Phys Final Liver/pancreas

Front 1

what is the path of digestive enzymes from pancreas to duodenum

Back 1

acinus
sac
ductule tree
duodenum

*ductule tree: intercalated --> intralobar --> extralobar --> main duct --> duodenum

Front 2

what is the exocrine part of pancreas
what is the endocrine portion

Back 2

exocrine: acinus/duct cells

endocrine: islets of langerhans (somatatin, delta cells)

Front 3

whats the onyl exnodrine product of the pancreas that we care about

Back 3

somatostatin from delta cells in islets of langerhan

**somatostatin also secreted by D cells in stomach

**inhibitory

Front 4

how are pancreatic secretions dif than salivary

Back 4

Salivary: STIMULATED by both PNS/SNS

Pancreas: SNS inhibitory
PNS activate

Front 5

name 3 pancreatic enzymes
active or inactive
similiar to what other enzyme

Back 5

1. pancreatic protease: trypsinogen, chymotrypsinogen, procarboxypeptidase (inactive)

2. pancreatic amylase: active similiar to salivary amylayse

3. Pancreatic Lipase: active, similiar to salivary lipase, TAG into 2FA and monoglyceride

Front 6

what pancreatic enzyme is secreted like pepsin, how so?

Back 6

pancreatic protease (trypsinogen, chymotrypsinogen, procarboxypeptidase)

both are INACTIVE when secreted

**made in RER/golgi of acinus, stored in zymogen granules, and then exocytosed

Front 7

in what 2 places are polysacharides broken into disaccharides

Back 7

1. mouth, salivary amalyase

2. duodenum, pancreatic amylase

**sucrose: glucose + fructose
**lactose: glucose + gelactose
**maltose: glucoase + glucose

MUST be _______ for ABS

Front 8

what 2 similiar locations are fat/carbs digestion

Back 8

mouth: salivary amylase & lipase
duodenum: pancreatic amylayse and lipase

Front 9

what is the activation of the 3 inactive proteases from the pancreas

Back 9

1. Trypsin is activated by enteridopeptidase

2. Chymotrypsin and procarboxypeptidase are activated by trypsin

Front 10

what pancreatic enzyme is activated like pepsin

Back 10

trypsin

**autocatalysis

**but trypsin is cool bc it then activates chymotrypsin and procarboxypeptidase

Front 11

what secreted enteropeptidase? what does it do?

Back 11

S cells from duodenum

*activates trypsin

Front 12

what happens when we dont have enough pancreatic enzymes

Back 12

incomplete digestion, esp fats (statorrhea)

**SI and mouth have enzymes to help digest protein/carbs

Front 13

what disease has statorrhea, why

Back 13

CF (pancreatic insufficiency assoc with CF)

not enough pancreatic enzymes,

Front 14

what is the largest part of pancreatic secretions? why

Back 14

HCO3

**neutralizes acidic chyme to prevent duodenal damage, allows pancreatic enzymes to work

Front 15

what is the net abs/secretion in pancreatic duct cell

Back 15

Secrete: HCO3, Cl
Abs: H

Front 16

what transporters are on the apical surface of pancreatic cell

waht about basolateral

Back 16

Cl/HCO3 counter transport
Cl CFTR channel

BasoLateral:
Na/K ATPase
H (out of cell)
Na/H exchanger
K (out of cell)
Na/K/2Cl (into the cell)

Front 17

is there a difference in toniocity of pancreatic acinus/duct?

Back 17

nope

**but there is in saliva. acinis is isotonic, duct is hypotonic

Front 18

on what surface is the CFTR in the pancrease

Back 18

apical, we want Cl LEAVING the cell adn entering the lumen

**when this enzyme is deficint the duct gets clogged and the pancreas autodigests

Front 19

what componets of pancreatic secrtions vary with flow rate? what is high when flow is high

Back 19

Cl
HCO3

*when pancreas is stim, flow increases, HCO3 increases and Cl decreases

Front 20

what component of pancreatic secretions is high when flow is high

*low

Back 20

Hi: HCO3

Lo: Cl

**Na/K NOT afectd by flow rate

Front 21

basal rates of pancreatic secretion gives isotonic soln in regards to what

what is iso at fast flow

Back 21

basal: Na Cl H20

stimulated: Na HCO3 H20

Front 22

what part of the ductule tree is active at rest

Back 22

intercalated, interlobar

Front 23

what does secretin do to pancreatic secretion? who secretes it? why is it secreted

Back 23

increases aq part (HCO3)
secretin secreted by s cells in duodenum
in response to H in duodenum

*good thing! secretin stimulates extralobar ducts to increase HCO3, high flow = lots of HCO3

Front 24

what 2 hormones regulate pancreatic secretion

*NOTE: pancreatic secretions mainly controlled hormonally, not neural/local like the tummy

Back 24

1. CCK

2. Secretin: when H in duodenum S cells in duo cause flow to increase, lobar duct, and HCO3 increases to neutralize the acid

Front 25

whn are pancreatic enzymes stim for release (cephalin, gastric, intestinal)

Back 25

intestinal

**CCK
**SEcretin

Front 26

waht causes CCK release, from where, what does it do?

