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This tutorial will take you through a case history of a woman with GI problems.

You will navigate through this tutorial using the buttons at the top of the screen.

The tutorial will ask you questions. Click on your chosen answer to see feedback; click the answer again to make the feedback disappear. When you're finished with one page, click the navigation button for the next page to move ahead.

Have fun! Click on button '1' to see the first page of the tutorial.

Page 9

The only way a gallstone could affect pancreas secretion is if it slid down the common bile duct all the way to the ampulla of Vater and blocked that.

The gallstone in the ampulla of Vater is preventing pancreatic enzymes and bile from reaching the duodenum. But more is happening!

The gallbladder is a muscular organ. When you eat fat and your duodenum releases cholecystokinin, the gallbladder squeezes and squirts bile into the duodenum. If the ampulla of Vater is blocked, though, where will that bile go?

There's only one place it can go - up the pancreatic duct, into the pancreas.

Page 10

This is called biliary reflux, and it causes a lot of problems. Inside the pancreas, the bile disrupts the walls of the pancreatic duct. It also activates the digestive enzymes that the pancreas has been emptying into that duct.

In these cartoons, you can see the sequence of events. The gallstone blocking the ampulla causes bile to reflux up into the pancreas, where it activates the digestive enzymes. In the second frame, the enzymes are digesting the pancreas from inside.

This is called autodigestion and it is both painful and dangerous!

Pancreas review page 1

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Here's a diagram of the pancreas. You can see that it is made of many lobules connected to the pancreatic duct, rather like a bunch of grapes connected to the stem. These lobules and the ducts make up the exocrine pancreas. The lobules create digestive enzymes and the ducts deliver them to the duodenum.

Scattered through the pancreas are small groups of cells which aren't attached to the ducts. They lie between the lobules. These groups of cells make up the endocrine pancreas - they have no ducts, but their secretions go directly into the bloodstream and are carried throughout the body.

Pancreas review page 2

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The exocrine pancreas sends digestive enzymes and bicarbonate to the duodenum. But what does the endocrine pancreas secrete into the blood?