Pancreatitis first hormone released

[loveoforganic2]

Pathoma says trypsin. UWorld says acute interstitial pancreatitis initially occurs via lipase release --> microscopic calcium salt deposition --> infllammatory response --> edematous pancreas --> ischemia --> acute necrotic pancreatitis following trypsin release

Anyone have a clarifying point of view? I'm inclined to believe world's description is accurate, but if an exam just says "pancreatitis" are they referring to necrotic pancreatitis?

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[Brain Bucket]

I know nada, and for some reason I'm inclined to chime in. If you throw in a comma between following and trypsin, it would imply that trypsin is released before the necrosis. Make sure it isn't just semantics that you're tripping over.

I think it's trypsin.

 

[loveoforganic2]

I know nada. But, Based on what you said, both of them say Trypsin first... UW is saying lipase mediated necrosis following trypsin release.

I'm referencing the explanation for UW QID 439. Direct quote below

In acute pancreatitis, duct obstruction leads to stasis of pancreatic secretions and digestion of adipose cells by lipase. This results in formation of fatty acids that bind calcium ions and precipitate as insoluble calcium salts. The areas of focal necrosis and calcium precipitation induce an inflammatory reaction. If the pathologic process stops at this stage, benign acute interstitial pancreatitis develops. In this subtype of acute pancreatitis, the pancreas looks edematous on macroscopic examination. On light microscopy, interstitial edema, focal fat necrosis, and calcium deposits are seen. If the inflammatory process continues, blood flow to pancreatic acini is compromised as a result of the edema. Ischemia damages the acinar cells and causes abnormal intracellular activation of trypsin. Trypsin then activates other proteolytic enzymes, thus initiating autodigestion (autolysis) of pancreatic tissue. Acute necrotic pancreatitis develops. Destruction of blood vessel walls can cause hemorrhage into the necrotic areas. Macroscopically, areas of white chalky fat necrosis are visible in the pancreatic tissue. They can spread onto the mesentery, omentum, and other parts of abdominal cavity. Black areas of hemorrhage are also seen on gross examination

 

[Brain Bucket]

I'm referencing the explanation for UW QID 439. Direct quote below

Yeah.

http://imgur.com/kdtPhrv

 

[hardee17]

I would go with trypsin since it activates all the others

 

[loveoforganic2]

I would go with trypsin since it activates all the others

Lipase isn't stored as a zymogen is it?

 

[wanderer]

Lipase isn't stored as a zymogen is it?

No, it wouldn't start destroying everything in its vicinity the way proteases do.

 

[Brain Bucket]

Lipase isn't stored as a zymogen is it?

no

 

[Brain Bucket]

No, it wouldn't start destroying everything in its vicinity the way proteases do.

Actually, it would appear it does, especially on adipose tissue, causing the fat necrosis as mentioned in the UW exp.

 

[wanderer]

Actually, it would appear it does, especially on adipose tissue, causing the fat necrosis as mentioned in the UW exp.

For some reason it's not the same. It only does that in pathological situations whereas if proteases were secreted as active forms they'd always autodigest.

 

[cage92]

lipase is the marker and trypsin is the main factor included in the pathogenesis of pancreatitis

 

[Transposony]

I'll go with Lipase