Pancreatic and Gastrointestinal Function

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Clinical Chemistry
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1

GI system

comprises mouth, esophagus, stomach, small and large intestines

2

digestion

process by which starches, proteins, lipids, and nucleic acids are degraded to molecules for absorption and use in body

3

pancreas

large gland involved in digestive process, but lies outside of GI system; located behind peritoneal cavity across upper abdomen at level of 1st and 2nd lumbar vertebrae, 1-2 inches above umbilicus; composed of both endocrine and exocrine tissue

4

endocrine component of pancreas

smaller component; consists of islets of Langerhans which secrete at least four hormones into blood: insulin, glucagon, gastrin, and somatostatin

5

islets of Langerhans

well-delineated, spherical, or ovoid clusters composed of at least four different cell types that secrete pancreatic hormones

6

exocrine component of pancreas

produces digestive fluid rich with enzymes in pancreatic acinar cells (grape-like clusters), which line pancreas and are connected by small ducts; proteins (trypsin, chymotrypsin, etc.), carbs (amylase), and fat (lipase and lecithinase); secretes fluid into ducts that empty into duodenum-also contains bicarbonate to neutralize stomach acid going into the duodenum

7

trypsin and chymotrypsin

pancreatic enzymes that digest proteins

8

amylase

pancreatic enzymes that digest carbs

9

lipase and lecithinase

pancreatic enzymes that digest fats

10

cystic fibrosis

disease of pancreas and mucoviscidosis; inherited autosomal recessive dysfunctino of mucous and exocrine glands throughout body; manifests as intestinal obstruction in newborn, excessive pulmonary infections in childhood, and pancreatogenous malabsorption in adults; causes ducts and acini to dilate and convert into small cysts filled with mucus, preventing secretions from reaching duodenum

11

pancreatic carcinoma

fourth most frequent form of fatal cancer; causes about 38,000 deaths each year in the US, which represents about 7% of all deaths from malignant neoplasms; most arise as adenocarcinomas of ductal epithelium

12

pancreatitis

inflammation of pancreas caused by autodigestion of pancreas as a result of reflux of bile or duodenal contents into pancreatic duct; leads to acute edema, cellular infiltration, intrahepatic and extrahepatic pancreatic fat necrosis

13

malabsorption syndrome

abdominal bloating and discomfort, frequent passage of bulky, malodorous feces, and weight loss

14

steatorrhea

failure to digest or absorb fats leading to greasy appearance to feces

15

amylase, lipase, secretin, CCK, fecal fat, trypsin, and chymotrypsin

tests used to assess pancreatic function

16

gastrin, insulin, and glucose

used to assess endocrine-related pancreatic disorders

17

bilirubin

assesses changes associated with extrahepatic obstruction

18

secretin/CCK

direct determination of the exocrine secretory capacity of the pancreas; intubation of duodenum without contamination by gastric fluid, which neutralizes bicarb; 6-hour fast; decreased flow: pancreatic obstruction and increase in enzyme concentrations; low bicarb and enzyme concentrations: cystic fibrosis, chronic pancreatitis, pancreatic cysts, calcification, and edema of the pancreas

19

fecal fat analysis

fecal lipids are derived from four sources: unabsorbed ingested lipids, lipids excreted into intestine (bile), cells shed into the intestine, and metabolism of intestinal bacteria

20

sweat sodium and chloride concentrations

test used to diagnose cystic fibrosis; significantly elevated in 99% of affected patients

21

amylase

serum enzyme most commonly used to detect pancreatic disease (pancreatitis); rises in a few hours and peaks at 24 hours; significant increases in 75% of patients; increased in mumps, cirrhosis, ruptured ectopic pregnancy, and others

22

lipase

produced by the acinar cells of pancreas; more sensitive indicator-stays elevated longer; also increased in bone fractures