Pancreas and Diabetes

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Pancreas and Diabetes

• Mrs. Ashley
• Medical Assistant Science

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PANCREAS ANATOMY
esophagus
stomach
ductus choledocus
pancreas
duodenum
duct of
Santorini
duct of
Wirsung
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Pancreas Function

• Exocrine and endocrine cells
• 90 of pancreas related to exocrine (digestive
  function)
• 10 endocrine (homeostasis for glucose levels in
  the body)

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Pancreas

• Both an exocrine and endocrine organ
• Cells with exocrine function release an alkaline
  fluid containing sodium bicarbonate and enzymes ?
• pancreatic duct ? small intestine
• Pancreatic juice aids in breakdown and
  digestion of food in the small intestine
• Pancreatic exocrine cells acinar cells

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Exocrine function

• Acinar cells - exocrine cells of the pancreas
  that produce and transport digestive enzymes
• Amylase, lipase, phospholipase, proteases
  (trypsinogen, chymotrypsinogen)

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PANCREATIC SECRETIONS
1. PROTEASES (70)
Endopeptidases (trypsin, chymotrypsin, elastases)
Exopeptidases (carboxypeptidases)
trypsinogen trypsin
activates all other precursors
enterokinase
(duct walls)
2. NUCLEASES (DNAase, RNAase)
3. PANCREATIC AMYLASE (hydrolyse starch and
glycogen)
4. PANCREATIC LIPASE (triglycerides
fatty acids and glycerol)
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PANCREAS (PANORAMIC)
islet of
Langerhans
pancreatic acini
islet of
pancreatic lobe
Langerhans
BV
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Endocrine function

• Islets of Langerhans - endocrine cells of the
  pancreas that produce and secrete hormones into
  the bloodstream
• Glucagon - Alpha cells (A cells) - raises the
  level of glucose (sugar) in the blood by causing
  liver to break down stored glycogen
• Insulin - Beta cells (B cells) - stimulates cells
  to use glucose and reduce glucose levels in blood
• Antagonistic Hormones

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Endocrine Function Cells of the Islet of
Langerhans synthesize and release hormones into
the circulation. Hormones travel through the
bloodstream to target tissues (especially liver
and muscle) At the target cells, hormones bind
specific receptors and cause cell changes that
control metabolism
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Insulin secretion is controlled through several
mechanisms

• Chemically high levels of glucose and amino
  acids in the blood
• Hormonally beta cells are sensitive to several
  hormones that may inhibit or cause insulin
  secretion
• Neurally stimulation of the parasympathetic
  nervous system causes insulin to be secreted.

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Insulin

• Transported through the blood to target tissues
  where it binds to specific receptors
• The binding of insulin to target cells
• Acts as a biochemical signal to the inside of the
  cell
• Overall, cell metabolism is stimulated
• There is increased glucose uptake into the cell
• Regulation of glucose breakdown within the cell
• Regulation of protein and lipid breakdown within
  the cell

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Insulin

• Blood glucose is decreased because insulin causes
  glucose to leave the bloodstream and enter the
  metabolizing cells.
• With the exception of brain, liver and
  erythrocytes, tissues require membrane glucose
  carriers.

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Pancreatitis

• Inflammation of the pancreas

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Acute pancreatitis

• Pancreas suddenly becomes inflamed
• Causes Gallstones
• Ethanol
• Trauma
• Steroids
• Mumps
• Autoimmune
• Scorpion venom
• Hyperlipidaemia,
  hypothermia ?Ca2
• Drugs

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• Symptoms
• epigastric and central abdominal pain
• vomiting and nausea
• swollen and tender abdomen
• fever
• dehydration and low blood pressure
• Diagnosis
• medical history and physical exam
• blood test ? amylase, lipase
• abdominal ultrasound, Endoscopic Ultrasound, CT
  scan

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• Treatment
• nothing to eat or drink
• intravenous fluids
• analgesia
• ERCP and gallstone removal
• Complications
• shock, Acute respiratory distress syndrome, renal
  failure, Disseminated intravascular coagulation,
  sepsis, ?Ca2
• pancreatic necrosis, pseudocyst, abscesses,
  bleeding, thrombosis

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Chronic pancreatitis

• inflammation of the pancreas - gets worse over
  time and leads to permanent damage
• Causes many years of alcohol use
• hereditary disorders of the
  pancreas
• cystic fibrosis
• haemochromatosis
• autoimmune conditions

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Pancreatitis

• Symptoms
• nausea and vomiting
• weight loss
• diarrhea
• steatorrhea

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• Treatment
• drugs - analgesia, lipase, fat-soluble vitamins
• diet
• surgery pancreatectomy
• pancreaticojejunostomy
• Complications
• pseudocyst, diabetes, biliary obstruction, local
  arterial aneurysm, splenic vein thrombosis

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Diabetes

• The single most common endocrine disorder group
  of glucose intolerance disorders
• Incidence is estimated at 8.3 of the North
  American population
• 35 are pre-diabetic
• Many of these cases are undiagnosed

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Diabetes mellitus
Historically - distinguished by weight loss,
excessive urination, thirst, hunger Excessive
urination polyuria Excessive thirst
polydipsia Excessive hunger
polyphagia Modern characterization is by
hyperglycemia and other metabolic disorders
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Diabetes

• increased level of glucose in the blood
• (normal blood glucose level 3.5-6.0
  mmol/l)
• 90 mg/100ml
• Type 1 ( insulin-dependent DM, IDDM)
• destruction of insulin-secreting pancreatic ß
  cells (autoimmune response)
• juvenile diabetes-tends to begin in early
  childhood
• patient always needs insulin

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• Type 2 (non-insulin dependent DM, NIDDM)
• insulin resistance
• ? cell dysfunction, ?insulin secretion
• Causes of insulin resistance
• metabolic syndrome (central obesity,
  hyperglycaemia, hypertension, ?HDL cholesterol,
  ?triglycerides)
• renal failure
• pregnancy
• cystic fibrosis
• polycystic ovarian syndrome

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Clinical Manifestations

• Glucose in urine- Because when insulin is not
  present, glucose is not taken up out of the blood
  at the target cells.
• So blood glucose is very highly increased ?
  increased glucose filtered and excreted in the
  urine (exceeds transport maximum)

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• Mechanisms of insulin resistance
• post-receptor defects in insulin action
• gene mutation
• circulating autoantibodies

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• Diagnosis
• blood glucose level
• urine sample
• HbA1c test

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• Treatment
• diet
• oral hypoglycaemics

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Control diet Carbohydrates should make up about
55-60 of patients total calories Fats should
make up lt30 of patients total calories Proteins
should make up about 15-20 of patients total
calories
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Monitor exercise Remember muscles are a target
tissue of insulin, and metabolize much glucose
for energy Sometimes exercise ?irregular blood
glucose levels So diabetic patients should be
monitored when they are exercising
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• insulin injections (long-acting, short-acting,
  rapid-acting)
• insulin pen
• insulin pump therapy

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• Complications

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• diabetec ketoacidosis
• hypoglycaemia
• diabetic retinopathy

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• atherosclerosis (heart disease and stroke)
• neuropathy (diabetic foot care)

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Diabetes risk factors

• Age over 40 years
• Diabetes during a previous pregnancy
• Excess body weight
• Family history of diabetes
• Dyslipidaemia (large amount of lipids in body)
• Hypertension
• Low activity level
• Metabolic syndrome
• Polycystic ovarian syndrome
• Acanthosis nigricans- darkening and thickening of
  skin