Pathophysiology Test 2 Lecture 9: Diseases of the Exocrine Pancreas

What is the pancreas?

an endocrine and exocrine glandular organ found deep to the transverse colon

The pancreatic duct empties into what?

duodenum of small intestine

What makes up the exocrine portion of the pancreas?

serous glands that drain to the duodenum via pancreatic ducts; which synthesize and secrete digestive enzymes

What makes up the endocrine portion of the pancreas?

cells are located in the pancreatic islets

What is the function of the endocrine cells of the pancreas?

synthesize and secrete the hormones insulin, glucagon, and somatostatin

What is the function of the exocrine pancreas?

acinar cells secrete digestive enzymes (mostly inactive pro-enzymes that are stored in zymogen granules)

What do duct cells secrete?

bicarbonate (HCO3-)

Serous cells secrete what?

lipases, nucleolytic enzymes, and amylase (mostly secreted as zymogens)

What is the importance of the hormone secretin?

promotes release of a pancreatic fluid low in enzyme activity and high in bicarbonates

What promotes the release of a pancreatic fluid rich in enzymes?

cholecystokinin (CKK)

What are the active enzymes secreted by acinar cells?

lipase, alpha-amylase, DNase, and RNase

What are the inactive proenzymes secreted by acinar cells?

trypsinogen, chymotrypsinogen, procarboxypeptidase, proelastase, and prophospholipase

What is acute pancreatitis?

inflammation and reversible parenchymal damage that ranges from focal edema and fat necrosis to widespread parenchymal necrosis and hemorrhage

What is the pathogenesis of acute pancreatitis?

caused by autodigestion of the pancreas by inappropriately activated pancreatic enzymes; premature activation of trypsin within the substance of the pancreas can unleash proenzymes, leading to tissue injury and inflammation

What are the main causes of acute pancreatitis?

duct obstruction, acinar cell injury (ischemia, drugs, alcohol, direct trauma)

What is the main sign of acute pancreatitis from a lab test?

increased serum amylase

What causes acute hemorrhagic pancreatitis?

most commonly due to gallstones or alcohol use and is a potentially life-threatening condition

What can acute hemorrhagic pancreatitis cause?

diffuse alveolar damage and disseminated intravascular coagulation

What are the signs and symptoms of acute hemorrhagic pancreatitis?

severe epigastric pain, referred to upper back, nausea and vomiting

What is the diagnosis for acute hemorrhagic pancreatitis?

elevated serum levels of amylase and lipase

What is the treatment for acute hemorrhagic pancreatitis?

-IV fluids

-Pain medication

-Fasting for 1-2 days

What is chronic pancreatitis?

irreversible parenchymal damage and scar formation

What are the clinical presentations of chronic pancreatitis?

chronic malabsorption and diabetes mellitus

In many patients, chronic pancreatitis is the result of what?

recurring bouts of acute pancreatitis due to causes such as alcohol abuse and gallstones

What is the pathogenesis of chronic pancreatitis?

similar to acute pancreatitis

What is the pathology for chronic pancreatitis?

progressive destruction of parenchyma, fibrosis and chronic inflammation

What are the treatments for chronic pancreatitis?

IV fluids, pain management, oral pancreatic enzymes, dietary changes

What happens cellularly during chronic pancreatitis?

pancreatic ducts are dilated and contain inspissated (thick) proteinaceous material