anemia, O2 capacity is ______

In polycythemia, O2 capacity is _____

Decreased

Increased

What is Hb Saturation Rate?

How close Hb is to being maximally bound to O2. Expressed as a percentage

At 100 mmHg (arterial Po2), Hb is ____ saturated

At 40 mmHg (venous Po2), Hb is _____ saturated

97%

75%

How do you calculate O2 content?

Dissolved O2 + Bound O2

(Po2 solubility) + (O2 capacity saturation rate)

(Po2 .003) + (1.34 saturation rate)

The percent of dissolved O2 should be _____

Less than 2%

Why is dissolved O2 important?

It is what binds to Hb in the blood.

If O2 sat drops below ______, hypoxia and hypoxemia occur

92.5%

How is volume of O2 unloaded calculated?

O2 content in arteries - O2 content in veins

What does acute pancreatitis do to amylase/lipase levels?

Increases

What is the function and origin of amylase?

Digests starch --> maltose

Saliva, pancreas, other sources

What is the function and origin of lipase?

Digests triglycerides --> fatty acids

Pancreas

ALT and AST are found in the ______

Liver

(ALT/AST)______ is only found in the liver

ALT

An ALT:AST ratio of 2:1 is indicative of what?

Alcoholic Liver Disease

What is the pyruvate-alanine cycle?

Muscle: Pyruvate --> Alanine

Liver: Alanine --> Pyruvate

Catalyzed by ALT

What are the two main functions of the pancreas?

Exocrine - Secretion of digestive enzymes

Endocrine - Release of insulin and glucagon

What are the cell types of the pancreas and what do they secrete?

Acinar - Digestive enzymes (as zymogens)

Ductal - secrete HCO3- and water

Which hormones stimulate pancreatic cells?

Secretin --> Ductal Cells --> HCO3-

CCK --> Acinar Cells --> trypsinogen (and other proenzymes)

Where are secretin and cholecystokinin produced?

small intestine

Secretin detects _______ content in the duodenum

acidic

Cholecystokinin detects _____ content in the duodenum

Fat

What are secondary function of CCK?

Gallbladder contraction and satiety

How does the pancreas not digest itself?

1.) Enzymes are produced as proenzymes

2.) Proenzymes are packed in zymogen granules

3.) Trypsinogen --> Trypsin occurs in the duodenum (past the pancreas)

What do zymogen granules contain that prevents activation of proenzymes?

Protease (mainly trypsin) inhibitors

Also granules are acidic

What do enterokinases do?

convert trypsinogen to trypsin

What role does trypsin play in the duodenum?

Cleaves proteins AND activates other proenzymes

What is the general pathogenesis of Acute Pancreatitis?

Disruption in the balance of homeostatic factors (extracellular, intracellular, ductal injury)

What does damage to ductal cells do to pancreatic function?

Delays enzyme secretion

How does tissue damage arise from ductal injury?

-Lysosomes and zymogens fuse, causing trypsin to become active in the pancreas

-Autoimmune response damages tissues

What do lysosomes contain that activates trypsinogen?

Cathepsins

Serum _____ is the primary marker for Acute Pancreatitis

Lipase

Why is serum amylase not a good diagnostic marker for A.P.?

It isn't specific enough to the disease.

UNLESS levels are 3x normal

What are the main causes of A.P.?

Insults:

Alcohol and Stones