acinar achlorhydria

pertaining to or effecting an acinus or acini, refers specifically
to glandular tissue with a structure that is often described as
grapelike clusters
amylase
enzyme derived primarily from the pancreas that functions in
the breakdown of starch
amyloclastic
method of measuring serum amylase by evaluating the
disappearance of starch substrate
endocrine
refers to the system of glands and other structures that secrete
hormones directly into the circulatory system
fructosamine
molecule formed as a result of the irreversible reaction of
glucose bound to protein
glucagon
hormone secreted by the alpha cells of the islets of
Langerhans in response to hypoglycemia
glucose
monosaccharide that represents the end product of
carbohydrate metabolism
glucose tolerance
metabolic test of carbohydrate tolerance
glycosylated hemoglobin
irreversible reaction of hemoglobin bound to glucose
hyperglycemia
abnormally increased glucose level in the blood
insulin
protein hormone that is secreted by the beta cells of the
pancreatic islets in response to elevated blood levels of
glucose and amino acids
lipase
pancreatic enzyme that functions in the breakdown of fats
pancreatic lipase immunoreactivity
pancreatic function test to test for pancreatitis
trypsin
proteolytic digestive enzyme that is produced by the exocrine
pancreas and that catalyzes the breakdown of dietary proteins
into peptones, peptides, and amino acids in the small intestine
trypsinogen
inactive precursor form of trypsin, it is secreted in pancreatic
juice and converted into active trypsin through the action of
enterokinase in the intestine
A useful test to detect ketoacidosis is:
B-hydroxybutyrate
The most common tests used to evaluate the acinar function of
the pancreas are:
Amylase and lipase
A sensitive and specific test for the diagnosis of exocrine
pancreatic insufficiency in dogs is:
Trypsinlike immunoreactivity
A test used in dogs and cats that provides an indication of the
average glucose concentration over the previous 1 to 2 weeks
is:
Fructosamine
A test used in dogs that provides an indication of the average
glucose concentration over the previous 3 to 4 months is:
Glycosylated hemoglobin
The __________ test is considered the most sensitive indicator
of pancreatitis in cats.
Pancreatic lipase immunoreactivity
The ketone that is produced in greatest abundance in
ketoacidotic patients is:
B-hydroxybutyrate
Under normal circumstances, blood glucose levels peak
__________ after the administration of glucose and return to
normal within __________.
30 min, 2 hrs
Lack of acid production by the stomach. Literally "without
hydrochloric acid".
acinar
A small, sack-like dilation (accented on the first syllable). From
the Latin word acinus, which means berry or grape
adenocarcinoma
a malignant growth that begins in the epithelial cells; for the
pancreas, it affects the cells that line the pancreatic ductules
and duct. Nearly all pancreatic cancer are adenocarcinoma
Ampulla of Vater
a flask-like dilation at the point where the biliary and pancreatic
ducts join. The ampulla joins the duodenal papilla (a nipple-
shaped structure), and its orifice is encircled by a ring of
smooth muscles called the "sphincter of Oddi". Note that the
ampulla and the sphincter are two distinct structures of the
human anatomy
Brain-gut axis
Similar peptides that are found in the gut, nerves, and CNS
Cholecystitis
Inflammation of the gallbladder
Cholecystokinin (CCK)
A gastointestinal hormone that is released when the duodenum
is distended after ingestion of food or alcohol. It is a powerful
secretagogue for the pancreas, producing a high-volume
secretion that is high in bicarbonate concentration but low in
proteins and enzymes. This hormone and secretin potentiate
each other's action
Chyme
Semisolid end product of gastic action of food. It consists of
mucus, gastric secretions, and broken down nutrients
Endoscopic Retrograde Cholangiopancreatography (ERCP)
an invasive diagnostic technique whereby the pancreatic duct
is cannulated and an X-ray contrast medium is injected into the
duct to visualize the biliary and pancreatic ducts.