Back 26

when fat/aa enter duodenum I cells secrete CCK, this
-delays gastric emptying
-contracts GB
-relax sphincter of Odi
-PANCREATIC ENZYME release

Front 27

I cells secrete
S cells secrete

Back 27

I: CCK
S: secretin

**both play a role in pancreatic enzyme release

**both also inhibit gastric stuff, CCK inhibits emptying, secretin inhibits HCL

Front 28

what causes secretin to be released?

Back 28

H in duodenum
causes S to secrete secretin
this increases pancreatic secretions (HCO3 esp)

Front 29

Acute Pancreatitis

Back 29

Acute: Gallstones, etoh, viral, no known cause

Chronic: stong link to EtOH & NO gallstones, recurrent episodes, pancreatic tissue replaced by scar tissue ---> decreased enzymes & fat mal as well as destruction of langerhans, DM

Front 30

Pancreatic Cancer
Sx
Tx
Risk

Back 30

super deadly, bad prognosis

*weight loss, abd pain, jaundice/no color in poo, fatigue, back pain

Tx: whipple surgery, chemo

increased risk with over nutrition and smoking

Front 31

what happens to fluid in duodenum when pancreatic duct is blocked

Back 31

duodenum will be ACIDIC, low pH

*low bicarb
*low volume

Front 32

what stim/inhibits pancreatic secretion (ANS)

Back 32

PSN: stim
SNS: inhibit

**but mainly under hormonal control (CCK, Secretin)

Front 33

what pancreatic ensymes are active, inactive

Back 33

inactive: proteases (tyrpsin, chymptrypsin, procarboxypeptidase)

Active: lipase, amylayse

Front 34

tonicity of duct cell secretions

Back 34

isotonic

*8secrete HCO3, Cl
ABS H

Front 35

what is chronic pancreatitis assoc with

Back 35

alcoholism

NOT gallstones

Front 36

what happens when CCK acts of acinar cells

Back 36

increase IP3 DAG

Front 37

what is a portal triad

Back 37

hepatic A
portal v
bile ductule

* 6 surround a central vein

Blood from portal v to central vein
Bile flow from central vein to bile duct

Front 38

what do bile duct cells add to bile?
what do hepatocytes add to bile?

Back 38

ducts: aq alkaline fluid

hepatocytes: bile salts, cholesterol, lecthitin, bilirubin

Front 39

where are bile salts abs

what else is abs here

Back 39

terminal ileum

B12/IF

Front 40

what is enterohepatic circulation

Back 40

recycling of bile salts

*at terminal ileum they are abs and brought back to the liver

Front 41

if bile salts are abs at the terminal ileum where must fat abs/digestion occur

Back 41

before that!

Front 42

what stim bile salt release

Back 42

CCK, it causes GB to contract and sphincter of odi to open

*cck secreted by I cells in duodenum in response to fats/aa in duodenum

Front 43

wht do bile salts do

Back 43

emulsify lipid drops (ie lots of little lipid drops suspended in chyme) to increase SA for digestion by lipase

**this makes the - charges of fa spread out an repel each other

Front 44

bile salts form micells. what are theses an what do they do?

Back 44

water soluble hydrophilic shell
hydrophobic core with FA

**the lipids are carried in this and then sent to SI for ABS

Front 45

what makes biliruben

Back 45

breakdown of RBC in liver

**old RBC removed my macrophages (kaupfer) cells in the liver sinusoids

Front 46

what contains biliruben

Back 46

bile

gall stones can block bile secretion and make your poop light

Front 47

what increases bile secretion by liver

Back 47

choleretics

Chemical: bile salts (major role, the more we secrete bile salts the more we want to secrete more)
Hormonal: secretin
Neural: vagus (minor)

Front 48

what is the most important choleretic

Back 48

bile salts themselves increase bile salt secretion

Front 49

what is prehapatic liver

Back 49

excess biliruben due to excess RBC breakdown

**problem is before the liver
**liver gets more biliruben than it can secrete

Front 50

what is hepatic jaundice

Back 50

liver diease makes liver unable to to deal with normal amts of biliruben

Front 51

what is post hepatic jaundice

Back 51

bile duct blockage, gall stone. biliruben isnt excreted

**phototherpy converts uncong bl to

Front 52

what is cirrhosis/

Back 52

hepatic infammation caused by etoh

**hepatocytes are replaced with scar tissue and cause liver failure

weight loss, emesis, abd pain, acites

Front 53

micelles are required to abs what in the intestines

Back 53

cholesterol

Front 54

how is gelactose transported/abs in the intestine

Back 54

Na dependent transport

Front 55

how are aa abs at BB?

Back 55

various transporters

Front 56

what are 3 components of a micelle

Back 56

bile salt
lecthin
cholesterol

Front 57

what does obstruction of the bile duct do to poo

Back 57

well, it will be fatty (no bile salts to aid fat digestion)

but more importantly it wont be brown, it will be light bc the biliruben isnt getting into it

Front 58

can bile secretion be increased by secretin and vagal stim

Back 58

yep, both are choleretics. so are bile salts themselves