Question

What is pancreatitis and what are some causes of this condition? Briefly outline the endocrine and exocrine functions of the pancreas

Answer 1

Pancreatitis - Pancreas + Itis
Itis = inflammation
So pancreatitis is inflammation( swelling) of pancreas .

Most common cause of Pancreatitis
1. Gall stones ( Stone in gall bladder ) Cholelithiasis
2.Alcoholism
3.Diabetes Mellitus
4. ERCP ( Endoscopic retrograde cholangiopancreatography ) procedure .

Most common cause in Children is trauma .

***Mechanism -->>Autodigestion occur of pancreatic tissues .Activation of proteolytic enzymes like trypsin and phospholipases are responsible .

**Most common symptom is Abdominal pain in epigastrium radiating to back

*Signs -Low grade fever,tachycardia ,hypotension ,
Cullen sign ( periumbilical light blue discolouration due to hemoperitoneum ) and
GREY TURNER sign ( Bluish / greenish discolouaration of flanks )

*Investigation - --->>Serum amylase levels more than 3 fold rise clinch the diagnosis .Serum Lipase is more specific because it is elevated for 7-14 days amylase return to normal in 3-4 days .

Treatment --
For gall stones - Lap cholecystectomy
Conservative management --Fluids resuscitation .
No antibiotics except for pancreatic necrosis where Imipenem ( Carbapenem ) prefered .

Functions of Pancreas

******Functioning as an exocrine gland, the pancreas excretes enzymes to break down the proteins, lipids, carbohydrates, and nucleic acids in food.

1)Pancreatic amylase breaks glucoside linkage of complex carbohydrate and convert them into smaller compounds .
Pancreatic amylases are secreted as active enzymes.

2) Pancreatic Lipase also as active enzymes .
Pancreatic lipases Glycerol ester lipase (pancreatic lipase) breaks glycerol ester leading to formation of 2 free fatty acids and one monoglyceride

3)Cholesterol esterase (sterol lipase) hydrolyzes cholesterol esters to yield cholesterol and fatty acids.

4) Pancreatic proteases are secreted as inactive zymogens. They include trypsinogen, chymotrypsinogen, and procarboxypeptidase.

**trypsinogen---------------->> trypsin (endopeptidase) by action of enterokinase.

**chymotrypsinogen -----> > chymotrypsin (endopeptidase). by action of trypsin

** procarboxypeptidase ------>>>>>    carboxypeptidase (exopeptidase) by trypsin .

*Enterokinase (also known as enteropeptidase) is an enzyme secreted by the lining of the small intestine. It is not a brush border enzyme. It functions to activate some trypsinogen, and the active trypsin generated activates the remaining proteases.

******" Functioning as an endocrine gland, the pancreas secretes the hormones insulin and glucagon to control blood sugar levels and maintain the homeostais .

1)When there is well fed state then glucose levels is very high in blood and pancreas secrete Insulin to lower blood glucose levels .

2)When during starvation or fasting state blood glucose levels fall down and glucagon is activated to break the glycogen ( Glycogenolyisis ) and cause release of glucose from liver into blood .