Enterokinase
an enzyme produced by the mucosa of the small intestine that
converts the inactive, digestive proenzymes from the pancreas
into their active forms
Gastrin
a hormone produced primarily by the G cells of the stomach
that stimulates the secretion of HCl by the parietal cells in the
stomach. Plasma gastrin is greatly increased in Zollinger-
Ellison syndrome, usually a pancreatic neoplasm, but gastrin is
not normally produced by the pancrease
Gastrointestinal hormones
substances that are produced by the gastrointestinal cells and
travel through the bloodstream to act at a separate site. These
hormones include cholecystokinin, secretin, glucagon, gastric
inhibitory polypeptide, vasoactive intestinal polypeptide,
bombesin, somatostatin, motilin, bulbogastrone, enterooxyntin,
and pancreatic polypeptide
Glucagon
An islet cell hormone that has multiple actions to raise plasma
glucose
Gluten
a protein found in wheat and wheat products
Hypoglycemia
a low blood glucose concentration, generally <50 mg/dL,
causing some individuals to become symptomatic
Immunoreactive trypsin
a form of the digestive enzyme found in blood. Because of the
presence of potent antiproteases in blood, the enzyme must be
measured in serum as a protein. It has little or no enzymatic
activity in the blood
Insulin
an islet cell, anabolic hormones that controls glucose uptake,
fat synthesis, and synthesis of proteins
Intubation
the procedure of introducing a tube-shaped instrument into the
body, usually through an anatomical opening, such as the
mouth
Islets of Langerhans
clusters of cells in the pancreas that produce the endocrine
secretions of the gland. They constitute about 1% of the
pancreatic mass
Laparoscopy
a technique used to view the pancreas or any other abdominal
organ. A small incision is made in the abdomen to allow the
insertion of the viewing instrument. It is probably the most
objective and reliable method for diagnosing pancreatitis
Multiple endocrine neoplasias (MEN)
an autosomal dominant inherited disorder that has many
different clinical presentations. Type I MEN disorder often
involves the pancreas and other endocrine organs, particularly
the pituitary and parathyroid glands
Pancreativ duct
A conduit that passes through the pancreas, collects the
pancreatic exocrine secretions of enzymes, water, and
electrolytes, and carries them to the ampulla of Vater
Pancreatic polypeptides
an islet cell hormone that slows the absorption of food,
stimulates gastric and intestinal secretions, and inhibits
intestinal mobility
pancreatic exocrine enzymes
enzymes required for digestion. Often released in a precursor
form. These enzymes include trypsinogen, chymotrypsinogen,
proelastase, procarboxypeptidase, ribonuclease,
deoxyribonuclease, amylase, lipase, phospholipase A, and
cholesterol esterase
Pancreatic hormones
endocrine hormones mainly concerned with carbohydrate
intermediary metabolism and includes glucagon, insulin, and
gastrin
Proteolytic
having the ability to break down proteins to peptides and amino
acids
Secretin
a gastrointestinal hormone that is released when the
duodenum is distended after ingestion of food or alcohol. It is a
powerful secretagogue for the pancreas, producing a secretion
high in protein and enzymes but low in volume
Somatostatin
an islet cell hormone that has largely inhibitory effects on
insulin and glucagon secretion, gastric secretions, and
exocrine pancreatic secretions
Trypsin
a potent proteolytic enzyme produced in the pancreas but
stored there in zymogen granules as the enzymatically inactive
protrypsin form
Trypsinogen
the enzymatically inactive or zymogen form of trypsin; aka
protrypsin
Vagus nerve
the tenth cranial nerve that carries motor, sensory, and
autonomic nerve fibers to the neck, thorax, and abdomen,
including the pancreas. Vagal stimulation of the pancreas
causes release of pancreatic fluid that is high in enzymes but
low in volume and electrolytes
Zollinger-Ellison syndrome
The clinical picture of a patient with a gastrinoma (frequently
malignant) in the pancreas, duodenum, or both. It causes
excessive acid production in the stomach, typically producing
multiple peptic ulcers and diarrhea
Five major regions of the GI tract
mouth, stomach, duodenum, jejunum-ileum, and large intestine
What do islet of Langerhans alpha cells produce?
glucagon to increase blood [glucose]
What do islet of Langerhans beta cells produce?
insulin to decrease blood [glucose]
What do islet of Langerhans delta cells produce?
gastrin
What is the exocrine function of the pancreas?
production of digestion enzymes
Possible causes of acute pancreatitis are
infections
obstruction of the duct
toxins
trauma
In all cases of acute pancreatitis, what seems to increase
membrane permeability with auto digestion by proteolytic
enzymes.
What enzyme is increased in patients with pancreatitis?
amylase (and lipase I suppose)
What is the amylase-creatinine clearance ratio?
100% x (Urine amylase x Serum creatinine)/(Serum amylase x
Urine creatinine)
How does one interpret the amylase-creatinine clearance
ratio?
2 - 5% is normal
>/= is acute pancreatitis and rules out burns, myeloma,
duodenal perforation, renal insufficiency, and ketoacidosis
Regarding the methods to analyze amylase, what is the first
step?
Incubate the patient's serum with a polysaccharide.
