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Pancreas – High-Yield MSRA Exam Points

1. Overview

The pancreas is both an exocrine gland (secretes digestive enzymes into the gut) and an endocrine gland (secretes hormones into the blood).It plays a central role in digestion and glucose regulation, and is a key organ tested in the MSRA clinical knowledge paper.



2. Exocrine Functions of the Pancreas


💡 Think: “E for Enzymes” – secreted into the duodenum via the pancreatic duct.

Cell type

Secretion

Function

Acinar cells

Amylase

Breaks starch → maltose


Lipase

Breaks fats → glycerol & fatty acids


Proteases (trypsin, chymotrypsin, carboxypeptidase)

Breaks proteins → peptides/amino acids

Ductal cells

Bicarbonate (HCO₃⁻)

Neutralises gastric acid; optimises pH for enzyme activity

Key MSRA points:

  • CF and chronic pancreatitis → exocrine insufficiency → steatorrhoea, weight loss.

  • Secretin stimulates bicarbonate secretion; CCK stimulates enzyme release.



3. Endocrine Functions of the Pancreas


💡 Think: “End in blood” – hormones go directly into circulation.

Islet Cell Type

Hormone

Main Action

β cells

Insulin

↓ blood glucose – ↑ uptake & storage (glycogenesis, lipogenesis)

α cells

Glucagon

↑ blood glucose – ↑ glycogenolysis & gluconeogenesis

δ cells

Somatostatin

Inhibits insulin, glucagon, GI secretions

PP cells

Pancreatic polypeptide

Regulates pancreatic secretion & gut motility

Key MSRA points:

  • Type 1 diabetes → autoimmune β-cell destruction.

  • Insulinoma → recurrent hypoglycaemia + high insulin + high C-peptide.

  • Glucagonoma → hyperglycaemia + necrolytic migratory erythema.



4. Why Amylase and Lipase Are Raised in Acute Pancreatitis


Pathophysiology:

  1. Trigger (e.g., gallstones, alcohol, hypertriglyceridaemia) → premature activation of pancreatic enzymes inside the pancreas.

  2. Enzymes (esp. trypsin) digest pancreatic tissue (autodigestion).

  3. Acinar cell damage → enzymes leak into bloodstream.


Enzyme patterns:

  • Amylase

    • Rises: 6–12 h after onset

    • Peaks: ~24 h

    • Normalises: 3–5 days

    • Less specific (also from salivary glands, gut)

  • Lipase

    • Rises: 4–8 h after onset

    • Peaks: 24 h

    • Remains elevated: 8–14 days

    • More pancreas-specific



5. MSRA-Relevant High-Yield Points on Acute

Pancreatitis

  • Diagnosis: Lipase or amylase ≥ 3× ULN + clinical features (sudden severe epigastric pain radiating to the back, nausea/vomiting).

  • Causes:GET SMASHED mnemonic: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypertriglyceridaemia/Hypercalcaemia, ERCP, Drugs (azathioprine, valproate, thiazides).

  • Severity scoring: Glasgow-Imrie criteria (PaO₂, Age, WCC, Urea, LDH, AST, Albumin, Calcium, Glucose).

  • Initial management:

    • ABCDE

    • IV fluids (aggressive early resuscitation)

    • Analgesia (opioids/NSAIDs)

    • NBM initially, introduce enteral feeding if tolerated

    • Treat cause (e.g., ERCP for gallstones)



6. Quick Memory Aids

  • Exocrine: A Little Protein Before → Amylase, Lipase, Proteases, Bicarbonate

  • Endocrine: BIG P → Beta (Insulin), alpha (Glucagon), delta (Somatostatin), PP (Pancreatic Polypeptide)

  • Pancreatitis causes: GET SMASHED



7. MSRA Exam Tips

  • Lipase is more specific than amylase – especially in delayed presentation.

  • Amylase may be normal in hypertriglyceridaemia-induced pancreatitis – don’t rule out.

  • Always link enzyme elevation to cellular injury + leakage – common question stem.

  • Endocrine hormone questions often test counter-regulatory roles (insulin vs glucagon).

  • Watch for syndrome associations (MEN1 → insulinoma, gastrinoma).


📚 References

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