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  • 1. The Pancreas Felicity Clark Speciality Registrar New Cross Hospital
  • 2. Why is it important ? Pancreatitis Diabetes Common primary FRCA question
  • 3. What you need to Know Exocrine Function Endocrine function Insulin Glucagon Somatostatin
  • 4. Structure of the Pancreas Loblues 2 types of parenchymal tissue Acinus (80%) Islets of Langherhans (2%) Blood vessels and ducts (15%)
  • 5. Exocrine Pancreas Lumen of Acini produce pancreatic secretions Accumulate in intralobular ducts Drain to the main pancreatic duct Drains directly into the duodenum
  • 6. Exocrine Pancreas Control is via hormones gastrin, cholecystokinin and secretin secreted by cells in the stomach and duodenum in response to distension and/or food
  • 7. Exocrine Pancreas 2 main classes of exocrine pancreatic secretions Bicarbonate ions – centroacinar cells – Secretin Neutralise acidic chyme Digestive enzymes – Basophilic cells – Cholecystokinin Proteases – trypsinogen & chymotrypsinogen Pancreatic lipase Pancreatic amylase Secreted as inactive enzymes - zymogens Enteropeptidase activates
  • 8. Endocrine Pancreas Islets of Langherhans  Insulin  Glucagon  Somatostatin  Pancreatic polypeptide
  • 9. Insulin Anabolic 51 amino acids pro- insulin – C peptide removed 2 polypeptide chains – disulphide bridges Beta cells Binds to alpha sub unit of insulin receptor Autophosphorylation of tyrosine kinase Activates protein kinases Gene on short arm of chromosome 11
  • 10. Effects of Insulin Carbohydrate metabolism  Glucose uptake – liver /skeletal muscle  Glycogen storage  Glucose utilisation as energy source
  • 11. Effects of Insulin Protein metabolism  Stimulates amino acid uptake by cells  Stimulates protein synthesis  Inhibits Gluconeogenesis
  • 12. Effects of Insulin Lipid metabolism  Inhibits lipolysis  Stimulates fatty acid synthesis from glucose  Stimulates glycerol synthesis  Promotes carbohydrate metabolism / sparing fat
  • 13. Controlling factors - Insulin Secretion stimulated  Secretion inhibited  Hyperglycaemia  Hypoglycaemia  Amino acids  Beta blockers  Beta agonists  alpha agonists  Acetylcholine  Somatostatin  Glucagon  Diazoxide  Thiazides  Volatiles
  • 14. Insulin Deficiency Type 1 DM – Autoimmune Type 2 DM – Insulin resistance Secondary Diabetes –  increased cortisol – cushings  increased growth hormone  increased glucagon
  • 15. Insulin deficiency – think DKA Carbohydrate  decreased glucose uptake  Hyperglycaemia, Glycosuria  Osmotic diuresis Protein  Increased amino acids in plasma  Nitrogen loss in urine  Dehydration  Ketoacidosis  Respiratory alkalosis  Coma  Death
  • 16. Insulin deficiency – think DKA Lipids  increased Lipolysis  Increased free fatty acids  Ketogenesis  Ketonuria
  • 17. Insulin excess Insulinoma (rare) Iatrogenic (can measure C-peptide) Hypoglycaemia Tremor Sweating Tacchycardia Coma Death
  • 18. Glucagon Catabolic 29 amino acids Alpha cells Acts as a second messenger via cyclic AMP Opposes insulin
  • 19. Effects of Glucagon Carbohydrate Metabolism  Increased Gluconeogenesis  Increased glycogenolysis  Glucose sparing – beta oxidation of fatty acids for energy – ketone bodies
  • 20. Effects of Glucagon Lipid Metabolism  Stimulates Lipolysis Other effects  Increases catecholamine production  Direct positive inotrope
  • 21. Controlling factors- Glucagon Secretion Stimulated  Secretion Inhibited  hypoglycaemia  Hyperglycaemia  increased amino acids  decreased amino  beta agonists acids  sepsis  increased free fatty  stress acids  trauma  insulin  somatostatin  alpha agonists
  • 22. Somatostatin delta cells hypothalamus also called growth hormone inhibiting hormone inhibits insulin and glucagon release inhibits gastric acid production inhibits gallbladder contraction Neurotransmitter – SG - pain