What is the common polysaccharide substrate for amylase
analysis method?
starch
Saccharogenic Method
Amylase splits substrate into glucose
Measure quantity of glucose produced
Account patient endogenous glucose by subtracting it
Amyloclastic (Iodometric) Method
Measure the quantity of starch remaining after reacting w/
amylase. Use iodine as color developer
Chromolytic Method
Dyes are made insoluble in water when linked to a substrate
(amylopectin)
Reaction w/ amylase splits substrate into water soluble
fragments
Dye color intensity proportional to amylase activity
What enzyme is produced in the pancreas that hydrolyzes long
fatty acid chains?
lipase
Describe the method used to measure lipase
Turbidimetric technique in which a fatty substrate, in an
emulsion which scatters light, is reacted with the lipase-
containing specimen.
As the substrate is hydrolyzed, less light is scattered
(Rate reaction)
How is the Iontophoresis (Sweat Test) performed
Patient's forearm cleansed
Positive electrode w/ pilocarpine placed over clean area with
negative electrode on opposite side of arm
Current of 0.16 mA/sq cm applied for 5 min.
Sweat glands stimulated
Electrodes removed and area cleansed with DI H20
Collection device applied 30 minutes
Sweat analyzed for chloride
Definition of digestion
The chemical process of rendering food into a form that can be
assimilated by the body. The process begins in the mouth and
is basically complete in the proximal end of the small intestine
(jejunum)
What enzymes digest starch?
pancreatic amylase
What enzymes digest disaccharides?
Mucosal disaccharidase A disturbance in antral-duodenal motility leads to the reflux of
What enzymes digest monsaccharides? duodenal contents (containing bile acids, proteolytic enzymes)
None into the stomach. These substances destroy the mucus lining
What digests protein? allowing acid to contact the stomach wall leading to ulcers
HCl, pepsin, trypsin Treatment of stomach ulcers
What digests triglycerides? Used to be stomach surgery
Emulsification with bile, hydrolysis with lipase Anticholinergic drug cimetidine (Tagamet)
Purpose of the mouth in digestion Antibiotics to treat H. pylori
Provide lubrication Bacteria associated with stomach ulcers
Salivary amylase initiates starch digestion Helicobacter pylori
Three zones of the stomach What can cause a pyloric obstruction?
Fundus: top of the stomach ulcer, tumor, or congenital abnormality
Body: main portion What can a pyloric obstruction cause?
Antrum: outlet separated from duodenum by the pylorus area severe vomiting, which can lead to hypochloremic metabolic
containing the pyloric valve alkalosis
Five type of stomach cells Bacteria associated with stomach cancer?
Mucous cells Helicobacter pylori
Surface epithelial cells What causes Zollinger-Ellison syndrome?
G cells a gastroma - gastrin-secreting tumor of the pancreas
Parietal cells The hyper secretion of gastrin stimulates the hyper secretion of
Chief cells HCl, which, when entering the duodenum, interferes with the
(MSG PC) digestion of fat causing steatorrhea and intereferes with salt
Mucous cell and water absorption, causing diarrhea
found throughout the entire stomach and secrete mucus, which What is an extreme form of peptic ulcer (recurrent peptic ulcer)
helps protect the stomach from its own acid and enzymes called?
Surface epithelial cells Zollinger-Ellison syndrome
secrete some mucus, but mainly proliferate rapidly and as they Pernicious anemia
are shed present a continually new surface gastric achlorhydria along with a decrease or absence of
Parietal cells intrinsic factor. This condition prevents the absorption of
produce HCl and intrinsic factor vitamin B12 leading to macrocytic anemia and degeneration of
Chief cells the posterior column of the spinal cord
produce the enzyme pepsinogen What are some malabsorption syndromes?
G cells Steatorrhea
aka antral cells. Found in the antrum and produces gastrin Celiac disease
What are the three phases of gastric activity? Lactose intolerance
Cephalic phase Diarrhea
Gastric phase Steatorrhea
Digestive phase Malabsorption or incomplete digestion of fats which are
Cephalic phase excreted in the feces
smell and sight of food triggers direct stimulation of the Celiac disease
stomach by the brain through the vagus nerve Immunologic response to gluten, causing destruction of the
Gastric phase microvilli
Vagus nerve stimulates the parietal cells to give HCl Lactose intolerance
Vagus nerve stimulates the G cells to give gastrin Caused by the lack of lactase. Patient is unable to split lactose
Gastrin stimulates parietal cells to release more HCl to glucose and galactose. Lactose in the intestines causes
Local distension of the antrum stimulates the release of more fluids to enter intestine resulting in bloating, diarrhea, etc.
