TRC: Pancreas

Regulation of the pancreas

Pancreas

The pancreas, localized in the retroperitoneum, plays an important role in the digestion and uptake of food. The endocrine pancreas is formed by the islets of Langerhans, which secrete insulin and glucagon. The exocrine pancreas includes the acinar cells which secrete pancreatic juice. This juice contains a variety of enzymes:

Buffer solution with bicarbonate and phosphate buffers, which restore the pH
Alpha-amylase, which breaks down carbohydrate chains
Pancreatic lipase, which breaks down lipids into fatty acids
Nuclease, which breaks down nucleic acids
Proteolytic enzyme, for the digestion of proteins

Upon arrival of containing food containing lipids, proteins, and glucose in the duodenum (1), the cells in the wall of the duodenum release cholecystokinin (CCK) and gastric inhibitory peptide (GIP) into the circulation (2). CCK stimulates the release of pancreatic enzymes into the intestine (3). GIP stimulates the secretion of insulin by the pancreatic islets into the circulation (4).

The most sensitive and specific test to diagnose chronic pancreatitis is:

Option explanation:

Fecal elastase

Fecal chymotrypsin

Serum trypsinogen

Secretin stimulation

Female, 40 years, has daily abdominal pain. ERCP: normal bile ducts; pancreatogram: definite "mild" chronic pancreatitis. No alcohol and no FH of pancreatitis. Which of the following is true regarding this patient?

Extra info: The best pain response to pancreatic enzyme supplements has been seen in females with mild, idiopathic pancreatitis. Uncoated preparations that are active in the duodenum appear to give the best response. Enzyme supplements are thought to work via negative feedback inhibition of pancreatic secretion. Orally administered proteases inhibit CCK-releasing peptide in the duodenum. This inhibits the release of CCK and decreases pancreatic secretion.

Option explanation:

CCK releasing peptide may have an important role in pain management

She is less likely to have a beneficial pain response to enzyme supplements because of the mild nature of her disease

Males have a greater pain response to enzyme supplements compared to females with chronic pancreatitis

The best pain response is seen when microencapsulated preparations that contain a higher content of lipases are used.

Regulation of the pancreas

Pancreas

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