gastrin resulting in more HCl Diarrhea
Distension of the fundus, stimulates the vagus nerve Caused by solute malabsorption, secretion of fluid into
Chief cells stimulated by low pH to produce pepsinogen, which intestine, and increased motility. This can lead to electrolyte
is broken down by pepsin (at pH of 3 or less) imbalance (also loss of K+) and acid-base imbalance due to
Digestive phase loss of HCO3- acidosis
Action breaks down the food to a substance called chyme, What are some GI function tests?
which eventually is released into the small intestine Gastric acidity
Purpose of the duodenum during digestion Gastric analysis
A number of hormones are released into the duodenum with Hollander Insulin Test
the end result being the secretion of bile salts, bicarbonate, Schilling Test
amylase, lipase, and proteolytic enzymes D-Xylose Absorption Test
Malnutrition Lactose Tolerance Test
Under or over nutrition or lack of essentials Purpose of Gastric acidity function test
What are the stomach pathologies? screens for the ability of the parietal cells to produce HCl.
Ulcers Gastric contents obtained by intubation
Pyloric obstruction What does achlorhydria indicate and rule out?
Cancer Indicates pernicious anemia and rules out peptic ulcer
Zollinger-Ellison syndrome Normal stomach pH is
Pernicious anemia <3.0
What blood group apparently gets more ulcers than the other Achlorhydria pH is considered to be
two? >6.0
Type O How is a gastric analysis performed?
What is the theory of "bile reflux"?
Collect basal specimen >Responds to high levels of glucose in blood
Inject stimulant (pentagastrin) >Lowers blood glucose
Collect specimen every 15 minutes for an hour +Islet delta cells secrete somatostatin which inhibits secretion
Evaluate for appearance, pH, volume, mMol [H+]/mL and of glucagon and insulin
mMol/[H+] per hour Consists of multiple small clusters of cells scattered throughout
True or False Hypoglycemia supresses the vagus nerve the gland as pancreatic islets (Islets of Langerhans)
False. Hypoglycemia stimulates the vagus nerve Endocrine function of the Pancreas
Administration of insulin lowers the blood glucose level to secrete glucagon which raises blood glucose
30 mg/dL Function of islets alpha cells
If there is no stomach acid for the Hollander Insulin test, what secrete insulin which responds to high levels of glucose in
happens? blood and lowers blood glucose
the vagus nerve is cut Function of islets beta cells
Schilling Test secrete somatostatin which inhibits secretion of glucagon and
Radioactive Vitamin B12 is given orally; if absorbed, it will be insulin
excreted by the urine. If no radioactive B12 is in the urine, Function of islets delta cells
malabsorption may be indicated
Prinicple of the D-Xylose Absorption Test
D-Xylose, an aldopentose, is absorbed by the small intestine in
a passive fashion reflecting the integrity of the surface area of
the small intestine. Once absorbed, it is not metabolized, but at
least 50% is excreted in the urine within 24 hrs in a linear
fashion
How should a D-Xylose Absorption Test be performed?
Give D-xylose in water orally
Collect blood and urine samples 5 hours later
If abnormally low levels in blood and urine, malabsorption in
the jejunum indicated
Lactose Tolerance Test
Give 50 grams of aqueous lactose
Collect blood samples
Fasting, 5, 10, 30, 60, 90, 120 minutes and assay for glucose
Normal is a glucose increase of at least 20 mg/dL over the
fasting level
Pancreas
Exocrine and endocrine gland
Exocrine function of the Pancreas
-Concerned solely with digestion
+Trypsin - protein
+Liapse - splits fatty acids and glycerol
+Amylase - breaks down starches into glucose
-Secretes alkaline pancreatic juice into duodenum through the
pancreatic ducts to aid with digestion
Concerned solely with digestion
Exocrine function of the Pancreas: 1
Secretes alkaline pancreatic juice into duodenum through the
pancreatic ducts to aid with digestion
Exocrine function of the Pancreas: 2
Trypsin
Exocrine function of the pancreas - concerned solely with
digestion: Digests protein
Lipase
Exocrine function of the pancreas - concerned solely with
digestion: Splits fatty acids and glycerol
Amylase
Exocrine function of the pancreas - concerned solely with
digestion: Breaks down starches into glucose
Digests protein
Trypsin
Splits fatty acids and glycerol
Liapse
Breaks down starches into glucose
Amylase
Endocrine function of the Pancreas
-Consists of multiple small clusters of cells scattered
throughout the gland as pancreatic islets (Islets of Langerhans)
+Secreted directly into the bloodstream
+Islets alpha cells secrete glucagon which raises blood
glucose
+Islet beta cells secrete insulin